How to Be Registered Nurse First Assistant - Job Description, Skills, and Interview Questions

Oct 22, 2023 / 6 Minutes Read / By Albert

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The Nurse First Assistant is a Registered Nurse with specialized training in the operating room. This allows them to assist the surgeon during procedures, which can result in faster, safer operations. Additionally, their knowledge of anatomy and surgical techniques can be beneficial to the patient and the surgical team, as they can provide support with proper positioning, wound closure, suturing, and other critical tasks. With the help of a Nurse First Assistant, surgeons are able to focus more of their attention on the details of each procedure, which can result in better outcomes for the patient.

Steps How to Become

Complete an Associate's Degree in Nursing. To become a Registered Nurse First Assistant (RNFA), you must first have a minimum of an associate's degree in nursing from an accredited nursing program.
Obtain a Nursing License. After earning your associate's degree, you must become a Registered Nurse (RN) by taking and passing the National Council Licensure Examination (NCLEX-RN).
Gain Clinical Experience. After becoming a registered nurse, you must gain clinical experience in a surgical setting. This experience can be gained through working as a surgical nurse, scrub nurse, or circulating nurse.
Get Certified. The next step is to become certified as a RNFA. This certification is offered by the Academy of Surgical Registered Nurses (ASRN). To qualify for the certification, you must have two years of experience in a surgical setting and complete an accredited RNFA program.
Take the RNFA Exam. Once you have completed the RNFA program, you can take the RNFA exam offered by the ASRN. The exam covers a variety of topics related to surgical nursing and is designed to test your knowledge and skills in this area.
Maintain Certification. Once you have become a certified RNFA, you must maintain your certification by completing continuing education courses and renewing your certification every 5 years.

Being a reliable and efficient Registered Nurse First Assistant (RNFA) requires commitment, knowledge, and experience. A well-trained and experienced RNFA can provide invaluable support to the surgeon, patient, and medical team. Without the RNFA's assistance, the procedure may take longer, require more resources, and be less safe.

The RNFA must be knowledgeable in surgical anatomy and instrumentation, able to anticipate the surgeon's needs, and be able to recognize and intervene in emergency situations. The RNFA must also be able to provide ongoing patient education and support throughout the procedure. In addition, the RNFA must be able to communicate effectively with the medical team and keep accurate records of the procedure.

When these elements are combined, the RNFA is able to provide reliable and efficient care for both the patient and the medical team.

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Job Description

Assess patient's condition and develop patient care plans.
Monitor vital signs, such as blood pressure, heart rate, and respiration.
Administer medications and treatments as prescribed by physicians.
Assist physicians in performing surgical procedures.
Prepare, maintain, and monitor sterile fields and equipment.
Provide education and support to patients and their families.
Document patient care during and after procedures.
Ensure that the operating room is clean and sterilized for each procedure.
Participate in quality assurance activities to ensure patient safety.
Monitor patient's vital signs during and after procedures.
Anticipate and respond to changing patient conditions.
Maintain patient confidentiality at all times.

Skills and Competencies to Have

Knowledge of basic surgical principles and procedures.
Ability to anticipate the needs of the surgical team.
Ability to apply sterile technique.
Ability to select and properly handle surgical instruments.
Ability to anticipate the surgeons preferences and modify technique accordingly.
Ability to assess patients condition in the operating room environment.
Knowledge of anatomy and physiology.
Knowledge of pharmacology and medications used in the operating room.
Knowledge of infection control protocols.
Ability to maintain aseptic technique and monitor sterile field.
Ability to suture and close incisions.
Ability to apply dressings and perform wound care.
Ability to perform hemostasis, including cauterization and ligation.
Ability to provide peri-operative patient education.
Knowledge of emergency response procedures including CPR and Advanced Cardiac Life Support (ACLS).
Ability to recognize and respond to changing patient conditions during surgery.

The ability to think critically and act quickly is an essential skill for a Registered Nurse First Assistant (RNFA). This is true in any healthcare setting, but especially in surgery where the RNFA must be able to assess and respond to the changing and often unpredictable needs of the patient and surgical team. To do this, the RNFA must possess excellent communication skills, understand anatomy and physiology, and be able to take direction from the surgeon.

the RNFA must know how to use surgical instruments, anticipate the surgeons needs, and manage the operating room environment. Without these skills, the RNFA may not be able to provide optimal care to the patient or support to the surgeon, leading to poor outcomes and potential complications. As such, having strong critical thinking and communication skills is essential for an RNFA to successfully practice in their chosen field.

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Frequent Interview Questions

What experience do you have in working as a Registered Nurse First Assistant?
How well do you work with a team and what strategies do you use to ensure collaboration?
What makes you a good choice for this position?
Describe a situation where you had to make a difficult decision while working as a Registered Nurse First Assistant.
How do you handle stressful situations in the operating room?
Describe your experience in assisting surgeons during major medical procedures.
What techniques do you use to stay organized and manage your time effectively?
Describe how you would provide patient education while working in this role.
What challenges have you faced while working in the operating room?
Describe how you maintain professional relationships with surgeons, nurses, and other healthcare professionals.

Common Tools in Industry

Surgical Instruments. A variety of tools used to perform surgical procedures, such as forceps, scalpels, and retractors (e. g. Metzenbaum scissors).
Suturing Supplies. Needles and thread used for stitching wounds (e. g. nylon suture).
Wound Care Tools. Tools used for cleaning, debriding, and packing wounds (e. g. wound irrigator).
Advanced Wound Care Products. Dressings and specialized products used to cover and protect wounds from infection (e. g. hydrocolloid dressings).
Intravenous Access Devices. Tools used to gain vascular access and administer medications or fluids (e. g. peripheral intravenous catheter).
Patient Monitoring Devices. Tools used to monitor vital signs and other indicators (e. g. pulse oximeter).
Endoscopy Equipment. Specialized tools used to view internal organs and tissues (e. g. flexible endoscope).
Operating Room Supplies. Various items used in the operating room, such as gowns, gloves, and masks (e. g. surgical goggles).

Professional Organizations to Know

American Association of Nurse Practitioners (AANP)
Association of periOperative Registered Nurses (AORN)
Association of periOperative Nurses-Certified First Assistants (APRN-CFA)
American College of Surgeons Committee on Trauma (ACS-COT)
American Society of Anesthesiologists (ASA)
National Surgical Assistant Association (NSAA)
National Board of Surgical Technology and Surgical Assisting (NBSTSA)
Association of Surgical Technologists (AST)
International Association of First Assistants in Surgery (IAFAS)
Council of Surgical Specialty Societies (CSSS)

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Common Important Terms

Intraoperative Nursing. The practice of nursing care during surgery and other related procedures.
Operating Room Nursing. The practice of nursing care within the operating room.
Preoperative Nursing. The practice of nursing care prior to surgery and other related procedures.
Surgical Technologist. A healthcare professional who performs duties during surgeries and other related procedures.
Perioperative Nursing. The practice of nursing care before, during, and after surgery and other related procedures.
Postoperative Nursing. The practice of nursing care after surgery and other related procedures.
Patient Education. Educating patients about their procedure, recovery, and any other necessary information before, during, and after a surgical procedure.
Documentation. The process of accurately recording patient information, assessments, treatments, and outcomes in accordance with medical standards.
Anesthesia. The administration of drugs to induce a state of partial or total loss of sensation or consciousness during surgery and other related procedures.
Pain Management. The assessment and management of pain before, during, and after a surgical procedure.

Frequently Asked Questions

What is a Registered Nurse First Assistant (RNFA)?

A Registered Nurse First Assistant (RNFA) is a specially trained registered nurse who assists the surgeon during a surgical procedure, providing patient care before, during, and after the operation.

What are the requirements to become an RNFA?

To become an RNFA, a registered nurse must complete an accredited RNFA program and pass the national certification exam. They must also have at least two years of experience in a critical care or operating room setting.

What duties does an RNFA perform?

An RNFA typically performs duties such as scrubbing in and preparing the surgical site, positioning and draping the patient, assisting in tissue retraction and closure, providing post-operative care, and educating patients and families.

What is the scope of practice for an RNFA?

An RNFA is permitted to perform tasks such as positioning and draping of the patient, providing tissue retraction, suturing and ligating vessels, providing wound closure and dressing, managing drains and tubes, assessing tissue viability, and educating patients and families.