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Registered Nurse First Assistant (RNFA)


Program Description

The Registered Nurse First Assistant (RNFA) is a perioperative registered nurse (RN) or an Advanced Practice Registered Nurse (APRN) who functions in an expanded role as a surgical first assistant. The RNFA works in collaboration with the surgeon and other health care team members to achieve optimal patient outcomes; utilizes the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice; and practices intraoperatively at the direction of the surgeon” (AORN, 2015).

The RNFA role is recognized within the scope of nursing practice by the nurse practice acts in all 50 states and may vary depending on patient populations, the environment in which the RNFA practices, services provided, availability of fiscal resources including reimbursement policies, and institutional credentialing regulations. (AORN, 2015). 

RNFA Program Outcomes

Upon successful completion of the RNFA program, the RN or APRN is able to:

  1. Explore potential surgical hazards and safety measures to prevent injury including patient and occupational related hazards.
  2. Explain the design and use of key surgical instruments used for surgical procedures.
  3. Demonstrate knowledge of common surgical procedures incorporating an understanding of anatomy, physiology and pathophysiology.
  4. Demonstrate proper sequence of procedures, assisting behaviors, operative technique and knowledge of potential complications related to the surgical procedure.
  5. Exhibit proper handling and knowledge of surgical instruments and medical devices, providing surgical site exposure, handling tissue, cutting tissue, providing hemostasis, suturing, and wound management.
  6. Develop a continuous and applicable nursing assessment, plan of care and patient evaluation throughout the perioperative period in collaboration with other health care providers.
  7. Document intraoperative patient management in the surgical first-assisting clinical experience.
  8. Document postoperative patient management such as participation in postoperative rounds and assisting with discharge planning including identification of appropriate community resources intraoperative clinical experiences precepted by Board-Certified Surgeons. 

Course Requirements

Course ID Title Credits
RNFA 540G  Surgical Techniques (Online - Fall)* 3
RNFA 541G  Advanced Perioperative Nursing I (Online - Spring) 3
RNFA 542G  Advanced Perioperative Nursing II (Spring or Summer)** 3
  Total 9

* One week (40 hours) on-campus simulation workshops offered during Fall term.
**180 clinical hours of perioperative practicum in Spring or Summer term precepted by Board-Certified Surgeons in area of student residence.

Technical & Performance Standards

Students in the RNFA certificate program must meet the Technical and Performance Standards expected of all students in the College of Nursing educational programs.  In addition, RNFA program students are expected to possess the mental, auditory, visual, sensory, strength, manual dexterity, and communication skills to:

View Technical and Performance Standards
  1. Manage common, acute, and life-threatening problems encountered with patients in the perioperative setting.
  2. Nurture interprofessional relationships that promote optimal patient care.
  3. Collaborate with the surgeon and other interprofessional team members to achieve optimal patient outcomes.
  4. Develop the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice.
  5. Utilize evidence-based care for meeting the needs of perioperative patients.
  6. Performs comprehensive health assessments of perioperative patients.
  7. Fosters patient advocacy and safety.



UTHSC RNFA program meets AORN educational standards and is recognized by National Assistant at Surgery Certification (NASC) as an acceptable program for the CRNFA examination.


Admission Eligibility

Applicants must have: (1) current unencumbered RN license, (2) BCLS, ACLS (required), (3) minimum cumulative Grade Point Average of 3.0 or higher or a cumulative GPA of at least 3.2 earned during the applicant's most recently completed degree program; AND (4) one of the following:  

  • BSN (CNOR/CNOR eligible required prior to the start of the RNFA program)
  • MSN/DNP/PhD with APRN certification
  • BSN/MSN/DNP/PhD seeking APRN and/or CNOR certification

To be awarded a Certificate of Completion you must successfully complete the 3 RNFA courses (9 credit hours).

Application deadline extended to April 1

Applicants should contact the Office of Student Affairs at 901-448-6139 for questions on state authorization. Students accepted into certificate programs are not eligible for federal financial aid. 

See complete admission requirements 
on NursingCAS. A fee of $70 is charged for application.

Feb 27, 2024