Training and Education

Prequests to be accepted into an RNFA Program

Format of RNFA education programs:

Most RNFA programs are built on a similar model. Generally this model includes three components:
  1. Modules or self study program done by correspondence – mail or computer mediated
  2. Didactic Session – classroom and lab work. This portion generally involves travel to the school offering the RNFA program for 5 – 7 days.
  3. Structured Clinical Internship – Clinical hours are mentored by a surgeon, and RNFA (if available). This portion of the program can be done at any hospital where the student has made arrangements and an agreement is in place with the school and hospital.

Prerequisites to be accepted into an RNFA program:

  1. Must be a registered nurse, graduated from an accredited school of nursing.
  2. Must be licensed to practice as a registered nurse in the province in which the clinical internship will be accomplished.
  3. Must have 5 years of perioperative experience (program dependent).
  4. Must be certified as a perioperative nurse. The Canadian Nurses Association manages the certification process in Canada. Successful candidates may utilize the acronym CPN (C). The American equivalent is CNOR.
  5. Basic cardiac life support (BCLS); advanced cardiac life support (ACLS) preferred.
  6. Letters of recommendation.
  7. Satisfactory health information.
  8. Application/registration information.
  9. Payment of tuition fees.

AORN (2008). AORN Recommended Education Standards for RN First Assistant Programs. Perioperative Standards, Recommended Practices. Denver: AORN, 47-49.

Mohawk College, Hamilton, Ontario

The first RNFA program offered by Mohawk College's Continuing Education Health Sciences and Distance Education departments commenced in September 2008. This program is comprised of part-time, online independent study, a full-time didactic component and a clinical internship. For more information, visit: Mohawk College, Registered Nurse First Assistant Certificate

Mohawk College RNFA Course Descriptions:

RNFA Theory 1: The preliminary theory course provides the theoretical foundation for RNFA practice. It involves 39 hours of facilitated part-time independent study through online learning activities with computer-based modules. The role diversity of the first assistant is explored in its interdependent relationship as the nurse works both with the physician and nurses and for the benefit of the patient. The nursing diagnosis is used as the defining guide in planning and implementing patient care.

RNFA Theory 2: The second theory course provides intraoperative knowledge and technique necessary to assuming responsibilities of the RN First Assistant. It involves 39 hours of facilitated part-time independent studies through on-line learning activities with the online-based modules. The nursing diagnosis is used as the defining guide in planning and implementing patient care.

RNFA Laboratory Practice: This face-to-face full-time tutorial/lab is offered over eight to ten days. It will include 60 hours of interactive learning activities with skills labs. RNFAs, physicians, and perioperative nursing faculty will be involved in this course. Expanded functions are stressed and elaborated on as the nurse is prepared to assume the RNFA intraoperative responsibilities for assisting at surgery.

RNFA Surgeon Mentored Internship: This course involves 175 surgical assisting hours with a surgeon mentored practice for perioperative nurses in the first assistant role. Students will be required to keep a log of surgeries that they have assisted with. Progress will be monitored.

RNFA Independent Internship: This course involves 50 hours of clinical time in areas of clinics, pathology, radiology, infection control and patient hospital and office visits.

In Newfoundland and Labrador

The Centre for Nursing Studies, in partnership with health board perioperative programs, offers educational programs to prepare perioperative registered nurses for the RN first assistant role in either cardiac or general surgery.

Fitzgerald, S. (2002). Letter to the Editor. ‘First Assist Program in St. John’s’. Canadian Nurse, 98 (8), p. 4 – 6.
Harkins, P. and Brazill, P. (2001). Development of an RNFA Program: A Newfoundland and Labrador Adventure. Canadian Operating Room Nursing Journal 19 (4), 20 – 24.

Trois-Rivieres, Quebec (French)

Program currently not being offered (2008)

USA RNFA programs

The Competency and Credentialing Institute (CCI) has a list of accredited RNFA programs. It is important if choosing an American program that it meet ‘AORN Recommended Education Standards for RN First Assistant Programs’.

The following website lists the AORN accredited RNFA programs:

More information can be found on AORN’s RN First Assistant Special Assembly website:


Certification Process

RNFAs graduate from their RNFA programs, educated as RNFAs. The certification process is one that is voluntary and regulated through a non-academic process.

The Canadian Nurses Association (CNA) says the following about specialty certification:

“Specialty certification is a voluntary program that allows you to build on the solid foundation of your Canadian RN registration. With it, everybody wins – you, your clients and your employer. Certification helps you stay current by evaluating your specialized knowledge and skills, and having letters after your name to designate certification will prove your abilities to everyone you work with. Your clients benefit from quality care and you benefit from new opportunities.

Certification is a commitment to the leading edge in national health care standards. It gives national scope to the principle of continued competence encouraged by provincial quality assurance programs. It’s a tangible distinction, confirming your knowledge and skill levels in your specialty.”

AORN has the following to say about certification:

“Certified individuals have met prescribed education, examination, or experience requirements. The purposes of certification include enhancing quality patient care, achieving professional growth, providing employing agencies with a means to identify professional achievement, and distinguishing professional nurses practicing in an expanded role.”

Reference: A Clarification About Listing Credentials (2002). AORN 76(5), 828.

Due to the newness of the RNFA role in Canada, CNA does not currently have a mechanism for Canadian RNFAs to become certified in their specialty. Registered Nurse First Assistants in Canada can, however, become certified as CRNFAs. Upon meeting the pre-requisites, Canadian RNFAs can apply to CCI – Competency and Credentialing Institute ( in the U.S and upon successful completion of the application process and examination, can become certified as CRNFAs.

The following pre-requisites are necessary in order to apply for certification:

  1. Licensed as a RNFA where you currently practice
  2. At least 2,000 documented hours of practice as a RNFA
  3. CNOR, or CPN(C) with special permission
  4. BScN, MSN or other degree
  5. Graduate of a formal RNFA program (BCIT is approved)

Source: Certification. RN First Assistant Guide to Practice, 3rd ed. (2007), Denver: AORN.

For information as to how to apply for special consideration with your CPN(C) contact: Grace Groetzsch, CRNFA