First Assist Nurse Salary Guide

Registered Nurse First Assistants, or RNFAs, are perioperative RNs who function as first assistants during surgical procedures. This specialty requires advanced coursework and additional certifications to be credentialed. Because of its extensive requirements and specialization, RNFAs are in demand and paid well, but several factors can impact their salary.

RNFAs work alongside surgeons and in collaboration with other healthcare team members in operating rooms to provide direct patient care and achieve optimal patient outcomes. They can perform duties during preoperative, intraoperative, and postoperative care. First Assistants aren’t the same as scrub nurses who hand surgical instruments and supplies to the surgeons. RNFAs can do everything from suturing patients’ wounds to stopping bleeding. Their exact role may vary based on the surgical institution and the surgeon.

Prospective RNFAs must first complete the educational requirements to become a registered nurse, which include earning an Associate Degree in Nursing or a Bachelor of Science in Nursing from an accredited nursing program and passing the NCLEX-RN licensure exam. However, as of January 1, 2020, RNs must have a BSN to enter an RNFA program.

RNs must complete an RNFA program that follows the Association of periOperative Registered Nurses (AORN) standards for RN First Assistant education. Admission requirements vary for each of the acceptable RNFA programs. RNs must be eligible for Certified Perioperative Nurse (CNOR) credentials offered by the Competency and Credentialing Institute, which requires two years of experience in perioperative nursing. They must earn CNOR certification before graduating from their RNFA program. Advanced Practice RNs can train to become an RNFA without any perioperative experience or CNOR.

Each healthcare facility bases its salaries on varied criteria, but many of the same factors can increase your base. Your years of experience are a given because experienced nurses always earn more than new grads no matter the field. To gain RNFA status, RNs need at least two years of experience in perioperative nursing to pursue certification and RNFA training. As you gain this experience, you’re simultaneously helping increase your salary base.

The size and location of the facility can impact an RFNAs base salary. According to a 2020 salary survey by the AORN, the base salaries of nurses working in freestanding surgery centers was $5,600 less compared to those working in acute care hospitals or hospital outpatient departments. Furthermore, RNs working in urban hospitals earned about $7,000 more annually than those working in rural hospitals. 

Besides the standard certifications, which include Basic Life Support and Advanced Cardiovascular Life Support, you need CNOR certification to enter an RNFA training program so work on getting this sooner versus later. Plus, having this certification should increase your salary even before you earn your RNFA credential. Certified RNs usually earn more than those who aren’t, so give your salary base a boost while simultaneously pursuing your RNFA career path.

Higher education is another sure way to accomplish a higher base salary and for RFNAs, it’s required. While you can enter the nursing field with an ADN, you need a BSN to enter RFNA training. Since many healthcare institutions prefer BSN-educated nurses, you may also earn a higher starting salary while obtaining the educational requirements to continue along the RFNA career path.

Earning a Master of Science in Nursing or a Doctor of Nursing Practice qualifies you to pursue Advanced Practice RN positions, such as Nurse Practitioners, Clinical Nurse Specialists, or Nurse Anesthetists, which increases your salary. APRN status also allows you to enter an RNFA training program without previous perioperative experience, which is convenient if you’re just transitioning to the field and don’t want to wait two more years to begin training.

Professional certification helps you achieve your personal and professional goals, enhance your career development, and increase your RNFA salary. The Registered Nurse Assistant at Surgery – Certified (RNAS-C) exam offered through the National Assistant at Surgery Certification (NASC) is for RNs who’ve completed an RNFA training program and 120 hours in the RNFA role. CRNFA certification is for experienced RNFAs with at least 2,000 hours of RNFA practice who hold a bachelor’s degree or higher. Applicants must satisfactorily complete the CRNFA Professional Portfolio to earn certification.

Yes, advanced education often opens new career paths that usually lead to higher salaries. RN first assist may benefit financially from pursuing a Registered Nurse Assistant at Surgery – Certified (RNAS-C).

Take a look at Vivian's First Assist Nurse Career Guide for more information, including required education, responsibilities, pros and cons and more.