Registered Nurse First Assistant (RNFA Canada)


Registered Nurse First Assistant (RNFA)

The Registered Nurse First Assistant (RNFA) practices expanded perioperative nursing by providing assistance to the surgeon and surgical team to facilitate quality care of patients undergoing surgical procedures. The increasing complexity of surgery provides the RNFA, who has additional perioperative nursing education, with the opportunity to practice in collaboration with and at the direction of the surgeon. As of 2000, all provinces within Canada acknowledge that the RNFA role falls within the scope of nursing practice. RNFA practice falls under the umbrella of perioperative nursing and encompasses the preoperative, intraoperative, and postoperative phases of the surgical experience.

Belonging to the Registered Nurse First Assistant Network of Canada provides RNFAs with:

  • A voice and vote on the ORNAC Board
  • Educational session(s) or workshops specific to RNFA practice at the ORNAC Conference
  • A means of communication with other RNFAs through the Forum on the ORNAC website
  • A chance to win the ORNAC conference registration fee, if you attend the ORNAC conference and RNFANC meeting at the conference.


RNFA Programs Currently Available in Canada


Related Links and Sources of Information

The ORNAC Standards for Perioperative Registered Nurses Practice, 12th edition, (May 2015). Section 1 – Practice Standards and Competencies For definitions for the RNFA, RNAA and Advanced Practice Nurses (CNS and NPs)

ORNAO RNFA Interest Group -

Canadian Nurses Association(2008). Advanced Nursing Practice: A National Framework


Canadian RNFA History

The term Registered Nurse First Assistant commonly referred to as a RN First Assistant or RNFA stems from the United States. The Association of periOperative Registered Nurses (AORN) formally recognized the role in 1982 and Delaware County Community College, under the leadership of Jane Rothrock, offered the first formal RNFA program in 1985.

In 1994, ORNAC established a seven member "Advanced Practice" Committee whose focus was specifically the Perioperative Nurse - Surgery (PNS) and Perioperative Nurse – Anaesthesia (PNA) roles. The Advanced Practice Committee (ORNAC 1996) developed a blueprint for PNS curriculum development and defined the Perioperative Nurse Surgery as:

"The registered nurse with advanced perioperative nursing education and skills provides assistance during the surgical intervention under the direction of the surgeon. This role has separate responsibilities to that of the scrub role. The PNS collaborates with the surgical team to coordinate the care of the client throughout the perioperative period. This new perioperative role requires a different body of knowledge and skills than was previously required of the scrub nurse. PNS practice may vary depending on patient populations, practice environments, services provided, accessibility of human and fiscal resources, institutional policy and provincial regulations of nursing practice" (p. 17).

In November 2000 the PNS name was changed to Registered Nurse First Assistant by ORNAC as this terminology is recognized worldwide.

At the 2001 ORNAC meeting in Banff, Alberta during the RNFA information session an Ad Hoc committee was struck of RNFA representatives from most provinces. The objective of this committee was to seek affiliate status with ORNAC by the 2003 ORNAC conference in Winnipeg. In 2002 the committee re-named itself RNFA Network of Canada.



  • Advanced Practice Committee (1996). Blueprint for: Curricula Development For the Role of Perioperative Nurse Anesthesia(PNA) and Surgery(PNS). Canadian Operating Room Nursing Journal, 14(4), 16-20.
  • Operating Room Nurses Association of Canada (1995). Unpublished document: Perioperative Nurse - Anaesthesia (PNA) + Perioperative Nurse - Surgery (PNS).
  • Operating Room Nurses Association of Ontario (1994). Letter to all members outlining the expanded perioperative nursing practice roles, January 17, 1994.


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