AORN Position Statement: Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN J.. 2013a; 97:(3)299-301

Association of periOperative Registered Nurses. The RN First Assistant (RNFA) Standards of Practice. 2013b. (accessed 25 January 2021)

Abraham J, Whiteman B, Coad J, Kneafsey R. Development and implementation of non-medical practitioners in acute care. Br J Nurs.. 2016; 25:(20)1129-1134

Al-Hashemi J. The role of the advanced scrub practitioner. J Perioper Pract.. 2007; 17:(2)76-80

Boyle DK, Cramer E, Potter C, Gatua MW, Stobinski JX. The relationship between direct-care RN specialty certification and surgical patient outcomes. AORN J.. 2014; 100:(5)511-528

Buch KE, Genovese MY, Conigliaro JL Non-physician practitioners’ overall enhancement to a surgical resident’s experience. J Surg Educ.. 2008; 65:(1)50-53

Bryant E. Perioperative nurse surgeon’s assistants in day surgery: an emerging role within Australia’s health system. Ambulatory Surgery.. 2010; 16:(2)25-27

Crowe Critical Appraisal Tool (CCAT) User Guide. v1.4. 2013. (accessed 25 January 2021)

Hains T, Turner C, Strand H. Practice audit of the role of the Non-medical surgical assistant in Australia, an online survey. Int J Nurs Pract.. 2016; 22:(6)546-555

Hains T, Strand H, Turner C. A selected international appraisal of the Non-Medical Surgical Assistant. Journal of Perioperative Nursing.. 2017a; 30:(2)37-42

Hains T, Turner C, Strand H. Knowledge and perceptions of the NMSA role in Australia: A perioperative staff survey. Journal of Perioperative Nursing. 2017b; 30:(3)39-45

Hepp SL, Suter E, Nagy D, Knorren T, Bergman JW. Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program. Can J Surg.. 2017; 60:(2)115-121

Lynn A, Brownie S. The Perioperative Nurse Surgeon’s Assistant: Issues and challenges associated with this emerging advanced practice nursing role in Australia. Collegian.. 2015; 22:(1)109-115

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ.. 2009; 339

Quick J. The role of the surgical care practitioner within the surgical team. Br J Nurs.. 2013; 22:(13)759-765

Quick J, Hall S. The surgical first assistant: are you compliant?. J Perioper Pract.. 2014; 24:(9)195-198

Quick J, Hall S, Jones A. The Surgical Care Practitioner role problems and possible solutions from nurses in the UK offered to RNFSA colleagues in New Zealand. The Dissector.. 2014; 42:(1)32-34

Quick J, Hall S, Jones A. Are you prepared to take the risk: extending governance for perioperative roles. J Perioper Pract.. 2015; 25:(9)169-172

Simpson K. Registered Nurse First Surgical Assistants improve patient outcomes post-surgery. The Dissector.. 2017; 45:(1)14-16

Smith C, Hains T, Mannion N. An opportunity taken: Sunshine Coast University Private Hospital’s Perioperative Nurse Surgeon’s Assistant experience. Journal of Perioperative Nursing.. 2016; 29:(3)23-28

Timpany MD, McAleavy J. Perioperative role development: evaluating a fast-track approach to advanced scrub and/or dual role practitioner training. J Perioper Pract.. 2010; 20:(1)13-17

Zarnitz P, Malone E. Surgical nurse practitioners as registered nurse first assists: the role, historical perspectives, and educational training. Mil Med.. 2006; 171:(9)875-878

The role of the registered nurse first assistant within the perioperative setting

11 February 2021
10 min read
Volume 30 · Issue 3


Perioperative setting registered nurse first assistants (RNFAs) are described as non-medical practitioners who perform surgical interventions during surgery. They provide medical care to perioperative patients under the supervision of a consultant surgeon. First assistants in surgery can be an expanded perioperative nursing role. A review of the literature illuminates the need for continuous learning in developing skills in becoming competent RNFA practitioners and how they utilise acquired skills to assist, mentor and teach their colleagues within the perioperative setting. The RNFA is an advanced and expanded practice role. RNFAs contribute significantly to the provision of care within all phases of perioperative care (preoperative, intraoperative, postoperative). There is little literature on the role of the RNFA due to its relatively recent emergence in the healthcare sector and the small number of countries where it is implemented.

Advanced practice in nursing has been described as a means of expanding nursing care that enhances patient safety and improves the quality of patient care (Zarnitz and Malone, 2006; Association of periOperative Registered Nurses (AORN), 2013a; Boyle et al, 2014). The introduction of the European Union Working Time Directive reduced working hours for junior doctors, changed medical training, and increased the demand for non-medical staff to undertake assisting roles intraoperatively. These directives recommended that nurses and allied health professionals undertake expanded practice roles, including the registered nurse first assistant (RNFA) (Al-Hashemi, 2007; Timpany and McAleavy, 2010; Quick et al, 2014; Abraham et al, 2016; Simpson, 2017).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content