283 - Registered Nurse First Assistants: A Scoping Review of Education and Role Development

Description:

Background:
The Registered Nurse First Assistant (RNFA) plays a critical role in perioperative care, yet there is limited research regarding RNFA workforce trends, educational pathways, and integration with advanced practice nursing. Despite its formal recognition since the 1980s, the RNFA role remains underutilized and underexplored in current literature. Given increasing surgical demand, physician work-hour restrictions, and the expanding scope of nursing practice, a clearer understanding of RNFA development and its intersection with nurse practitioner (NP) training is needed.

Objective:
To conduct a scoping review of the literature on RNFAs to identify existing research, highlight educational and workforce gaps, and explore the implications of combining RNFA and NP preparation — particularly within acute care settings.

Methods:
We conducted a comprehensive scoping review using the databases PubMed, CINAHL, Scopus, Embase, and RNFAs.org. The search spanned 1984 to 2024 and included 22 articles meeting inclusion criteria. Search terms included: "RN First Assistant," "RNFA," "RNFA AND APRN," "RNFA AND Nurse Practitioner," and variants combining RNFA and NP terminology. Articles were analyzed for themes related to role development, education, certification, scope of practice, and clinical utility.

Results:
Findings reveal a scarcity of research on RNFAs over the past two decades. Only a limited number of RNFA programs exist nationwide, creating a bottleneck in workforce development. Exposure to perioperative nursing in prelicensure education is minimal, contributing to low pipeline interest. The literature consistently affirms the clinical and economic value of RNFAs, citing improved operative efficiency and favorable outcomes. RNFAs — especially those dually trained as acute care nurse practitioners (ACNPs) — offer enhanced utility, with the ability to provide first-assist services and bill as advanced practice providers. Legislative support and hospital adoption vary, but interest is growing due to positive cost-effectiveness and clinical outcomes. Major gaps persist in formal educational pathways, role standardization, and reimbursement policies.

Conclusion:
This review highlights a pressing need for expanded RNFA education, clearer integration into advanced practice nursing, and standardized pathways to support workforce growth. The dual preparation of RNFAs and NPs may offer a promising solution to surgical staffing demands, particularly in high-acuity specialties. Future research should investigate RNFA-prepared APRNs' outcomes, cost impact, and barriers to clinical integration. Strategic investment in education, credentialing, and policy change is essential to fully leverage the RNFA's potential within modern surgical teams.