Registered Nurse First Assistant (RNFA) program

Sponsored by Cone Health and the School of Nursing at North Carolina Agricultural and Technical State University

nurses in operating roomBased on the Association of periOperative Registered Nurses (AORN) Core Curriculum, our expanded practice program is one of only 13 approved programs nationwide that has met specific criteria and is recognized by Competency & Credentialing Institute as an acceptable program for Certified Registered Nurse First Assistant eligibility. As a Registered Nurse First Assistant (RNFA), your nursing role will be expanded and will require independent nursing judgment related to tissue handling, retracting, providing exposure, clamping, ligating, suturing and providing hemostasis. Our RNFA program is designed to provide the perioperative nurse with the advanced knowledge and skill set to function at an advanced level.

Dates: March 3-9, 2024 (Sunday-Saturday)

Cost: $3,672

Credit: This program offers six semester hours of University credit for the student who completes the didactic and 135-hour clinical components (NURS 481 and NURS 491).

Who should attend?

Operating room registered nurses (baccalaureate degree required), nurse midwives, and nurse practitioners.

How to apply:

Preregistration is required. Class size is limited to 16. Register online to start the application process. The balance of the tuition and application must be received by Feb. 2, 2024

To provide the perioperative nurse with the knowledge and skills to:
  • Describe factors influencing scope of practice for the RNFA
  • Utilize the nursing process as a foundation for practice
  • Apply principles of asepsis and infection control
  • Describe surgical anatomy and physiology
  • Utilize surgical techniques related to first assisting
  • Recognize surgical hazards and initiate appropriate action
  • Validate intraoperative nursing behaviors
  • Apply principles of hemostasis, suturing and wound exposure in a laboratory setting
  • Demonstrate appropriate techniques of knot tying
  • Apply principles of first assisting in a laboratory setting
  • Develop effective communication skills

  • Lectures by experienced and engaged surgeons
  • Suturing and knot-tying lab
  • In-depth physical assessment lab
  • Lectures on current laparoscopic surgeries
  • Lectures (by experienced RNFAs) and discussion on the credentialing process
  • Interactive laparoscopic lab
  • Inter-professional collaboration across specialties
  • Surgeon-led live porcine lab with specialty stations


The didactic component of the program is designed to provide the student with the necessary knowledge to function as an RNFA. Teaching methodologies include lecture, discussion, independent study requirements, audiovisual aids, demonstration and return demonstration, and laboratory practicums. The student must attend one week of class at North Carolina A&T State University.


The clinical component provides the student with the opportunity to gain the skills needed to perform as an RNFA. Prior to enrollment, the student must have two letters of agreement: one from a surgeon who will serve as a mentor and one from the clinical practice site. The clinical consists of 135 hours in a hospital setting. The student has up to one year to complete the entire program, including Certification for periOperative Registered Nurse (CNOR).


Faculty will consist of master's-prepared perioperative nurses, RNFAs and board certified surgeons.

The following information must be provided before enrolling in the program:
  • Completed N.C. A&T Contract Course Enrollment Application
  • Transcript copies (post-secondary only)
  • Curriculum vitae or resume
  • Proof of RN licensure
  • Licensure to practice as a registered nurse in the state in which the clinical internship will be accomplished
  • Experience: Must have 2 years of recent operative nursing experience. This experience must include demonstrated competency in the scrubbing, circulating or first assisting roles of the intraoperative nursing dimension. (CNOR Eligible)
  • For APNs without intraoperative experience, a perioperative skills assessment will need to be submitted
  • CNOR: Must be CNOR or eligible with CNOR status obtained before a certificate of program completion is awarded or
  • Board certified or board eligible as an Advanced Practice Nurse (APN). APN Board certification must be obtained before a certificate of program completion is awarded.
  • Proof of CPR or BCLS is required. ACLS is preferred.
  • Proof of current personal professional liability insurance specific for RN first assistants.
  • A copy of your flu shot record and a copy of any other appropriate immunization records that may be requested by clinical facility
  • Two letters of recommendation to validate:
  1. Your proficiency in the role of scrubbing, circulating
  2. Your ability to perform effectively in stressful situations
  3. Your ability to perform effectively and harmoniously as a team member
  4. Your ability to perform effectively as a leader
  • Baccalaureate degree (new requirement as of Jan. 1, 2020)

If your clinical facility requires an affiliation agreement, please contact Pat White ( as soon as possible. This process requires some time to process through the legal departments at both institutions. To ensure this document is in place in time, please start this process no later than Friday, Jan. 14, 2022.

For more information

For program content questions, contact:

Nicole Small, MSN, RN, RNFA, CNOR
Cone Health System
Phone: 336-832-2575

North Carolina A&T State University
Cynthia Shores, Ph.D.
School of Nursing
Phone: 336-285-3572

For registration information, contact:

Pat White, MS, CPP
North Carolina A&T State University
Extended Campus: Continuing Education
Phone: 336-334-7810
Fax: 336-334-7081

About the sponsors

Cone Health
Since opening its doors in 1953, The Moses H. Cone Memorial Hospital has grown from a 51 bed, 200 employee facility into a multi-institutional health network. The hospital is one of five in Cone Health, an organization whose services are provided by 1,800 physician partners and a staff of over 13,000 health-care professionals. Moses Cone Hospital remains the organization's flagship facility and is a recognized leader in cardiology, neuroscience, trauma and rehabilitation services.

North Carolina Agricultural and Technical State University’s School of Nursing
The School offers a bachelor’s degree in nursing with three entry options: traditional; accelerated second degree; and BSN completion. With a strong commitment to the non-traditional student, the School has been a pacesetter in North Carolina. The School of Nursing provides services to improve the health of communities locally and globally.