Program Opportunities for Enhanced /Advanced Perioperative Registered Nurses

Enhanced Perioperative Nursing Practice

Registered Nurse First Assistant (RNFA)

The Registered Nurse First Assistant (RNFA) practices enhanced 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.

RNFA Programs 

  • Eastern Health Centre for Nursing Studies, St. John's Newfoundland.   

           Registered Nurse First Assist Program Centre for Nursing Studies (

These programs are currently on hold (2023)

 Related Links and Sources of Information

The ORNAC Standards for Perioperative Registered Nurses Practice, 15th edition, (May 2021). Section 1 – Practice Standards and Competencies

For definitions for the RNFA, RNAA and Advanced Practice Nurses (CNS and NPs)

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.


Enhanced Perioperative Nursing Practice

 Registered Nurse Anesthetic Assistant (RNAA)

The RNAA provides assistance to the anesthesiologist to facilitate quality care of the patient undergoing anesthetic procedure(s). The increasing complexity of anesthesia provides the perioperative Registered Nurse who has enhanced perioperative education with the opportunity to collaborate with the anesthesiologist in clinical, technological, and administrative aspects of anesthetic care during the preoperative, intraoperative, and postoperative phases of anesthesia.

Anesthesia Assistant Programs in Canada (2020)

There are currently 3 programs offered in Canada that provide the academic education and clinical experience required to function as an Anesthesia Assistant.

British Columbia                  Cariboo College/Thompson River University
Ontario                                  Michener Institute for Applied Health Sciences     Fanshawe College

 Global Surgical Care- Advanced Practice

Post Graduate Degree:  The Master of Global Surgical Care (MGSC) is designed to prepare surgical care professionals from many disciplines to address surgical challenges and contribute to solutions in low-resource settings globally. The Master’s Degree is a two-year, 30-credit specialized program. This program is offered through the University of British Columbia.

Post Graduate Certificate:  The Graduate Certificate in Global Surgical Care (GCGSC) is designed to meet the growing need for professional development of students interested in focusing on the global health problem of the burden of unmet surgical care. The Certificate is comprised of four graduate level online courses. This certificate is offered through the University of British Columbia.

For more information on these exciting opportunities visit the Branch for International Surgical Care, University of British Columbia. 

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