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How Much Do RNFAs Make?

NurseJournal Staff
Updated February 8, 2023
The demand for registered nurse first assistants continues to expand. Learn more about RNFA salary prospects and how to earn higher income in this promising career.
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Surgical nurse scrubbing handsCredit: Reza Estakhrian / The Image Bank / Getty Images

Interested in a career as a registered nurse first assistant (RNFA)? RNFAs work with doctors during surgery, applying their specialized knowledge and training to provide better patient care and ease the pressure on the healthcare team. These RNs have more operating room responsibilities than scrub nurses and other perioperative nurses.

The growing need for surgical care and the rise in outpatient clinics and same-day procedures have boosted average RNFA salary levels and career opportunities. Find out more about RNFA salaries, the highest-paying states, and how to increase your pay.

Average Salary for RNFAs

How much does an RNFA make? The median RNFA salary in the United States, as of August 2022 data from Salary.com, is $102,740. Earnings range from $84,040 to $125,120.

Like all RN positions, earnings can vary significantly depending on education, certification, and type of employer. RNFAs with more work experience will command top salaries. Nurses who work in states with higher than average cost of living can also expect higher pay.

The increasing demand and value placed on RNFAs by hospitals and surgical clinics has lifted RNFA salary potential compared to other RN roles. Because of their broader responsibilities and specialized training, these nurses typically earn more than other operating room RNs. For example, staff nurses, who do not hold the same certifications as RNFAs, make an annual salary of $78,760 as per Salary.com in August 2022.

Average Annual Salary
Source:Payscale, August 2022

Average Hourly Wage
Source:Payscale, August 2022

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The Highest-Paying States for RNFA

The U.S. Bureau of Labor Statistics (BLS) does not provide salary data for RNFAs. However, BLS state-specific estimates for all RNs reflect salary ranges for RNFAs. As of May 2021, RNs earn an average annual salary of $82,750. Average compensation ranges from $59,450 for nurses in the bottom 10% to over $120,520 for the top 10%.

Because RNFAs enter the field after getting specialized certifications and at least two years experience as a perioperative nurse, they can expect to command higher-than-average pay.

Where an RNFA works will also impact compensation levels. According to the BLS, RNs make the highest salaries in California, Hawaii, Oregon, District of Columbia, and Alaska. Not only does California offer the highest RN salaries, the state boasts the top 10 paying metropolitan areas in the U.S. for RNs, offering salaries well above the national average. Salaries range from $124,000 to $155,000.

Average RNFA salary typically correlates with the cost of living. For example, the average annual salary for RNs working in Alabama is less than $62,200, but living expenses run much lower than the top-paying states.

Highest-Paying States
StateAverage Salary
District of Columbia$98,540

Source:U.S. Bureau of Labor Statistics (BLS)

4 Ways to Increase Pay As an RNFA

RNFAs can pursue several options to bump up their earning potential. Earning an advanced degree or specialized certification, moving into an administrative position, or changing practice settings can open up more career opportunities that come with pay raises.

  1. 1

    Consider Pursuing Certifications

    Although many RNs earn certifications to demonstrate their specialized knowledge and increase their earning power, RNFAs must hold thecertified nurse operating room(CNOR) credential to practice.

    According to a report by the Association of periOperative Registered Nurses reports that CNORs earn on average $1,700 more each year than RNs. In addition to the CNOR, the certified registered nurse first assistant certification (CRNFA) is recommended for RNs who assist in surgical procedures and perform pre- and postoperative assessments.

  2. 2

    Increase Your Education Level OR Earn Your Bachelor’s/Master’s Degree

    RNs must complete a nursing diploma, associate degree in nursing, or bachelor of science in nursing (BSN) to begin working in perioperative nursing roles before entering RNFA positions.

    The CRNFA certification requires a BSN and two years of perioperative experience. RNFAs who become advanced practice nurses by earning a master of science in nursing (MSN) will earn considerably more than BSN-holders. Nurse practitioners who typically have at least an MSN degree earn an average yearly salary of $118,040, almost $31,000 more than RNs.

  3. 3

    Gain Experience in Administrative Roles

    RNFA interested in advancing their earning potential may choose to move into administrative roles, managing surgical care programs and budgets, training staff, and serving as precepts for nursing students. The certified surgical services manager credential, designed for perioperative nurses including RNFAs, prepares these nurses to qualify for managerial positions as administrative team leaders, directors of surgical services, and surgery support coordinators.

  4. 4

    Change Practice Setting OR Become a Travel Nurse in Perioperative Care

    RNFAs may boost their earnings by changing practice settings or taking temporary assignments as travel nurses. Large-scale healthcare organizations, hospitals, and surgical centers in major cities may offer more competitive compensation.

    Also, the demand for nurses in medically underserved areas or regions facing nursing shortages has led to an increasing reliance on specialized travel nurses. RNFA travel nurses receive above-average salaries and other benefits compared to staff nurses.

How Do RNFA Salaries Compare to Other Nurses or Specialties?

Because generalist RNs do not have the necessary skills and training to work as first assistants alongside surgeons in operating rooms, they typically make less than RNFAs. Compared to other surgical and operating room nurses, RNFAs must have mandatory certification and additional training beyond basic perioperative experience. Consequently, RNFAs can expect to earn higher salaries than scrub nurses or circulating nurses.

Other nursing roles with similar earning potential include postanesthesia care unit nurses, certified ambulatory surgery nurses, and advanced practice nurses with specializations in high demand areas such as critical care and gerontology.

What Kind of Salary Growth Can RNFAs Expect?

Compensation for all RNs depends on several factors, including education, certification, and type and location of employer. RNFA salary ranges vary considerably by years of perioperative experience, clinical focus, and educational background. In general, nursing shortages and retirements, the expanding need for surgical care by the aging population, and the rise in outpatient and same-day surgeries drive the demand for RNFAs, resulting in more competitive salaries.

Frequently Asked Questions About RNFA Salaries

What does an RNFA do?

While specific duties vary by the type of healthcare facility, RNFAs always practice under the supervision of a surgeon. Their responsibilities include working with the surgical team, providing patient care before, during, and after surgery, administering medications, and preparing surgical tools. They also conduct surgical procedures such as suturing and wound management and give postsurgery assessments.

Where do RNFAs work?

The most common work settings include hospitals, ambulatory surgical centers, and other outpatient healthcare facilities. They may also practice in plastic surgery centers, ophthalmology clinics, dental offices, and any healthcare setting that performs surgical procedures.

Are RNFAs paid well?

Because RNFAs enter the field after certification and gaining specialized clinical experience, they make higher-than-average RN earnings. Salary ranges for RNFAsfall between $84,040 for the lowest 10% to $125,120 for the top 10%, according to Salary.com in August 2022.

How do I become an RNFA?

After earning a nursing degree, and passing the nurse licensure exam, prospective RNFAs must have at least two years of perioperative nursing experience before applying for the CNOR certification. RNFAs may not practice without the CNOR credential. Some healthcare facilities may establish additional educational and certification requirements.

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