Am I setting myself for failure wanting to be an RNFA?

Abby Suh · Feb 10, 2022

On 2/5/2022 at 12:26 PM, GenSurgRNFA said:

Hi, I would not suggest CST, when your done with your ADN position, go back right away for BSN and try to get your foot in the door as circulator or RN scrub nurse so you can start getting your hours in the OR. Take CNOR as soon as you are eligible. I am doing RNFA program at NIFA right now.

That was my plan! I was actually talking in class about BSN’s and I want to go IMMEDIATELY when I finish my ADN and after I pass boards. I had other classmates saying “not bothering” or “I’ll wait”. I’m definitely not.

Hoping to find a job or residency after graduation that offers periop-101.

I will say CST is a good backup plan because nursing school isn’t easy and I’m seriously afraid of failing every second. I’ve been doing well but I don’t know if it’s luck or actually me at the moment.

Aortic_Surgery_RNFA, BSN, MSN, DNP, NP · Feb 18, 2022

On 11/14/2021 at 11:12 AM, Abby Suh said:

Hello, I just got into nursing school and am pretty dead set on the OR. It was only reaffirmed when I got to shadow a surgeon, he let me be uncomfortably close (like 1 step from the sterile table, which they move around vs using a mayo and 1 step from him close at one point, but I basically was behind him the entire time), and it was the most incredible thing ever.

I really want to be a first assist, his FA highly suggested I change to CST school, while the surgeon and CRNA disagreed, and said that hospitals are so short staffed, if I got a new grad OR nurse position and said I wanted to scrub only they’d probably let me due to being desperate for people.

I’m fully aware that to become an RNFA you have to work 2000 hours in the OR, get your CNOR and go to FA school. I’m in an ADN program, and I’m worried I’m going to have issues finding new grad OR nurse jobs to get my foot in the door and start those 2000 hours while I work on bridging to BSN to take the CNOR exam.

A more logistical note. Nursing school is 2 years and the CST program is 1 and cost far less than the nursing program. I am definitely going to incur debt getting my RN, while I wouldn’t for my CST. I know CST’s make far less than RN’s though. So is RN then still needing my BSN still the better investment? I basically see CST as get what I want ASAP and nursing as a slower route with more investment.

Just need reassurance and suggestions. I’m tempted to just apply to the local CST program while in nursing school to put the option on the table.

I also hear RNFAs compete with PA’s/NP’s and CSFA, so will it be difficult to find a job and get experience?

As @Rose_Queen mentioned, a lot of it is about the institution that you choose to practice at AND the sponsorship from a surgeon to get you the experience of really learning how to operate, which is what you do as an RNFA. I pondered the same fork in the road and chose RN (then APRN (ACNP RNFA)) and think it’s one of the best decisions I made. I started in smaller institution and began scrubbing on all services. When we started our full Cardiothoracic program, I was recruited to scrub on that team, which was a hand-picked unit when it started. From there, I was blessed to have a Cardiac Surgeon who took a real interest in my passion for perioperative nursing and being ‘in the field’. She really has developed my skills and provided the ongoing sponsorship to now be our Lead RNFA on our CVOR service and also a member of our Open Aortic / High-Risk team. There was certainly luck involved, but I’m a believer that you create your own luck! @Abby Suh - Please message me with any questions.

Abby Suh · Feb 19, 2022

On 2/18/2022 at 12:22 PM, Aortic_Surgery_RNFA said:

As @Rose_Queen mentioned, a lot of it is about the institution that you choose to practice at AND the sponsorship from a surgeon to get you the experience of really learning how to operate, which is what you do as an RNFA. I pondered the same fork in the road and chose RN (then APRN (ACNP RNFA)) and think it’s one of the best decisions I made. I started in smaller institution and began scrubbing on all services. When we started our full Cardiothoracic program, I was recruited to scrub on that team, which was a hand-picked unit when it started. From there, I was blessed to have a Cardiac Surgeon who took a real interest in my passion for perioperative nursing and being ‘in the field’. She really has developed my skills and provided the ongoing sponsorship to now be our Lead RNFA on our CVOR service and also a member of our Open Aortic / High-Risk team. There was certainly luck involved, but I’m a believer that you create your own luck! @Abby Suh - Please message me with any questions.

Thank you so much! Personally really interested in ortho and neuro.

cho52 · May 7

I read all your comments can anybody from CA advise what to do on RNFA program. My daughter is enrolling in the RNFA program with RN-BSN with preoperative experience at UCLA Surgery center. She have completed all the required checklists, but I have a concern. Despite her extensive experience as a scrub nurse and circulating nurse as a Nurse II, she mentioned that the individuals performing the role of First Assist are not RNFA-certified but are mostly intern doctors or physician assistants (PAs). How will she complete her 140 hours if she does not have the opportunity to intern with a surgeon after completing the workshop and study at NIFA? Any advise would be great. (NIFA and all RNFA program requires student to secure their 140 internship with surgeon that's board certified on their own).

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CV_Surgery_FirstAssist · May 9

Hi Abby -

Like you, I was immediately drawn to the Operating Room when I started my clinical rotations. Also like you, I felt like I was discouraged from pursuing a career in the O.R. by my professors as not a good foundation such as med-surg or ICU. In the end, I made the decision to go with my heart, which was in the Cardiac Operating Rooms and went through a very amazing CVOR-specific residency program for new RNs or RNs looking to transition into the Cardiac Operating Rooms - note this was at a world-renowned and prestigious institution known for the most daring heart cases.

The great thing about the residency was the following:

Exposure to all dimensions of perioperative nursing: Our 12-month residency program provided almost a 50 / 50 split between scrubbing and circulating - I ended up scrubbing for probably 70% of the time because of surgeon preference I was able to establish after scrubbing a few of her heart cases. I was not a huge fan of circulating just because I wasn't in the operative field and actually working directly with the operative team hand-to-hand.
Showed me the possibilities: The institution did have residents and fellows, but really came down to surgeon preference and it was amazing to see how many surgeons had a dedicated PA or NP RNFA that they used exclusively as First Assists on their most complicated Heart and Aortic cases. Seeing 'symphony' between a Surgeon and her FA during complex cases was one of the most inspiring things I've ever seen - how much is done and accomplished with so few words ever spoken.
Mentorship opportunities: The residency enabled me to be formally mentored by a DNP RNFA who scrubbed all high-risk aortic cases for a surgeon who is world-renowned in complex aortic surgery. Being able to pick-her-brain but also see how she prepared for cases and built that rapport with her surgeon was invaluable.

After completing the residency, I received an offer to scrub on one of the open-heart teams there. I subsequently obtained my APRN and completed my DNP last year. During my APRN, I enrolled in a CRNFA program and was able to get all of the hours to obtain both my CNOR and CRNFA. I am now a CRNFA on the open-heart team and work exclusively with a surgeon on a variety of high-stakes heart cases. My story may not be the norm, but it taught me to follow my intuition when so many told me not to.

Abby Suh · Sep 15

I know this post is old, but an update to all this:

I graduated nursing school December 2023, started a job in the OR in January 2024 and first went through orientation to circulate, went on my own after 4 months (they do not have a residency, it's individual), now 8 months in, I'm learning to scrub too. Total joints are overwhelming... all the nurses learning to scrub are learning their service line. There's a nurse who started a little before me who learned general and vascular... me it's all ortho LOL.