I have just started the NIFA first assist training. I am a recent FNP graduate and was lucky enough to get on with a cardiothoracic surgery group that was interested in sending me. I have no prior OR experience as a nurse. My background is in ICU. From what I've learned, NPs aren't actually "required" to have any type of FA certification or training in order to first assist and bill in the OR. However, good luck finding a hospital that will give you surgical privileges without it! Like bsnanat2 mentioned.. the good news is that you don't need any OR experience to start the NIFA training as a NP. FYI: The financial outlook for the triple threat NP (OR, inpatient, clinic) is extremely good! Wish you the best!