You apparently don't know many RNFA's. RNFA's are first educated with a bachelors degree. Then atleast 2 years of ciruclating and scrubbing before they can even attend RNFA training. Then they must be certified as OR nurses. Then complete a year long program which includes didactic and precepted first assisting. Then if they choose to certify as an assistant they have to document 2000hrs of assisting to sit for the exam. Then they must maintain CME's every 5years to recertify. What basis of education does a CSA have? I happen to be an RNFA and completing my FNP degree in Dec. so perhaps I am 2/3 the best 1st Assistant.