Publication Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Alice Butzlaff

Second Advisor

Clair Kuriakose


APP, AORN, First Assist, RNFA, Advanced Practice Providers


As the number of surgical procedures increase, many Advanced Practice Providers (APPs) are being required to scrub in as a First Assist (FA). Unfortunately, many APPs lack any formal surgical training. The Association of perioperative Registered Nurses (AORN) now requires that all advanced practice providers in the perioperative environment to complete a course that complies with Registered Nurse First Assist (RNFA) standards. The purpose of this project was to evaluate knowledge acquisition of APPs participating in a surgical FA educational program. A surgical FA course was comprised of five days of didactic learning, which included lecture, small groups, skills lab, and surgical simulation. Each student completed a survey at the beginning of the course and at the end, inquiring about level of confidence, professional experience and prior surgical first assist experience. Students also completed a pre- and post-course knowledge assessment to measure level of knowledge on perioperative management. This course showed an increase in both confidence and competence in surgical skills, in addition to an increase of knowledge base by over 25 percent overall. Advanced practice providers are being utilized as FA on many surgical services without formal training in perioperative management. This course provided the knowledge base and surgical skills necessary to function as an FA, while complying with the mandated content set forth by the AORN.


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