By James X. Stobinski, Ph.D, RN, CNOR, CSSM(E), CNAMB(E)
In late 2024 a remarkable success story unfolded as the CRNFA credential earned accreditation from the Accreditation Board for Specialty Nursing Certification (ABSNC).
The Certified Registered Nurse First Assistant (CRNFA) credential has existed since the mid-1990s but was purchased by the National Assistant at Surgery Certification (NASC) company in late 2018. Achieving accreditation is a noteworthy achievement considering the challenges faced by both the Registered Nurse First Assistant (RNFA) community and NASC. In way of disclosure, I know the owners of NASC well and I have served as an unpaid consultant on the accreditation application.
The sale of the CRNFA certification to NASC, a for-profit company, was initially upsetting to the RNFA community. Collectively, RNFAs have faced numerous recent challenges to include changes in reimbursement for assistants in surgery and the rapid increase in nurse practitioners in surgery. The sale of the credential to NASC was not well received by many in the community.
The CRNFA credential was originally an examination-based credential, the predominant model for nursing certifications. However, a long steady decline in testing volume and numbers of CRNFAs made maintaining valid examinations increasingly difficult. As the number of CRNFAs declined and interest in the credential fell the certification lost its long-held accredited status secondary to these test development challenges. The loss of accreditation was a blow to these nurses and lowered the status and recognition of the RNFA role.
The lack of accreditation also had practical implications for some CRNFAs to include surgical privileging, reimbursement and benefits such as bonuses for certification. Upon purchasing the credential the NASC leadership recognized these issues and quickly began work on a remedy. The infusion of resources from NASC coupled with a fresh perspective on the process of certification opened an alternative route to regain accreditation – a portfolio-based certification.
In early 2019 NASC began the long, resource-intensive process of converting the CRNFA certification to a portfolio-based assessment requiring active engagement and documentation of reflective learning. Patel and Metersky inform us that, “Reflective practice is a cognitive skill that demands conscious effort to look at a situation with an awareness of own beliefs, values, and practice enabling nurses to learn from experiences, incorporate that learning in improving patient care outcomes.”¹
An assessment by portfolio requires a peer review process using validated scoring rubrics. This is a much different experience than taking a certification examination. The CRNFA portfolio, “…documents the validation of the professional achievement of identified standards of practice by an individual registered nurse serving in the expanded role of the registered nurse first assistant (RNFA).”² It must be noted that an accredited portfolio is developed using many of the same processes as examination-based certifications. The key difference being in the manner of assessment.
To meet accreditation standards, NASC hired psychometricians with competency assessment experience to supervise the portfolio development process. Dr. Judith Hale, Ph.D., of Hale Associates led a group of dedicated, industrious volunteers in months of development and validation work to forge an industry-leading assessment process.³ The visionary leadership and resources of NASC secured ABSNC for the CRNFA certification accreditation after 5+ years of work; a remarkable achievement.
The employment outlook for Registered Nurse First Assistants is promising as the overall volume of surgery continues to increase and more surgeries are shifted to the ambulatory setting.4 As facilities search for cost-effective, proven strategies to increase efficiency and surgeon satisfaction RNFAs are well positioned. The accredited CRNFA credential provides a logical career path for RNFAs and satisfies facility requirements for certification. Those RNFAs now entering the role have far more professional development opportunities because of the efforts of NASC and its volunteers.
– James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is a senior perioperative consultant with the National Institute of First Assisting and a professor at Central Michigan University.
References
- Patel, K. M., & Metersky, K. (2022). Reflective practice in nursing: A concept Analysis. International Journal of Nursing Knowledge, 33(3), 180–187. https://doi.org/10.1111/2047-3095.12350
- National Assistant at Surgery Certification. (2020). CRNFA certification. https://nascertification.com/crnfa/certification/
- Hale Associates. (n.d.) About Judy Hale. Hale Associates Center. https://halecenter.org/about-judy
- Brusie, C. (January 15, 2025). 15 Highest paying nursing jobs in 2025. American Society of Registered Nurses. https://www.asrn.org/journal-advanced-practice-nursing/3249-15-highest-paying-nursing-jobs-in-2025.html
