The registered nurse first assistant (RNFA) role is an expanded perioperative nursing role and includes performing first assistant activities in collaboration with the operative surgeon and other perioperative team members, such as handling tissue, providing exposure, using instruments, suturing, and providing hemostasis during surgery. These activities of the RNFA are executed within the context of the nursing process. The RNFA practices at the direction of the surgeon and does not concurrently function as a scrub person or circulator.