How to Become a Surgical Nurse in California: From RN to RNFA Certification
The United States sees around 110,000 surgeries performed each day, which adds up to 40 million major surgeries every year. These remarkable numbers express why surgical nurses play such a vital role in healthcare delivery.
The career path of a surgical nurse comes with attractive financial benefits. You can earn an impressive average salary of $117,052 per year ($56 per hour), which is a lot higher than the national median RN salary of $93,600. Your trip to becoming a surgical nurse takes three to five years based on your educational background. The role teaches you to prepare patients for surgery, help surgeons in the operating room, and provide complete post-operative care.
Career growth opportunities await those ready to take the next step. The registered nurse first assistant (RNFA) certification offers excellent advancement potential. This specialized role needs an unencumbered nursing license, a BSN degree (as of 2020), and at least 2000 hours of professional experience. On top of that, certification might not be mandatory for surgical nurses, but getting one helps career advancement, especially when you have the CNOR credential.
This piece guides you through every step to become a surgical nurse in California. You’ll learn everything from simple requirements to advanced RNFA certification, whether you’re just starting nursing school or working as an RN looking to specialize.
What Does a Surgical Nurse Do?
Surgical nurses are the backbone of operating rooms across America. These specialized healthcare professionals, also known as perioperative nurses, give complete care throughout a patient’s surgical trip. They need specific skills to support patients during their most vulnerable moments, unlike general floor nurses.
Pre-op, intra-op, and post-op responsibilities
Surgical nurses start their work long before the first incision. They prepare patients both physically and emotionally for surgery during the preoperative phase. The nurses handle paperwork, give medications, set up equipment, and help ease patient fears. They also provide a full picture, check laboratory results, and make sure patients understand their upcoming procedures.
The operating room gives surgical nurses two significant roles to fill. They can work as scrub nurses who select and pass instruments to the surgeon while keeping everything sterile. They might also serve as circulating nurses who manage the overall nursing care and ensure a safe environment during the procedure. These nurses watch vital signs, help the surgical team, and follow safety protocols.
The nurses stay vigilant after surgery. They watch for complications, take care of wounds and pain, and create discharge plans. They also teach patients and families what to expect during recovery, how to manage medications, and the best ways to care for wounds. This helps ensure a smooth transition from hospital to home.
Common surgical specialties
Many surgical nurses focus on specific areas to become experts with certain procedures and patient groups:
- Cardiac: Helping with heart catheterizations, stent placements, and pacemaker implantations
- Ophthalmic: Supporting surgeries for cataracts, glaucoma, and traumatic eye injuries
- Orthopedic: Working with bone, joint, and muscle surgeries
- Transplant: Getting donors and recipients ready for organ transplantation
- ENT (Ear, Nose, Throat): Supporting head and neck procedures
- Plastic surgery: Helping with cosmetic and reconstructive surgeries
Other specialties include neurosurgery, general surgery, urology, thoracic, and vascular surgery. Each area needs knowledge of specific procedures, equipment, and surgeon’s priorities.
Typical work environments
Hospital operating rooms employ most surgical nurses, but they can work anywhere surgical procedures happen. Jobs exist in day-surgery centers, ambulatory surgery centers, outpatient clinics, physicians’ offices, and urgent care facilities.
Surgical nurses start their days early. They arrive before 7:00 AM to prepare for the first cases at 7:30 AM. They work with a team of surgeons, anesthesiologists, and surgical technicians throughout their shift. Strong communication skills and teamwork help them succeed in this ever-changing environment.
The work can be demanding, but surgical nurses love seeing immediate results from their efforts. Whether it’s fixing a broken bone, removing a kidney stone, or completing a life-saving procedure. This field gives an excellent foundation for those who want to become scrub nurses or pursue registered nurse first assistant (RNFA) certification.
Step 1: Get Your Nursing Degree
Starting a journey to become a surgical nurse or RNFA starts with getting your nursing degree. Your initial choice will shape your career path and advancement opportunities in the operating room.
ADN vs BSN: Which is better for surgical nursing?
You’ll face a crucial decision between an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) as you begin your nursing education. Both paths lead to RN licensure but differ in several ways.
An ADN typically takes two years at community colleges, and some programs finish in 18 months. A traditional BSN takes four years at a university. The programs differ substantially in their focus. ADN programs emphasize hands-on skills and nursing fundamentals. BSN programs include extra coursework in nursing theory, leadership, research, health policy, and population health.
BSN degrees offer clear advantages for surgical nursing. BSN-prepared nurses achieve higher NCLEX pass rates (82.3% compared to 77.9% for ADN holders). The salary difference is substantial – BSN nurses earn about $92,000 yearly versus $75,000 for ADN nurses. This $17,000 annual difference adds up to over half a million dollars during a 30-year career.
Hospitals now prefer or require BSN degrees for surgical positions. A BSN becomes mandatory if you want to become a Registered Nurse First Assistant (RNFA).
Top nursing schools in California
California’s nursing programs offer excellent NCLEX pass rates:
- University of California, Los Angeles (UCLA) – Accepts only 9% of applicants with a 97% retention rate; graduates earn a median salary of $90,678
- University of California, Irvine – Stands out for diversity with 21% acceptance rate; graduates earn about $81,929
- California State University, Sacramento – Runs a strong traditional BSN program with graduates earning $108,495 median salary
- California State University, Long Beach – Ranks among the state’s best nursing programs with $85,795 average graduate earnings
- San Diego State University – Keeps 89% of students through graduation who earn about $87,377
Accelerated and bridge programs
California offers several options to accelerate your nursing education:
Accelerated BSN (ABSN) programs suit those who already have a bachelor’s degree in another field. These intensive programs take 12-18 months and cost between $23,000 and $90,000. Notable ABSN programs include California State University, Los Angeles (15 months), Mount Saint Mary’s University (12 months), and Samuel Merritt University (12 months).
LVN holders can take bridge programs as the quickest way to RN status. SJVC’s LVN to RN Bridge helps you earn an Associate Degree in Nursing in 11 months. Carrington College offers an LVN to ADN program you can complete in 8 months.
These accelerated programs have strict requirements. You need a minimum 3.0 GPA, prerequisite courses, and often must take the TEAS examination. In spite of that, these programs offer a quick path to surgical nursing for career-changers or advancing LVN professionals.
Step 2: Become a Licensed RN in California
Your California RN license through the NCLEX examination is your gateway to a surgical nursing career after nursing school. The California Board of Registered Nursing (BRN) has specific requirements you need to follow carefully.
How to apply for the NCLEX-RN
Here’s what you need to do for your NCLEX application in California:
- Create an account on the California BRN website (ca.gov)
- Complete the online “Application for Licensure by Examination” form
- Pay the required application fee (non-refundable)
- Register with Pearson VUE, the official testing provider
- Wait for your Authorization to Test (ATT) email
California nursing students’ schools will send transcripts electronically after graduation. Students from other states must get their transcripts sent electronically through their school or certified vendors like Parchment or National Student Clearinghouse.
You should apply about two weeks before finishing your nursing program. The BRN will send your ATT within 72 hours once they process your application and confirm your eligibility.
California Board of Nursing requirements
The California BRN requires:
You must graduate from an approved nursing program that meets California’s educational standards. You’ll also need fingerprints. The BRN accepts LiveScan (recommended) or fingerprint cards. You can get LiveScan done at several places, including some university police departments.
International applicants must fill out a “Breakdown of Educational Program for International Nursing Programs” form with certified English translations of their transcripts. Your California RN license comes after passing the NCLEX, letting you apply for surgical nursing positions.
Tips for passing the NCLEX
The NCLEX tests your nursing skills through 75-145 questions in a computerized adaptive format. The first-time pass rate hit 79% in 2021. Here’s how to succeed:
- Understand the question types: Learn multiple-choice, fill-in-the-blank, select-all-that-apply, drag-and-drop, and hot spot questions
- Practice prioritization: Focus on ABCs (Airway, Breathing, Circulation) and tackle life-threatening conditions first
- Manage your time: Spend no more than a minute per question
- Trust your instincts: Your first answer is usually right
- Simulate exam conditions: Take timed practice tests
Good preparation means reviewing the NCLEX Candidate Bulletin, focusing on your weak areas, and using sample questions from the NCLEX website.
Show up early on exam day with your government-issued photo ID. You’ll need biometric identification, including palm scanning. Your nursing education has prepared you well – take the exam with confidence.
Step 3: Gain Perioperative Experience
Your next step after getting your RN license is to build valuable perioperative experience. This vital phase connects your theoretical knowledge with hands-on surgical skills that will become the foundation of your operating room career.
How to become a scrub nurse or circulating nurse
The biggest difference between these two main surgical nursing roles needs to be clear. A scrub nurse directly assists the surgeon during procedures and maintains sterility. The circulating nurse manages the overall OR flow and is not considered sterile. New graduates can access both roles. You can start your nursing career directly in the operating room, despite common beliefs.
Some facilities will hire you right after you get your RN license, especially for circulating positions. Outpatient surgical centers might need prior hospital OR experience. The path to becoming a circulating nurse takes 2-4 years, depending on your education route.
Building your credentials first? AORN’s “Preparing for the Scrub Role” course is a great way to get specialized training. The course teaches sterile technique, instrumentation, and procedural responsibilities.
Recommended clinical rotations
A strong foundation in surgical nursing comes from clinical rotations or work experience in these key areas:
- Critical care and ICU nursing
- Emergency room nursing
- Medical-surgical nursing
- PACU (Post-Anesthesia Care Unit)
- Progressive care
- Trauma nursing
These specialties help you develop significant skills in high-stress environments and patient management that directly apply to the operating room. Emergency settings show you know how to perform under pressure—surgical departments value this quality highly.
Joining OR residency programs
Major California hospitals offer dedicated perioperative nursing residency programs that create structured paths into surgical nursing. These programs mix classroom instruction with mentored clinical practice under experienced surgical nurses.
These residencies are a great way to get experience for new graduates and bridge the theory-practice gap. Programs usually run 6-12 months and include rotations through different surgical specialties to build detailed skills.
Healthcare employers often prefer candidates with this specialized training. UC San Diego Health, Stanford Health Care, Dignity Health, and Kaiser Permanente lead California’s OR residency programs.
Note that surgical nurse certification needs specific clinical hours. The CNOR certification requires at least two years and 2,400 hours in a perioperative setting, with 1,200 hours in an intraoperative environment.
Step 4: Advance with RNFA Certification
Becoming an RNFA marks the highest achievement in perioperative nursing practice. This specialized role gives nurses more independence and responsibility, while also providing better compensation.
What is a Registered Nurse First Assistant (RNFA)?
RNFAs are perioperative registered nurses who take on expanded roles during surgical procedures. They work side by side with surgeons to handle instruments, make incisions, manage hemostasis, and close surgical sites. These professionals need advanced technical skills beyond regular nursing practice. Their role spans the whole perioperative period as they prepare patients, assist in procedures, and help with postoperative care.
Eligibility and training requirements
RNs and APRNs have slightly different requirements:
For RNs:
- BSN degree (mandatory for all RNFAs certified after January 2020)
- Current, unrestricted RN license
- CNOR certification
- Minimum 2,000 documented perioperative practice hours
- Completion of an AORN-approved RNFA program
For APRNs:
- Master’s degree or higher in an advanced practice program
- Current, unrestricted RN license [222]
- APRN certification
- Completion of an AORN-approved RNFA program [221]
- Minimum 2,000 documented practice hours
Best RNFA programs in California
California hosts several respected RNFA programs:
UCLA Extension and UCLA School of Nursing delivers complete training through 52 hours of lectures and labs plus a 120-hour preceptorship. Students learn everything in scrubbing, draping, retracting, clamping, ligating, and suturing.
NIFA/Southwestern College in Chula Vista lets students learn remotely while including hands-on training. The National Assistant at Surgery Certification (NASC) recognizes this program.
How to get certified as a first assist RN
After completing an approved program, you can get certified through NASC, which offers two credentials:
- Registered Nurse Assistant at Surgery-Certified (RNAS-C): Entry-level certification requiring 120 practice hours
- Certified Registered Nurse First Assistant (CRNFA): Advanced credential requiring 2,000 practice hours and a bachelor’s degree
CRNFA certification requires candidates to submit a professional portfolio with clinical case studies. RNFAs must complete 30 hours of continuing education every two years to keep their credentials current.
Become a Surgical Nurse Today
Becoming a surgical nurse in California comes with rewarding challenges and exceptional opportunities to grow your career. This experience will take you from being a newly licensed RN to potentially earning the prestigious RNFA certification. You’ll find yourself at the heart of critical healthcare delivery.
Your surgical nursing career starts with the right education—through an ADN or better yet, a BSN program. This foundation and California licensure will open doors to perioperative environments where you can build specialized skills. On top of that, the financial rewards match your responsibilities, with surgical nurses earning by a lot more than general RNs.
This career path lets you advance continuously. You can pursue RNFA certification after gaining valuable OR experience as a scrub or circulating nurse to expand your practice scope and boost your earning potential. Of course, this advanced role represents the best in perioperative nursing excellence.
Your professional growth goes hand in hand with personal development. Each surgery gives you meaningful chances to make immediate, real differences in patients’ lives. Surgical nursing stands out because it challenges you intellectually and meets your emotional needs.
California’s healthcare world just needs qualified surgical nurses. With approximately 40 million major surgeries performed annually nationwide, your skills will always be in demand. The career stability and competitive pay make surgical nursing an excellent long-term choice.
The surgical nursing pathway offers clear steps toward a rewarding career, whether you’re starting nursing school or working as an RN looking to specialize. The experience needs dedication and continuous learning. The rewards ended up making every effort worth it—from job satisfaction and career growth to helping patients when they need you most.