The American Board of Surgical Assistants defines First and Second Assistants as follows:

First Assistant

The first assistant on a surgical procedure is defined as the individual providing primary assistance to the primary (main) surgeon, during a surgical procedure. This individual CANNOT be involved in any other role or function, during the surgical procedure (i.e. first or second scrub and/or passing instruments). This individual must also be listed on the operative record as the first assistant, not as a first or second scrub!

Although descriptions may vary from institution to institution, the role of the first assistant requires active participation, during the surgical procedure. This involves providing exposure, hemostasis, tying or sewing plus other functions (excluding acting as the scrub nurse or technician) as determined by the primary surgeon, responsible for the patient and procedure.

An individual may not act as a first assistant, for example, on a simple hernia repair or similar case with only themselves and the surgeon. This is a surgeon/scrub role and not a surgeon/assistant role.

Second Assistant

This individual is not the primary surgical assistant to the primary surgeon and is hereby defined and designated as a retractor holder. An assistant as defined under this section does not qualify as a first assistant.

Important to Note

We acknowledge that the role and function of a surgical assistant is to assist the surgeon in the performance of a surgical procedure.

It is understood and acknowledged that certification as a surgical assistant through the ABSA does not allow for any independent performance of any medical or surgical procedures, within the United States of America or its territories.

Please Note: Anyone found guilty of “Practicing Medicine Without a License,” in the United States of America or its territories, either by court trial or plea agreement, will lose their certification and never be eligible to certify with the ABSA again.

Clarification Note: The above-mentioned definition of “independent performance of any medical or surgical procedure” does not include the “closing / suturing” of a patient, following a surgical procedure.

Important: The surgeon must remain in the “department” to be readily available, if needed, and must not begin another surgical procedure until the patient is completely closed and safely removed from anesthesia.

Certification as a Surgical Assistant-Certified (SA-C) by the American Board of Surgical Assistants does not convey blanket certification or authorization as a surgical technologist (Surgical scrub / scrub tech or scrub nurse). Surgical assistants and surgical technologists are two separate and distinct positions each having separate training, certifications and designations.

Surgical Assistant Titles

Hospitals and/or free-standing surgical centers often refer to Non-MD surgical assistants by general terms such as: certified first assistants, surgical first assistants, first assistants, or just surgical assistants.

  • Different credentialing organizations utilize different registered designations.
  • Examples: SA-C, CSA, CSFA & CRNFA
  • Please contact each individual organization for their specific credentialing information.
  • Individuals holding the above credentials along with the ABSA’s “SA-C” credential ALL perform the same role, of a surgical assistant, during a surgical procedure.
  • The ABSA designation is Surgical Assistant – Certified (SA-C).
  • The Surgical Assistant – Certified (SA-C) may function in the role of either a first or second assistant, as determined by the primary surgeon, depending on the operative procedure.

What is the difference between an RNFA and an SA-C?

  • An RNFA is a Licensed Registered Nurse who also functions as a surgical assistant. This individual can also perform all the duties of a Registered Nurse.
  • The SA-C can only function in the role of a surgical assistant, in the perioperative setting.
  • Regarding the roles of the RNFA and SA-C in the perioperative surgical assistant setting; they are identical.
  • Both the RNFA and SA-C may or may not have “Scrub Nurse” or “Scrub Tech” experience, but it is not required.
  • A surgical technologist is not the same as a SA-C or an RNFA.

U.S. Bureau of Labor Statistics, Standard Occupational Classification

U.S. Bureau of Labor Statistics, Standard Occupational Classification (2018) 29-9093 Surgical Assistants

Assist in operations, under the supervision of surgeons. May, in accordance with state laws, help surgeons to make incisions and close surgical sites, manipulate or remove tissues, implant surgical devices or drains, suction the surgical site, place catheters, clamp or cauterize vessels or tissue, and apply dressings to surgical site. Excludes “Registered Nurses” (29-1141) and “Surgical Technologists” (29-2055).

To download a Surgical Assistant Scope of Practice / SA Position Description: