Skip to main content

New registered nurse first assistant roles introduced in Cape Breton as part of multi-year action plan for hip and knee replacements

Registered nurse first assists with surgeons

New registered nurse first assistant roles introduced in Cape Breton as part of multi-year action plan for hip and knee replacements

Registered nurse first assistants .

Registered nurse first assistants Jeff Hardy (left) and Matthew Rizzato (right) with clinical preceptors, Dr. Don Brien, orthopedic surgeon (second from left) and Dr. Rod McGory, site lead for surgery at Cape Breton Regional Hospital (second from right) (NSHA).


SYDNEY, N.S. – Two registered nurses (RNs) from Cape Breton are taking the final step towards becoming registered nurse first assistants (RNFAs) as part of Nova Scotia’s multi-year plan for hip and knee replacements. 

A small number of RNFAs currently support other surgical sub-specialties in parts of Nova Scotia, but these are the first recruited to support orthopedic surgery. The need for these roles was identified as a priority by the team at Cape Breton Regional Hospital and could expand to other sites over time.

Within operating rooms, RNFAs practice beyond the scope of traditional operating room nurses, assisting with surgeries under the direct supervision of the surgeon. This can include:

• handling tissue
• helping expose tissues and structures,
• using instruments,
• suturing, and
• helping control bleeding.

Their assistance can help reduce the length of surgery and the amount of time that patients are sedated.

RNFAs also help build capacity by freeing up surgeons from some of their typical responsibilities to focus on other needs. Their additional responsibilities can include:

• Obtaining a client's history and performing health/physical assessments.
• Initiating the nursing plan of care in collaboration with the client and family and communicating this to the operating room staff.
• Providing client/family/community teaching.
• Performing assessments after surgery including monitoring pain and monitoring wound management for tissue healing and surgical site infections.

“Our investment in innovative and enabling roles like these helps change the way we care for hip and knee patients in the province, said Dr. Marcy Saxe-Braithwaite, senior director of NSHA’s perioperative (surgical) services program. “These new roles will enhance the care offered to patients before, during and after surgery and allow more Nova Scotians to receive the surgery they need.”

Recruitment for the roles took place last summer and two operating room (OR) nurses from Sydney were selected to enroll in the RNFA program offered by Mohawk College in Hamilton, Ont. last fall. The program consists of several months of combined classroom and distance education, followed by a clinical mentorship with a surgeon.

Registered Nurses Jeff Hardy and Matthew Rizzato completed their training at Mohawk College in May and began their clinical mentorship this month.

Both Hardy and Rizzato look forward to practising in their new roles beginning this fall. They feel introducing RNFAs will complement and support the work of the handful of family physicians who have historically assisted surgeons as family physician surgical assistants at Cape Breton Regional Hospital. 

“The registered nurse first assistant role is something that we have always imagined implementing in our facility. It has allowed us to advance our skill set as operating room nurses and will also allow us to play an expanded role outside of the OR,” said Hardy.

“Through our RNFA education and training we’ve gained the specific knowledge, judgment and skills needed for this role,” said Rizzato. “We will be able to collaborate with surgeons and other disciplines to further assist surgical patients, and their families, throughout each phase of their care.”

These new roles are among more than 80 full time equivalent (FTE) positions added across the province to date, along with four new orthopedic surgeons. These roles are helping increase access and improve care and supports for hip and knee patients. Other roles have included physiotherapists, dietitians, nurse practitioners and more.

More information on Nova Scotia’s multi-year hip and knee action plan is available at


Provincial Media Line: 1-844-483-3344

About Nova Scotia Health Authority
Nova Scotia Health Authority (NSHA) provides health services to Nova Scotians and a wide array of specialized services to Maritimers and Atlantic Canadians. NSHA operates hospitals, health centres and community-based programs across the province. Our team of health professionals includes employees, doctors, researchers, learners and volunteers. We work in partnership with patients and families, community groups, schools, governments, foundations and auxiliaries and community health boards. Visit for more.

Accessing Primary Care

There are many ways to access primary care, even if you're not currently attached to a primary care provider.

Answer a few quick questions to receive personalized instructions for accessing Nova Scotia Health's primary care options near you including in-person, virtual and telephone options.

Get Started

Find Emergency Care

Use this tool to identify the emergency care options that are currently available nearest to you.

If this is a medical emergency, please call 9-1-1 for immediate assistance

Get Started

YourHealthNS App

Much of Nova Scotia's healthcare program and service information is now available on the YourHealthNS mobile app. Download for free on the Apple Store and Android Apps for Google Play.

©2024 Nova Scotia Health Authority. All rights reserved.