Advanced practice nurses (APN) who practice in the surgical subspecialty areas may have the opportunity to expand their scope of practice to include first assistant at surgery. Surgical APNs who practice as registered nurse first assistants (RNFA) should seek credentialing and apply for institutional privileges to assure the consumer of competent providers. Credentialing as an RNFA documents the educational learning process and skills acquired, and recognizes this area of expertise. The role of the APN as an RNFA at surgery is practiced within the specialty area of perioperative nursing which includes preoperative, intraoperative, and postoperative care. In this study, the nurse practitioners describe the role of the RNFA, its historical evolution over wartime, the required educational training, and the benefits of the role for patient care. The surgical nurse practitioner who undertakes training and education as a surgical RNFA is in an excellent position to provide patient care across the surgical continuum.