Nurse Fist

Nurse Fist

Nurses First™
Nursing Handover Training That Achieves All 3 E’s
Efficacy • Efficiency • Engagement

Tools and training to hardwire standardized communication at the change of shift.

Frequently Asked Questions about Nurses First

Is this more work for frontline nurses?
What happens during a Nurses First implementation?
When clinicians, patients, and hospital leaders all say they love something, that’s worth listening to.
“From their eyes she could have been a nurse with 20 years experience” – Ellen, RN
“She came back to the ward really proud and really confident that she’d given it a great handover” – Amy, RN
“There is no way in the past that would have happened” – Ron, MD
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Register for a webinar to ask the hard questions like, “How can we do this hospital-wide?” and “How do we ensure this will support our nurses?”
Nurses will hand off patients more than 100,000 times this year at your hospital
High-reliability hospitals can’t afford to let things fall through the cracks
For 160 years, nursing has advanced by elevating tasks into elite competencies
Works with hospital complexities and reduces burn out
Access to reliable and predictable information is essential to a safe and collaborative nursing practice. Every shift is a chance to actively ensure our patients stay safe in the hospital. Co-produced care is better care, and partnerships with patients and families is at the heart of nursing care.
Streamline the start of every shift
for optimal communication, workflow and safety
Nurses First (N1) is designed by nurses for nurses. N1 standardizes information transfer at each shift and is offered to help staff start each shift with what is needed to be their best.
N1 is designed to improve the culture, safety, and efficiency profile of nursing care. It has been developed in the field from thousands of nursing shifts and refined across dozens of implementations. Nurses in over 100 hospital units worldwide have field-tested and refined the N1 processes, using timeless principles and modern evidence-based practice.
Change the first 20 minutes of each shift,
and you change the culture of your unit
Our nurses didn’t feel like a team and started each shift more like a group of individuals running around. So we began a Change of Shift Huddle which takes 3 minutes. The off-going charge nurse reads through a standard form to the oncoming shift. It’s the most professional, efficient team meeting you’ll see anywhere in the hospital and starts with a 1-page form. You can use ours. Tens of thousands of nursing shifts have used it.
As nurses, we dread getting bad handoff. When there’s no structure, each nurse gives report their own way and it feels less safe and more stressful.
So our units decided to standardize each bedside handover. The heart of our handover is a structured, single-page shift report form using an ISBAR framework, Review of Systems outline, and it’s customized for the unit. It’s presented top to bottom by the outgoing nurse, then handed over with our patient.
The assurance of quality and safety is the single most significant responsibility of leaders in healthcare delivery. It’s a cornerstone of our careers.
The hand-off process is pivotal to patient safety. Many breaches of patient safety occur around change-of-shift. Most hospitals have adopted some level of bedside handover by now, but telling nurses to give report at the bedside doesn’t reduce unnecessary variation. Every nurse has their own way of giving report and nursing handover is typically inconsistent and unstructured.
High patient satisfaction scores are achievable and it’s a natural result of hardwiring a daily “wow moment” for each patient.
HCAHPS scores are driven by “top box” positive responses, but it’s hard to impress every patient every day. Asking stressed-out nurses to also be “customer service agents” isn’t the best approach.
We’re living in a new era. Hospital nursing is more complex than ever and 50% of bedside nurses now say they’re burnt out. Turnover rates are spiking. Nurses choose hospitals that find meaningful ways to care for them, and we leave the ones that don’t. They prefer hospitals that:
-Reduce stress
-Help them get familiar with patients as quickly as possible
-Reduce unnecessary variation in communication
-Make them feel part of a high-performing team
-Have a collaborative work culture
We help take care of them by giving you up-to-date access to tools and best practices, and by helping you make them work for your hospital.
It’s a privilege to share this information with you. Thank you for the chance to support you and your nurses in the care of their patients.
Nurses First (N1) is designed by nurses for nurses. We offer N1 to units ready to start each shift with the support and information to be our best.
N1 is designed to improve the culture, safety, and efficiency profile of nursing care. It has been developed in the field from thousands of nursing shifts and refined across dozens of implementations.
N1 units standardize and sustain the following evidence-based communication processes through each nursing shift:
Nurses in over 100 hospital units worldwide have field-tested and refined these two processes for Nurses First — timeless principles and fresh evidence-based practice.
N1 is based on a ‘pay-it-forward’ ethos of nurses caring for each other first, starting every shift feeling supported by each other.
For the first act of every shift, N1 brings the outgoing and oncoming nursing staff together in a Change of Shift Huddle , handing over the unit as if it were a patient.
Then we go to the heart of nursing by visiting the patient, transferring care and responsibility in a warm, super-professional Bedside Handover . Nurses First elevates Bedside Handover from a task into purposeful skill set we learn, practice, and role model.
Yes, both Change of Shift Huddle and Bedside Handover are nursing processes that we do in the first 30 minutes of the shift.
There are a few reasons we focus on this first half-hour:
Actually, since the right information and details are handed over at the change of shift, we spend less time searching for information and much less time playing catch-up and dealing with surprises later in the shift. The pay-it-forward approach is less work because it’s more proactive. The work also feels more purposeful and collaborative.
Customization happens during in-service training and launch usually happens the following Monday. More detail is in the N1 Partnering With You page.
In Step 5, the unit has the chance to try to achieve Nurses First Excellence.
For participating units, implementation proceeds through several stages, culminating in Nurses First Excellence:
In-service training typically happens over a 3-day period (e.g., Tue – Thurs) so we can reach as many nurses as possible.
When > 90% of nurses on a unit have been skills-verified in Bedside Handover competence, the unit has achieved Nurses First Excellence and there is a governance and accountability model in place to maintain training, verification and service level commitments on each unit.
This is an important milestone. It means a pay-it-forward skill set is verifiable on the unit. Nurses First Excellence means nurses, leaders, and patients can have high confidence in the communication between shifts for that unit.
A unit can maintain Nurses First Excellence by refreshing verification for > 90% of nurses at least every other year. This includes training and verifying the Bedside Handover skills of new hires.
Nurses First provides units the opportunity to give exquisite attention to a specific part of their daily routine, shift change. As a new group comes in to take the reigns from their off-going teammates, the transfer of care of the unit and each patient should be handled in a very intentional way. So we start the shift with a brief and warm Team Huddle that communicates timely information that all staff should know. Then nurses pair off for Structured Bedside Handover, an efficient, consistent, nurse-developed and patient-centered version of giving report. The concepts are not novel, but the way they are put into practice and sustained with high performance behaviors is why hospitals ask us to partner with them.
The easy way to reveal frontline enthusiasm for a safer and more efficient nursing handover.
Unit nurses watch a quick video and answer 4 short questions
Get a report revealing frontline enthusiasm and readiness
Share the consensus with nurse leaders to support a pilot
We are a group of doctors, nurses and engineers that create great hospital teams.
© 2022 1Unit • All rights Reserved.

This is the website for the Nurse First Community Interest Company.
If you are looking for the current Nurse First programme for graduates wanting to enter nursing, please fill in the form below and we will send you further information.
Nurse First is an intensive 21-day residential programme that runs over a year and includes learning sets and coaching support. It works by:
As part of the programme,participants are challenged to design, raise funding for, and deliver a real-world project to improve health outcomes in their local area. This is an ambitious goal to put development coaching into practice.
We produced a two year report in conjunction with Johnson & Johnson, The QNI and Bucks New University, to evaluate the pilots as we moved into our third year of the programme and you can view it here (12Mb pdf). Alongside information on the programme it contains valuable insights into innovation within the public and private sector from our survey which we conducted earlier in the year.
The first three cohorts of Nurse First participants brought in an average of £16,000 each of funding for their projects. The Business Plans demonstrated cash-releasing savings of an average of £1.2 million each.
Nurse First provides an extremely effective way for an organisation to:
Nurse First was initially created through a partnership between

Medically reviewed by:
Kathleen Gaines

News and Education Editor, MSN, RN, BA, CBC

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What is a Registered Nurse First Assistant (RNFA)? What Does an RNFA do? Registered Nurse First Assistant (RNFA) Salary How to Become an RNFA What are the Best Registered Nurse First Assistant Programs? RNFA Career Outlook Where to Learn More About Becoming an RNFA

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Interested in learning more about becoming an RNFA? Find out what a Registered Nurse First Assistant - RNFA - is, what their duties are, how much they make, and how to become one in this comprehensive career guide.
A Registered Nurse First Assistant, or RNFA, is a perioperative registered nurse that functions as a first assistant during surgical operations.
According to the Association of periOperative Registered Nurses (AORN), an RNFA is defined by the following:
The aforementioned definition is the standard to which RNFA’s practice and allows these individuals to practice beyond the normal scope of practice. First Assistants are required to take advanced coursework, additional certifications, and orientation in order to be credentialed.
The role of the RNFA will vary on the surgical institution and will also vary depending on the surgeon. It’s important to know that many academic teaching hospitals do not regularly use RNFAs due to the presence of surgical residents and fellows. After obtaining credentialing, a First Assistant can perform duties during the preoperative, intraoperative, and postoperative care. These nurses have the ability to help develop treatment plans in conjunction with the lead surgeons and then assist in postoperative management. While nurses can generally perform similar tasks, the real differences are their increased abilities in the operating room.
According to payscale.com , the average salary for an RNFA is $104,000 per year. Unfortunately, due to the specialization of this field salary data is extremely limited. The U.S. Bureau of Labor Statistics provides salary figures for all registered nurses combined rather than for particular specializations. As of May 2021, the median annual salary was $77,600.
The BLS identifies the following as the highest paying states for nursing:
In the same year, the BLS ranked the highest mean annual salaries for nurses, and the top ten were in California. The top five from the list are as follows:
Most health care systems pay nurses on an hourly scale while others have a fixed annual salary, such as nurses in a free-standing surgical center. Those paid on an hourly scale are able to earn overtime pay whereas salary employees would need to discuss that with the hiring committee.
Overall, pay generally correlates with cost of living for a specific geographical area. For example, nurses in Oklahoma earn significantly less than their counterparts on the west coast regardless of specialization. Despite having the same job title, the cost of living in California is much higher and thus equaling a greater pay.
As with all jobs in the nursing field, earning potential increases with additional education and experience. Nurses typically are awarded a raise during annual employee performance reviews. Certifications can give nurses an additional bump in their paycheck. Furthermore, nurses who agree to precept new nurse employees can also receive additional compensation.
Regardless of the workplace setting, full time and part-time RNFA enjoy similar benefits. While actual benefits may vary depending on the institution most include the following:
To become an RNFA, first, the nurse must have substantial perioperative experience as this advanced training builds upon the basic fundamentals and focuses on surgical anatomy, procedures, and techniques. Courses vary throughout the country in regard to credit hours needed in order to work as an RNFA. Prerequisites also vary on the institution but generally consist of:
Regardless of the program chosen it must be approved by the AORN. You can see a list of approved programs here . After successfully finishing the RNFA courses, individuals should work towards becoming certified. It is important to clarify there is a difference between an RNFA and a CRNFA.
To become a certified RNFA, the nurse must have a CNOR certification, active and unencumbered RN license, a bachelor’s degree as well as 2,000 hours of experience working as an RNFA.
This list is based on a number of factors including:
Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:
There are numerous registered nursing first assistant programs and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 registered nurse first assistant programs are ranked in no particular order.
In-State Program Tuition: $1,500 Out-of-State Program Tuition: $2,250
Delaware County Community College's RNFA program is based in the township of Marple, located just outside of Philadelphia. This six-credit program combines online and in-person education, splitting the two required courses over two semesters. The first-semester course requires a five-day visit to campus, and the rest is completed online. The second-semester course is an independent internship completed wherever the student wants. Nurses can accelerate the internship, and they graduate once the internship is finished.
One of the more comprehensive RNFA programs is offered by NIFA, a Colorado-based organization that focuses solely on first assisting education. Currently, the largest RNFA program in the nation, NIFA uses three- and five-day workshops to teach nurses basic RNFA skills and requirements. Nurses then complete an internship to finish the program. Any graduates who feel they haven't mastered the subject matter can take the program again at no cost. While the program takes up to two year
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