Featuring Cynthia Kreps, BS, CFSA, CST, Surgical First Assisting Program Director, Southeast Community College

Southeast Community College (SCC) in Lincoln, NE, recently launched a certificate program for students looking to become surgical first assistants (SFAs). Hear from Program Director Cynthia Kreps on what drove this decision and how launching the certificate has benefitted their college and community.

What prompted you to start a surgical assisting program?

In 2014, the United States Centers for Medicare & Medicaid Services (CMS) and the state of Nebraska launched an investigation into the role of the surgical first assistant, after an uncertified surgical technologist was found be practicing as an SFA. After several review processes with the Nebraska Department of Health and Human Services and multiple hearings with legislators, the state passed Legislative Bill 721 (LB721). This required licensure of the surgical first assistant under the Board of Surgery and Medicine, but it did not do much else for the role of the surgical technologist, which remains relatively unregulated.

Licensure enforcement began in January 2017. Most of the then practicing SFAs in Nebraska acquired their education though experience and then sat for board exams with the National Board of Surgical Technology and Surgical Assisting (NBSTSA). A few went to an online surgical first assisting program, though at this time there were only three such programs in the country.

Since Nebraska has a law that requires graduation from a CAAHEP or other programmatically accredited program, SCC felt that an online program would be advantageous for the community and rural Nebraska.

What benefits have you seen for your institution, your students and your community as a result of this?

We are just in our second cohort for this new program, so we haven’t had a lot of feedback from hospitals yet. Even so, the program seems to be off to a good start.

It’s worth noting that not all surgeons have a physician assistant, especially in rural Nebraska. Surgeons like knowing who will assist them. They appreciate that the Certified Surgical First Assistants (CSFAs) are invested in the procedure. Here are some quotes from a few of the surgeons received on student evaluations:

“In addition to reduced OR time for the surgeon, staff and (most importantly) the patient, having a first assist allows me to have someone that I trust. The first assists are generally more proactive and anticipate surgeon needs. I like having someone I know and can trust to help close, dress and splint patients, whether or not I have an advanced practice provider (APP) with me. When I do not have an APP with me, certainly having a first assist is almost the same intra-op… it’s just the pre- and post-op care that differentiate things in the OR setting.”

“Highly trained assistants make my job easier, which leads to better outcomes and less complications for patients.”

“The assistant becomes familiar with my techniques and the operation goes smoother.”

In our program, we’ve found that students are excited to advance their involvement with the surgical procedure. Their desire to learn and grow comes from their passion for the profession, and the new skills they gain increase that passion. At this time, the CSFA cannot bill as a provider in Nebraska, so they are practicing out of professional pride.

SCC’s strategic plan includes several goals surrounding student success, enrollment growth and new program development. The college has been supportive and encouraging with not only the program development, but also in assisting employee growth throughout this process. For example, I was sent to the ARC/STSA Accreditation Fundamentals for Educators (AFE) Workshop twice. That was so helpful.

At the time, I was still teaching a full load with the surgical technology program. When I asked my dean and program director to release me from some of my duties as a surgical technology instructor, as I was overwhelmed, they released me from all of those duties. This allowed me to grow as a program director to be able to devote all of my time to content development and research.

What are some of the lessons you learned in starting this program?

It took me awhile to learn this, but be prepared for some frustrating reactions from local hospitals and don’t take it personally. A few of the hospitals in the city are reluctant to allow the licensed CSFA to function within their entire scope of practice. I felt that I needed to fix this and had to pull myself away from the situation. This is something that the medical director of the program, other surgeons and the employees need to take care of, since they are employed by the hospital or practice in the facility. My job is to be the educator, and to provide the means to learn.

What is your advice for those seeking to start a surgical assisting program within their own institution?

The SCC Institutional Research department was involved from the start. They developed a survey to send to local hospitals and surgeons, collecting data and interest in the utilization of surgical first assistants. Beyond that, here are a few tips from personal experience:

  • You will need to complete a Needs Assessment and present the findings to a review panel to decide if the program is necessary. Work with your dean to guide you through this process.
  • Attend state assembly workshops and present about the upcoming program. This will help with future student enrollment and interest from the certified surgical technologists in your state.
  • Make sure your program’s medical director is involved. They will act as the liaison between the college and hospital administration.
  • Don’t reinvent the wheel. I attended several educator workshops sponsored by the Association of Surgical Technologists and networked with other surgical first assistant program directors. They were gracious and shared information with me, let me bounce ideas off them and looked over my program development. They gave me encouragement when I felt overwhelmed.
  • Don’t see other programs as a threat. The more highly skilled, passionate surgical first assistants out there, the better it is for the profession and for our patients.
  • ARC/STSA is your friend! Call them and ask them questions — I did a lot. Once I got over the fear of sounding stupid, I never hesitated to send them an email or call.
  • Give yourself time. I spent many nights, weekends and school breaks working on the program’s curriculum.
  • Attend one or two AFE Workshops sponsored by ARC/STSA. For me, attending that workshop and learning how to read the Standards Interpretive Guides (SIGs) was a “eureka” moment. Once that happened, I felt more confident that I was completing the initial application for ARC/STSA and CAAHEP accreditation correctly.
  • Follow the Core Curriculum when developing your program content. Keep on track and you will cover everything. I have students take a pathophysiology class prior to the start of the SFA program. Why re-invent the wheel?

Good luck with starting your program. Remember, you can do anything if you put your mind to it and you will surprise yourself — I know I did!

Cynthia Kreps, BS, CSFA, CST, is the surgical first assisting program director at Southeast Community College in Lincoln, NE. She worked in a Level 2 trauma center for 25 years and taught surgical technology classes for 17 years.



Are you interested in starting or expanding a surgical assisting or surgical technology program at your institution? ARC/STSA’s EdAccred program has resources to help. Reach out to info@EdAccred.org or visit arcstsa.org/edaccred for more information.