In 1984, AORN developed its first official statement on RN first assistant (RNFA) practice. This article is a guide for RNFAs seeking self-employment. The dynamics of change, with reference to the role of the RNFA, in perioperative nursing and entrepreneurship will be discussed. Nurses' responsibilities in this expanded role, methods of becoming a change agent, and methods of obtaining privileges to practice as a self-employed RNFA (ie, functioning under the supervision of a surgeon) in health care organizations will be identified. Current trends and issues influencing RNFA practice, including certification, reimbursement, practice setting, education, competition, and changes in health care, also will be discussed.