October 7, 2015


Professional nurses wishing to become a Certified Registered Nurse Anesthetist (CRNA) must take the National Certification Examination (NCE) within three months of becoming “Certification Eligible.” The examination is administered at an authorized testing location, and individuals take the test on computers.
Identification, usernames and passwords are required to obtain access to the test. Test-takers receive username and password information in the mail prior to the time of the examination. If this information fails to be available at the time of the examination, individuals may not take the exam that day.

The NCE is a variable length test that features mainly multiple-choice questions. The test varies in length because it is administered based on computer adaptive testing techniques. The Item Response Theory is applied to the examination, which means that as an individual answers a question, his or her capacity for knowledge is assessed by the computer system in order to select the next question. No two tests are ever the same due to user-input creating the test as time progresses.

Test takers may have up to 3 hours to take the exam, which is at the minimum a 100-question test. The test may require an individual to answer up to a maximum of 170 questions. At least seventy questions conform to the NCE content outline in most study preparation guides, and the other 30 questions are pretest questions that are not utilized in the scoring of the examination.

Pretest questions are ones that have not been administered to students previously. In order to be usable as applicable questions on future exams, the questions must undergo use by real students. Metrics are collected about the questions and how students answer them to determine if they should be used in the future on examinations.
Because the examination is administered by a computer, questions are answered one at a time. There are no time limits for questions (beyond the overall 3-hour timeframe), however students may not go back over previous questions to review them or change their answers. Test takers must answer all questions presented to them.
The questions presented during the examination reflect a specific formula of subjects the National Board On Certification & Recertification Of Nurse Anesthetists (NRBCRNA) believe to be necessary and minimal knowledge to obtain a certification. The breakdown includes:

  • 25 percent covering Basic Sciences, including anatomy, physiology, chemistry and pharmacology
  • 10 percent covering Equipment, Instrumentation and Technology, including anesthetic delivery systems, airway devices and monitoring devices
  • 30 percent covering Basic Principles of Anesthesia, including positioning, data interpretation, fluid/blood replacement, post-op pain management and local/regional anesthesia
  • 30 percent covering Advanced Principles of Anesthesia, including surgical procedures, obstetrics, pediatrics and obesity
  • 5 percent covering Professional Issues, including patient safety, legal issues, research and professional standards

Other than multiple-choice questions, alternate question formats started appearing on the NCE in 2009. Multiple correct response (MCR) questions appear as one question that may have more than one correct answer within a field of 4 to 8 possible answers. Calculation questions may require computation and numeral answers that include decimal places. Questions featuring a drag and drop option are common on the test. Test takers are asked to match or categorize objects in the correct order by clicking and dragging the items to the target location. Hotspot questions require students to indicate an answer by clicking on the correct region of an image corresponding to a question.

Finally, graphics or videos may accompany questions as multimedia additions to the test.

CRNA Career Opportunities

Certified Registered Nurse Anesthetists (CRNAs) have significant career opportunities once they finish their educations and pass the National Certification Examination (NCE). From working in clinics and hospitals, serving the military on Naval ships or using their expertise in rural areas, CRNAs can work in any geographic region in a variety of settings.

Education and Examination

CRNAs must take and pass a stringent program of education that is approved by the National Board for Certified Registered Nurse Anesthetists. In addition to passing and completing the program of education, CRNA candidates must pass the National Certification Examination (NCE) to become certified. Several other variables determine certification, as well, such as professional reputation, references and other criteria.

Duties of a CRNA

A CRNA is a registered nurse who works alongside surgeons, physicians and specialists to deliver anesthesia for patients undergoing surgery or other medical procedures. They care for patients before, during and after procedures and surgeries. From patient assessment to sedation to pain management, CRNAs work to keep a patient safe and comfortable.

Often seen working in labor and delivery units, operating rooms, intensive care areas and plastic surgery clinics, CRNAs fill important roles that regular nurses or physicians cannot. Their expertise about anesthesia and its interactions with various organs, symptoms and conditions make them reliable experts that are necessary to nearly any clinic or health care facility.

Many military, government and rural health care facilities only employ CRNAs, instead of full-fledged anesthesiologists. The United States Department of Labor predicts that employment for CRNAs will only increase in the future. The growth in the career field is projected to be significant.

Average Salaries of a CRNA

CRNAs across the United States earned (on average) over $160,000 annually in 2006. Salaries are dependent on the type of facility a CRNA works in, the geographic region he or she is employed and the experience of the CRNA.
It is common for CRNAs to work in temporary positions or to only work part-time in a facility. The average hourly rate for a temporary CRNA is $100 per hour.

Locum Tenens

Numerous CRNAs work transitory positions in hospitals, clinics or other health care facilities. They fill in for professionals who are on extended leave, work in a role that has been recently vacated or provide services when a clinic or hospital is overbooked and need additional providers. This type of work is excellent for newly certified CRNAs because it allows them to build up experience in a short matter of time. It also lets a new CRNA determine what type of work setting he or she prefers due to opportunities to work in several. Many work in this capacity to supplement one’s income, especially right after completion of the certification process which, combined with an educational program, can be quite expensive.

A good number of semi-retired professionals work in the Locum Tenens capacity, as well. For someone who does not want to entirely leave the workforce, working in this capacity can offer fewer hours and more flexibility than traditional positions. And, it still allows the professional to work in the field.

CRNA Exam Study Preparation

To become a Certified Registered Nurse Anesthetist (CRNA), one must successfully pass the National Certification Examination (NCE) administered by the Council on Certification of Nurse Anesthetists (CCNA) and the National Board On Certification & Recertification Of Nurse Anesthetists (NBCRNA). The examination consists of 100 to 170 test questions, and questions appear in various formats.

The NBCRNA advises that students study and review the textbooks they used during the time they received their education in the nurse anesthetist program. The books cover all pertinent content that will be referenced in the examination questions. The CCNA uses no research articles or review books to create its test questions, so text books used during schooling are the most advised method of studying. Additionally, the CCNA does not endorse or sponsor any review manuals or courses.

CRNA candidates are encouraged to review subjects that account for significant portions of the test. Each year the NBCRNA distributes the “Candidate Handbook for National Certification Examination” which provides a generalized look at the examination, subjects covered and some sample test questions.

Because the examination’s purpose is to test a candidate’s overall knowledge about all subjects necessary to be a skilled CRNA, the test covers a wide array of subjects. The test is broken down into the 5 major areas of subject coverage. The areas include:

  • 30 percent of the NCE challenges the test taker’s skill levels when dealing with Basic Principles of Anesthesia. Positioning, blood/fluid replacement, local/regional anesthesia, data interpretation and post-operative pain management may be included in subject matter, along with many other question subjects that pertain to basic principles.
  • 30 percent of the examination measures a candidate’s knowledge concerning the Advanced Principles of Anesthesia. Surgical procedures and procedures related to organ systems make up the majority of this category, however obesity care, geriatrics, pain management, paediatrics and obstetrics are other subjects covered within this area of testing.
  • 25 percent of the test assesses one’s knowledge about Basic Sciences. The basic sciences cover anatomy, physiology, chemistry and pharmacology. Questions may jump from cardiovascular issues and central nervous system questions to muscle relaxant concepts and basic chemistry theories.
  • 10 percent of the test’s questions evaluate one’s knowledge about Equipment, Instrumentation and Technology. Airway devices, delivery systems and monitoring devices, along with other subjects, are tested within this subject.
  • The remaining 5 percent of the questions on the examination deal with professional issues, such as patient safety, professional standards, legal issues and other more administrative concerns.

The questions are not divided by category, and subjects range from one to the next with no pattern or pre-conceived order. Because the examination relies on computer adaptive testing (CAT), the order of questions rely on answers you give to previous questions.
In addition to regular multiple choice questions, test takers should expect other formats, as well. For instance, the test takes advantage of Multiple Correct Response questions that require more than one correct answer to be chosen from a field of answers, Calculation questions that require math and computations, Drag and Drop questions that involve the matching or ordering of answers through a click and drag method and Hotspot questions that are answered by indicating a portion of a picture of image. Some questions feature a multimedia element involving a video or audio.

Expectations for the CRNA Exam

It’s important that a CRNA candidate knows what to expect on the day of the National Certification Examination. Several things are important to consider including documentation for check-in, preparation to take the test on a computer and leaving certain items at home or in a vehicle the day of the examination.

Firstly, test takers must bring eligibility documentation and identification to the test center when it’s time to take the examination. At check-in, test takers must present the original document from the NBCRNA Council on Certification of Nurse Anesthetists that certifies their eligibility to take the test. A copy of the original document will not suffice. Additionally, test takers must present two forms of identification. Both forms of identification must include a signature and the same first and last names that are on the eligibility certification document. One piece of identification must include a photograph of the test taker. A driver’s license works well for the photo-identification. If a test taker does not have the required identification or documentation, he or she will not be permitted to take the examination at that time.

Students are not allowed to bring into the testing area certain disruptive devices or devices that are capable of storing data and information. These devices include PDAs, notes, cell phones, reference books or other study materials. All personal belongings (purses, backpacks, coats, etc.) may be stored in a designated area at the test center.

Test takers are reminded that the testing center may be used by others taking different examinations where keyboard noise may be a factor. Additionally, personnel may enter and leave the room at various times. If students are easily distracted, they may use earplugs to filter some of the noise.

Once seated at a computer to begin the test, the test taker must verify his or her Test Taker ID and Password. The ID and password are provided on the eligibility documentation. After verification, the screen changes to display a “Statement of Confidentiality and Non-Disclosure Agreement.” After reading and agreeing to the on-screen document, the directions to the test are presented and test takers may proceed to the examination questions.

Questions are presented one at a time. The minimum questions a test taker must answer is 100 questions. However, because the test delivers questions until a definable pass/fail rate is reached, test takers may have to answer up to 170 questions. A timeframe of 3 hours is allowed for the taking of the examination.

Test takers are not permitted to go back and review previous questions. Once a question is answered, a test taker may only move forward. However, a help screen is available to assist a test taker during the examination. The help screen includes information to remind students about answering procedures and other important directions specific to the examination.

All candidates are monitored closely during the examination period for an indications of cheating or academic dishonesty. Any interaction with others during the examination period is discouraged.
After finishing, the test taker will be notified of his or her preliminary, unofficial pass/fail results on the examination during the time he or she checks out of the testing center. Official results will be mailed to the test taker within 2 to 4 weeks. Scores will not be released for passing students. However, students who fail the examination will receive a scaled score with a summary score report for all subject areas covered by the examination.

Qualifications to Become Certification Eligible for CRNA Exam

Only qualified individuals are given the opportunities to take the National Certification Examination to become Certified Registered Nurse Anesthetists. CRNAs work in hospitals and clinical surroundings by assisting with anesthesiologists to administer anesthesia to patients undergoing surgery or other medical procedures. In rural or less populated areas, CRNAs are often the sole providers for anesthesia. The demand for well-qualified and educated CRNAs is increasing with population growth and extended lifetimes.

Various eligibility requirements must be met before a candidate is allowed to take the National Certification Examination (NCE) to become a CRNA. Criteria include:

  • All CRNA state requirements for licensure as a registered professional nurse must be met by the candidate. If a candidate fails to maintain an unrestricted licenses, eligibility may be forfeited.
  • CRNA candidates must fulfill the requirements of completion of an accredited nurse anesthesia educational program. The program must be accredited by the Council on
  • Accreditation of Nurse Anesthesia Educational Programs. The program must have been completed within the two past years prior to applying to take the NCE.
  • Candidates must submit a fully completed, accurate and signed exam application form. The application form must be accompanied by the submission of a signed “NBCRNA Waiver of Liability and Agreement of Authorization, Confidentiality and Nondisclosure Statement.”
  • Applicants must arrange for a notarized transcript signed by both the candidate and the educational program’s director to be sent to the National Board On Certification & Recertification Of Nurse Anesthetists (NBCRNA). The transcript must be typed on a form provided by the NBCRNA and include information about the course curriculum and the applicant’s full completion and passage of the program. Forms that are amended with erasures, correction fluid or pencil corrections will not be accepted.
  • A copy of the candidate’s current, valid registered professional nurse license needs to be provided to the NBCRNA. If a copy of the license is unavailable, the board will accept web verification or a written statement submitted by the state nursing board.
  • Applicants must submit a non-refundable application fee. The fee can be paid by cashier’s check or money order.
  • Candidates must sign an “Authentication of Applicant Identity Form.” The identity form deters cheating and falsification of identity. The form must be accompanied by a photo of the candidate that is no older than six months old. The photo should be a head shot or have similar qualities to a passport photo.
  • During the application process, candidates are asked to self-disclose and verify past personal history. Candidates who have questionable histories may be asked to submit further explanation about various circumstances. Questionable history includes:
    • Suspension, revocation or surrendering of a state nursing license
    • Mental or physical conditions that may impair one’s ability to deliver nursing services
    • Drug and alcohol abuse that may hinder one’s competency when under the influence
    • Allegations of past misconduct, incompetence or unethical behavior as a nursing professional
    • Dismissals, suspensions or periods of probation from nursing educational programs due to cheating or academic integrity issues

Passing all eligibility criteria may result in a candidate being declared “Certification Eligible” by the NBCRNA. All “Certification Eligible” applicants have up to three months to take the NCE for future certification as a CRNA.