October 7, 2015


Candidates hoping to become Certified Registered Nurse First Assistants (CRNFA) must first take the CRNFA certification examination. After being declared eligible to take the exam by the Competency and Credentialing Institute (CCI), a CRNFA candidate may apply to take the examination and sign up for a date and location.

Basic Test Information

The examination consists of 180 multiple choice questions that must be answered within a 3 hour and 45 minute timeframe. The score a test taker receives is based on the number of correctly answered questions submitted before the timeframe expires. The test is administered on a computer, and the computer automatically calculates when a test taker has answered enough questions correctly on the exam that a passing score has been achieved. Once a passing score has been achieved, a student’s examination ends. Some students incur shorter tests than others due to answering more questions correctly sooner.

Candidates are not required to have any previous computer experience or in-depth knowledge in order to take the CRNFA examination. The CCI presents a brief, 10-minute tutorial to test takers on the day of the exam. The tutorial provides directions for taking the exam, plus it provides examples about how to select answers to questions. Additionally, it instructs students how to flag questions they may desire to go back and check before completing the examination.

The test is designed to evaluate a test taker’s knowledge and skills applying to task-oriented categories of required duties of CRNFAs. Test question writers use the regular duty categories to create questions that are pertinent to a CRNFAs skill set. Categories of duties tested include: intra-operative patient care, factors influencing professional practice, post-operative patient care and pre-operative patient care.
The test’s questions can be broken down into several subjects covered. Test writers determine the most important areas of knowledge, and the majority of questions cover that subject, with other subjects creating the rest of the test. Questions will be presented in no particular order and will not be broken down into subject type. The subjects include:

  • Basic Sciences: 13 percent
  • Assessment Techniques: 17 percent
  • Intra-operative Techniques: 50 percent
  • General Knowledge/Skills: 10 percent
  • Professional Practice: 10 percent

Information to Know the Day of the Exam

A test taker needs to know what to expect when he or she goes to take the examination at the testing center. In order to check in, a student needs to present a current, government-issued identification to the test administrator. The identification must include a photo and a signature. Recommended forms of identification include a passport, driver’s license or military identification. The identification must bear the identical name the test taker used to register for the examination.

In rare cases, a test taker’s identification may be questioned. It is advised to have a second form of identification with you in order to check in and take your exam.

Test takers are not allowed to bring any personal belongings into the testing area. The test administrator will provide test takers with pencils and scratch paper, if desired. But, no further items are to be taken into the testing area. Students may not drink, eat or use tobacco while in the testing area.

The use of cell phones, PDAs or pagers (or other electronic devices) is strictly prohibited in the testing area. Students observed attempting to remove test questions from the room will be disqualified from the day’s examination. Close observation of all test takers is conducted on the day of the exam. Any interaction with others during the examination may be seen as an attempt to cheat.

CRNFA Career Opportunities

A Certified Registered Nurse First Assistant (CRNFA) is an expert in all processes of patient care before, during and after surgery. Because of their expanded skills and enhanced knowledge, CRNFAs are in high demand in the health care industries. While their job duties may not change after becoming certified, their salaries and professional opportunities may increase as a result.

What does a CRNFA do?

A CRNFA fills many roles in a hospital or clinic. Their involvement in the management of pre-operative patient management makes them essential to any facility that performs surgeries with any regularity. They may evaluate and focus nursing assessment prior to surgeries, collaborate and communicate with other experts about the plan of care for patients and write up preoperative orders.

CRNFAs are involved in first-assisting during intraoperative surgical procedures. Their duties in the operating room often include utilizing medical instruments and devices, dealing with human tissue, suturing and providing exposure or hemostasis.

They provide postoperative care and management and document post-op notes or orders, visit patients post surgery and collaborate with others to plan a patient’s discharge from the medical facility. Additionally, CRNFAs often assist patients with finding community resources to fulfill needs after surgery.

Certification Significance

While CRNFAs perform many of the same duties prior to certification that they do afterward, certification has its benefits. Certification provides credibility and recognition to accomplished nurses, along with enhancing their career development. Among colleagues and peers, certification works to validate their knowledge and provide evidence of personal commitment to one’s trade.
Continued learning is valued by health care administrators, and certification helps to identify a nurse with higher qualifications and experience when going through hiring processes.
Essentially, certification proves that a nurse is dedicated to his or her work, has the knowledge to fully function at a higher level and has developed the skills to exceed the standard performance of others.
Salary of a CRNFA
Salary averages change throughout the United States depending on one’s geographic region, area population and the type of facility where one works. On average, a CRNFA makes between $30 to $40 per hour, depending on experience. Some CRNFAs within the Midwest make approximately $70,000 per year; however, others throughout the country exceed $90,000.
The type of facility where one works greatly influences the salary of a typical CRNFA. Working for a privatized health care facility often results in a higher salary than working for a hospital that is a non-profit organization.

Variety of Workplace Opportunities

A CRNFA may find work in many different settings. Most suited for operating room work, CRNFAs work in private practices where regular surgical procedures take place, such as orthopedic clinics, cosmetic surgery clinics or other specialized facilities. Hospitals (both private and public) offer numerous opportunities for someone as highly qualified as a CRNFA.

The military employ a significant number of CRNFAs both in the United States and overseas. In demand because of their versatility and vast knowledge, CRNFAs find enhanced roles and increase responsibilities when serving as a nurse in the military.

Many CRNFAs find opportunities to step up into administrative roles, overseeing other nurses who work with surgical patients. These administrative roles may take the CRNFA out of the operating room, but their skills and abilities are used to help improve a facility’s operating capacities.

CRNFA Exam Eligibility Requirements

Passage of the CRNFA examination is one of the requirements to being a CRNFA (Certified Registered Nurse First Assistant). Several guidelines exist in order to sit for the examination, however. Prior education, licensing and maintenance of a RNFA practice log are all part of the requirements to being eligible to take the CRNFA examination. Here is a complete list of requirements:

  • Candidates must be registered nurses with licenses in good standing within the state in which they work. Licenses must not subject to provisions or any other conditions.
  • An applicant must be a CNOR at the time of application. This certification means that the he or she as a candidate has demonstrated sufficient knowledge and skills that show competency within a specialized area of peri-operative nursing.
  • If a candidate is not a CNOR at the time of application, he or she must be an advanced registered nurse practitioner who has acquired certification in any operative specialty.
  • A candidate must have acquired a bachelor’s degree at some point in his or her educational career. The degree may be in any field. A copy of one’s diploma must accompany the application for the examination.
  • An applicant must complete at least 2,000 hours of practice as an RNFA. These hours may include post-, pre- and intra-operative patient care. The hours may be part of an RNFA practicum or internship. However, these hours may not be included in those spent attending classes, seminars or programs.
    • At least 500 hours must have been acquired within the two years prior to the time of application.
    • 600 hours of practice may be combined pre- and post-operative patient care, which equals 30 percent of the required hours.
    • 1,400 hours of practice must be intra-operative practice with patients, or 70 percent of the necessary practice hours.
    • A practice log of these RNFA practice hours must be maintained and submitted with one’s examination application. Each entry on the log must include: name of the procedure, date of the surgery or procedure, surgeon’s initials with whom you assisted, times for pre-op, intra-op and post-op practice. This log needs to be maintained very carefully and meticulously as it will be checked by a board of experts.
  • Each applicant must provide proof of successful completion of a formal RNFA educational program that is accepted and approved by the

Competency and Credentialing Institute (CCI). The educational program must have a curriculum that instructs students in all possible subject areas necessary for a CRNFA’s necessities. Many schools are approved across the United States for this level of education. A copy of one’s certificate of completion must be submitted along with the examination application.

Eligibility to take the CRNFA examination must be established before a candidate is allowed to register for an examination date. A panel of experts will evaluate one’s education, license, practice log and other criteria to determine if a candidate has met the professional expectations necessary to sit for the examination and possible become certified as a CRNFA.

CRNFA Exam Preparation

Nurses who are planning to take the examination in order to become a Certified Registered Nurse First Assistant (CRNFA) should create a plan of action so they are prepared when test time comes around. The Competency and Credentialing Institute (CCI) advises several resources, tools and guidance that may be helpful to a potential CRNFA.

CRNFA Exam PreparationThe CCI encourages nurses to study for the exam for several weeks. On average, the CCI reports that most nurses take up to 3 months to prepare for the examination. Many nurses study individually, however several report that working with a study group was helpful.
To help potential CRNFAs pass the examination, the CCI provides electronic practice tests, test-taking tips and a comprehensive study guide, in addition to personal assistance supplied by CCI staff members.
Advised by the CCI, an official study guide is produced and recommended to future test takers. The guide incorporates much of the information necessary to prepare for the exam within its 83 pages. The guide includes several helpful viewpoints for taking the test, including:

  • A summary at the end of each chapter that includes task and knowledge statements
  • Sample test questions formatted in a fill-in-the-blank method after each chapter
  • Space for taking your own notes at the end of each chapter to document your thoughts concerning the content of a chapter
  • Definitions and summaries of all responsibilities, functions and knowledge that a CRNFA must know in order to be proficient in his or her duties

The official study guide is available for purchase from the CCI and online at its website.
Other resources are advised by the CCI, as well, in addition to the study guide. Because the test refers to several subjects, more than one text is necessary to fully prepare a nurse for the examination. Resources include:

  • “Assisting in Surgery: Patient Centered Care”
  • “Alexander’s Care of the Patient in Surgery”
  • “Competency for Safe Patient Care During Operative and Invasive Procedures”
  • “Berry and Kohn’s Operating Room Technique”

These four texts are available in book form and electronic media format. The CCI website provides a location from which to purchase these resources, however they are available from other outlets, as well.

An 11-week study plan that was created by the CCI for study preparation is available and recommends a week-by-week focus on important study topics. Each study area is matched with its proper resources (including the correct chapters to focus on).

Finally, after a student has taken the time to study for the examination, he or she may wish to take an e-practice test. The test is available for purchase and includes two modes of preparation. One is a study mode that flags incorrectly answered questions and explains the theory or logic behind the correct answer. The exam mode allows students to take the examination as a practice run to see what they can score. The test is available for a total of 72 hours, where a student may log in and utilize the practice test (in either mode) as many times within the timeframe as he or she wishes. The sample examination gives test takers insight as to how questions are asked, how the questions may appear and what taking the test on the computer is like.

Steps to Take After the CRNFA Examination

There is much to do after taking the Certified Registered Nurses First Assistant (CRNFA) examination. Whether a test taker passes or fails, he or she has much to consider and work to do for future professional development.
First and foremost, the most important thing to do is to get your test results. The results should be available as you check out of the testing center. If you pass, you get notification of your passing score. The Competency and Credentialing Institute (CCI) will send you a packet of information about your new certification within 4 to 6 weeks. Additionally, the CCI will mail you an official CRNFA certificate suitable for framing and display. Your CRNFA certification endures for 5 years without any additional work from you. However, recertification does take some work, so it’s a good idea to start planning in a couple of years.

If you fail to pass the examination, you will receive a score report at the time you check out of the testing center. The score report will indicate subject areas that need your attention if you choose to take the examination again in the future. Your eligibility to take the examination is already established; all you will need to do is to locate a time and location that works with your schedule and sign up for it. You will be required to pay another fee to take the examination a second time.

After passing the examination, most people choose to announce their accomplishment to their friends and family. However, it’s imperative that your announcement be made to the administration at your workplace, along with your colleagues and peers. You worked hard for this accomplishment, and your coworkers need to have a chance to recognize you for meeting your goal. This is also the appropriate time to explore opportunities for raises or jumping to the next pay scale. Consult your supervisors and facility administrators to determine their policies on your salary and position. Many facilities offer new roles or titles to newly-certified CRNFAs.

Newly-certified CRNFAs often seek out additional opportunities to further their educations or professional development. Look for continuing education opportunities nearby that will help you continue to expand your knowledge base, expertise and performance. Consider offering your services as a professional and be a presenter for seminars or programs. Furthermore, many CRNFAs find that obtaining executive education helps them open doors to administrative positions that hold more responsibility and pay better. Executive positions allow them to use their management skills and oversee others.

The CCI encourages CRNFAs to give back to the process and help with future projects or examinations. The organization hopes that nurses will help out with an exam development committee or give their services as an item writer. Item writers evaluate the roles and duties of a CRNFA and create appropriate questions for use during examinations. The exam development committee works on all aspects of the examination process including the actual exam, study guides and other ways the test is administered.

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