October 6, 2015

ION Exam Overview

Inpatient obstetrics nurses care for women who are at or past the first 20 weeks of gestation and their unborn and newborn children. The Inpatient Obstetrics Nurse examination tests the experienced obstetrics nurse’s knowledge in this area of specialty. Successfully passing this examination results in additional credentials behind the RN, written as RNC-OB and is a designated sign of expertise within the field. This certification remains active for three years and you must maintain at least 45 continuing education hours in the specialty for eligibility to renew.

As a component of the labor and delivery field, these nurses must possess a wide array of knowledge including but not limited to antepartum and postpartum care, fetal assessment and potential maternal and newborn complications to be proficient, skilled nurses in this challenging field. The ION will test knowledge in these areas of practice as well as professional issues as an RN, legal and ethical considerations of this position. Test content is discussed in further detail in the article titled, “ION Exam Content”.

The exam is offered in either a paper and pencil or computer-based test; the nurse can choose which version to take. Although the paper and pencil exam is less expensive, it is only offered in one location on an annual basis. The computer-based test is offered through AMP testing centers, which are usually housed in professional buildings such as the H&R Block offices throughout the nation. The computer version of the ION is offered year-round with 90-day testing windows. After application and review of eligibility to test you will be given 90 days to finish studying, schedule, take and pass your examination for certification. You can retest if you fail, however this expense may add up over time. It is advisable to thoroughly prepare and become familiar with the content to avoid this possibility.

The ION has 175 questions, only 150 of which count towards your score on the computer-based version. The questions are scaled based on difficulty of the content. For instance, some questions will award you a higher overall score if they are answered correctly. Likewise, someone taking an easier version of the exam may have to answer more questions correctly to pass. There are many different versions of this examination, but all will thoroughly test your knowledge in obstetrics and your ability to apply that knowledge in situational-type questions. Each test question is composed of a stem with three possible answers.

Professionals at the National Certification Corporation, or NCC carefully develop exam content. The NCC is the governing body for the development, testing and maintenance of Inpatient Obstetric Nurses’ certifications. Registered nurses develop the questions, all of whom hold certification in labor and delivery as well as inpatient obstetrics. A host of reference manuals are used to extract test content and the list is available on the NCC website.

Although the American Nurses Credentialing Center, or ANCC, offers myriad certification examinations in nursing specialties, they do not offer certification for obstetrics, labor or delivery nurses; this certification can only be obtain through the NCC. Examination content, availability and pricing are all subject to change – review the NCC web site for further information.

ION Exam Content

Like many nursing specialty certification examinations, the Inpatient Obstetrics Nurse Exam (ION) is a challenging test meant to prove your expertise and dedication to this field. Successfully passing the test awards you with the credentials RNC-OB, which are displayed in your signature and on your resume as a testament to your dedication to the field and your profession. This examination is offered through the National Certification Corporation, or NCC for short. Nurses preparing for the ION exam should pay close attention to the test content and outline while arranging their studies.

The largest focus of the ION exam is in labor and delivery. Almost 30 percent of the questions will test your knowledge in this field and may include questions regarding healthy labor such as management, physiology, progression and procedures associated with the process. This section can also test on pain management aspects of labor and delivery including epidurals, oral and intravenous medications and their dosages, effects and contraindications of use.

The second largest component of the ION will test your knowledge of complications in obstetrics. Nurses certified in Inpatient Obstetrics must be able to identify, assess and know how to treat complications at any stage of the laboring process. This knowledge is vital and will help the nurse both the mother and unborn child. A percentage of the population is at advanced risk for complications during the birthing process and is identified as those with pre-term labor, multiple gestation or prolonged pregnancy. Women with disorders of the placenta, such as placenta previa, are also considered an at-risk population and require special monitoring and treatment.

A thorough understanding of fetal assessment will reflect in your test scores. These questions can contribute up to 20 percent of your ION test content. Test candidates must demonstrate knowledge regarding fetal assessment and monitoring including both electronic and non-electronic monitoring for the antepartum period. Electronic monitoring questions may focus on fetal heart rate assessment and interpretation, whereas non-electronic can include assessing fetal movements and behavior and the experience to correlate these findings. This portion of the test will include laboratory data interpretation, such as the acid-base tests used to determine fetal oxygenation and stress.

The Accounting section makes up 14 percent of the ION, the section on maternal factors is a relatively small yet important category. This area of practice focuses on the status of the gestating woman, which may include her medical history or any factor that can impact the ability to labor and the well-being of both the fetus and newborn. Included in this category is knowledge of disease processes, such as hypertension, kidney disease or sexually transmitted diseases, all of which could impact the fetus and mother. The section on pregnancy risks may reflect lifestyle considerations including understanding how a pertinent medical history will affect labor.

Postpartum and the newborn assessment comprises up to 10 percent and 5 percent of the test. In these sections you will be tested on your understanding of this period after birth including both the adaptation of mother and family to the newborn and the newborn to extrauterine life. These sections have their own focus on complications, which will include newborn resuscitation. Newborn nutrition and lactation are included in newborn assessment, as well as the nurses’ ability to provide education and plan for eventual hospital discharge and home care of the new family unit.

The final section of the ION centers on professional practice issues associated with registered nurses in the obstetrics profession. This is a relatively small portion of content supporting only 2 percent of the exam questions. Topics covered in this section include legalities, ethical considerations, ongoing research and patient safety in general.

ION Testing Eligibility

Labor and delivery nurses who specialize in inpatient obstetrics can highlight their knowledge, professionalism and expertise by obtaining a Inpatient Obstetrics Nurse Exam (ION) certification within this specialty. Despite years of practice or education, not everyone is eligible to sit for this exam. The standards set forth by the governing body, the National Certification Corporation or NCC for short, are very specific and inflexible. Make sure you are eligible prior to applying for this exam, as some fees may be non-refundable.


Although plenty of licensed practical nurses work in the field of inpatient obstetrics, this exam and subsequent certification is only offered to those holding their registered nurse license. LPNs practicing in inpatient obstetrics who wish to sit for the certification exam may enter an LPN to RN program, which can take anywhere from 2 to 4 years of schooling prior to licensure, dependent on the degree obtained (associates versus bachelor’s in science). Following their license conversion, these nurses will still need to meet the work-experience hour requirements before applying to test – their experience as an LPN will not count towards these hours.

Work Experience

Specialty work-experience hours are an inflexible requirement. RNs must have at least two years of inpatient obstetrics experience within some point at their career as well as sometime during the last 24 months. This includes the requirement for 2,000 work hours within the specialty of inpatient obstetrics, however the hours do not need to be cumulative according to the NCC.

Unrestricted License

Registered nurses in the United States and Canada must have an unrestricted license prior to examination. This means that your RN license cannot be under suspense, expired or restricted in any manner prior to testing. Licenses may be restricted for any outstanding arbitration on your practice or any violations of the Nursing Practice Act. If you have questions regarding the status of your RN license they should be directed towards your state board of nursing.

Certification Maintenance

Your job is not complete upon passing your certification examination. It is never to early to start on the 45 continuing education hours that are needed to maintain your specialty certification of RNC-OB. The NCC allows a 3-year certification period. At least 90 days prior to its expiration you must apply for maintenance of the certification with proof of these CEUs within inpatient obstetrics. If the NCC does not receive the application for maintenance you will have to apply and retest for certification all over again.

Special Needs

If you applied for a computer-based test, you will take your exam at an approved AMP testing center. The NCC and the AMP centers follow the rules set forth by the American Disability Act and can accommodate nurses with special needs. However, you must inform the NCC of these needs and have medical proof prior to arranging a test date and center.

Test Failure

In the event that you fail the ION examination you may re-take the test at a later date. Unfortunately, this can get expensive as well as frustrating. The re-take is not free, but offered at a slightly reduced rate. You must wait 90 days before you will be allowed to take the ION exam again; use the 90 days to rethink your study methods and review exam content.

Studying for the ION Exam

The Inpatient Obstetrics examination (ION) is a certification test for registered nurses, which is sponsored by the National Certification Corporation, or the NCC. This exam awards the credentials of RNC-OB, signifying an elite group of RNs who possess expert-level knowledge and experience in the specialty of obstetrics. This examination is provided once annually for pencil and paper test takers or year-round for computer-based exams. It is challenging and expensive – plan to pass the first time as opposed to paying for retakes.

Choose Your Learning Method

It may sound like overkill, but preparing a study method before you even get started is a good way to approach this challenge. Study methods vary from nurse to nurse. Explore your personal learning methods the same way you do for your patients – are you an audio, visual or hands-on learner? The plethora of study methods and tools available should be tailored to your learning styles to increase your success in passing the ION exam.

Take a Pretest

Although the NCC does not offer either example questions or pretests, these can be found online, in ION exam review texts and on CD-ROM study aids. Take a pretest before you get started studying. This may help you focus on areas where your experience fails you – allowing you to tailor your study efforts to these areas of need. Just prior to the actual ION examination, those taking a computer-based test are offered a pretest to help acclimate them to the computer system.

No Refunds

The NCC does not offer refunds for those who skip the exam or wait too long to reschedule. If test day is approaching and you are not ready for the exam you can defer your test date, assuming you do it at least 30 days prior to the end of your 90 day window. However, this deferral is associated with another fee and you must send in a new application with supporting documentation. Regardless if you believe you are ready or not, do not miss your exam date. Failure to appear for your exam will result in a loss of all fees paid and the NCC does not have to provide a refund.

Study Groups

The NCC allows for group certifications of six or more people at discounted rates. Special rules apply, so be sure to check the NCC web site and policies for more information. Whether you are part of an institutional application or singularly applying for the exam, some nurses learn best in study or review groups.

Study Materials

One of the best tools you possess is your knowledge and experience within obstetrics. Build upon that knowledge by reviewing texts from a local library or you can purchase study materials commercially. Many companies offer study materials for the ION exam, but none are affiliated with the NCC. The NCC does not endorse or provide any study materials for this examination. Choose your aides well; perhaps start by researching the provider’s customer satisfaction and guarantees. Flashcards, textbooks and study guides with pretests are all good study aids.