In 1978, the Association of Perioperative Registered Nurses (AORN) voted to begin a voluntary certification program for operating room nurses. The certification council created as a result of this vote eventually evolved into the Competency & Credentialing Institute (CCI), an incorporated organization which develops and maintains the CNOR and CRNFA certifications.
CNOR is not an acronym. Rather, the CNOR certification is defined as "the documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing care for patients before, during and after surgery."
The CNOR exam is updated continuously. Throughout the year, CNOR-certified nurses convene to participate in question writing and review workshops, and the questions developed at these workshops enter the pool of possible CNOR exam questions. At any given time, several forms of the exam exist, and new forms are developed and statistically validated every year to reflect current practice. Occasionally, the examination is overhauled more thoroughly, most recently in 2013.
Function of the Test
The CNOR exam is one part of the CNOR certification process for operating room nurses. CCI defines CNOR certification as a "voluntary recognition program [which] acknowledges... an individual nurse's performance which exceeds that for competent practice in the perioperative setting."
Candidates for the CNOR certificate must have a current, unrestricted RN license and be working at least part-time in perioperative nursing, whether in nursing education, administration, research, or clinical practice. Candidates must also have completed a minimum of two years and 2,400 hours of experience in perioperative nursing, including a minimum of 1,200 hours in the intraoperative setting.
The CNOR exam is administered by computer. Test takers are allowed three hours and 45 minutes to complete the exam.
The CNOR exam is offered continuously year-round. Once a candidate applies, he or she may take the examination during any of the three following months. For example, a candidate who applies in February may take the test in March, April, or May.
The CNOR exam is normally administered at test center locations run by Prometric Inc. Candidates are not required to take the examination in the United States; special accommodations may be made to help overseas nurses find a testing center within five hundred miles of their current location.
Members of the AORN may take the examination for $310. Non-members must pay $385. Some discounting programs are available. If five or more nurses apply at the same time, each candidate's fee is reduced by $25. CCI also participates in the Department of Veterans Affairs and Defense's "Let's Get Certified" program and offers a price of $285 for VA and DoD perioperative nurses.
Candidates who wish to retake the examination may reapply the month after their original testing window. There is no limit to the number of times a candidate may take the examination, but every time a candidate takes the examination, he or she will see a different version of the exam. CCI does not offer refunds or retesting discounts to candidates who do not pass the CNOR exam.
|Sections of the CNOR Test|
|CNOR Exam Topic Areas||% of Questions|
|Preop Patient Assessment and Diagnosis||14%|
|Develop Individualized Plan Of Care||9%|
|Transfer of Care||5%|
| Cleaning, Disinfecting, Packaging, Sterilization,
Transporting & Storing Instruments, Supplies
|Management of Personnel, Services, & Materials||6%|
The CNOR Exam is offered at Prometric Testing Facilities. At these facilities, a valid ID must be presented by every test taker. A log book must also be signed. Each test taker will be given a locker to store their things while the test is being taken. The TCA facilities may also provide test-takers with scratch paper, pencils, and any other supplies needed. Only the locker key and valid ID are allowed into the testing rooms.
The CNOR exam is made up of 200 questions, 15 of which are unscored, pretest questions. These pretest questions will be dispersed throughout the test, so every question still needs to be answered. The 200 questions will cover nine different topic areas with three hours and forty-five minutes to complete them. The topics covered are Preop Patient Assessment and Diagnosis; Develop Individualized Plan of Care; Intraoperative Activities; Communication; Transfer of Care; Cleaning, Disinfecting, Packaging, Sterilization, Transporting & Storing Instruments, Supplies; Emergency Situation; Management of Personnel, Services, and Materials; Professional Accountability. Test takers will find out immediately following the test whether they pass or fail.
- Sample CNOR Questions:
- Prophylactic antibiotics should be administered:
- A. 30 minutes to 1 hour preoperatively
- B. 4 to 8 hours preoperatively
- C. 12 hours preoperatively
- D. 24 hours preoperatively
- The most common cause of toxic anterior segment syndrome (TASS) is:
- A. Contamination with powder from surgical gloves
- B. Improper cleaning and sterilization of instruments
- C. Improper positioning during surgery
- D. Leakage of anesthetic gases
- Intravasation of fluids during surgery may result in clinically significant:
- A. Hyponatremia
- B. Hypernatremia
- C. Hyperkalemia
- D. Hypomagnesemia
- When documenting implant devices, the following information must be included:
- A. Manufacturer, lot and serial number, and size
- B. Size, type, and lot and serial number
- C. Manufacturer, size, type, lot and serial number, and anatomic placement
- D. Manufacturer, size, type, lot and serial number, anatomic placement, patient’s gender and age
- All of the following are true about the Association for the Advancement of Medical Instrumentation (AAMI) standards except:
- A. Requirements should be based on performance
- B. One global standard should apply to each product, activity, or service
- C. Current technology and consensus of opinion should be the basis of standards
- D. Government should be the primary agent in establishing standards
- When developing quality improvement projects, the diagram that is used to help identify cause and effect and root causes is:
- A. Ishikawa diagram.
- B. Affinity diagram.
- C. Prioritization matrix.
- D. Gantt chart.
Of the 200 questions on the CNOR examination, 185 are used to calculate the test score. The remaining 15 questions, which do not count toward the test score, are pretest questions scattered throughout the examination. Because the raw test score is the total number of questions answered correctly, it is advantageous to answer every question. Guessing is not penalized.
Because there are many different forms of the CNOR examination, there is no single raw score cutoff to pass the exam. Rather, the raw scores of any given form of the examination are converted to a standardized scaled score. The passing score of the CNOR exam is a scaled score of 620.
CCI does not publish specific test statistics, but they report that approximately 70% of test takers pass the examination.
The CNOR exam was substantially revised as of July 1st, 2013 to address the 2013 AORN Perioperative Standards and Recommended Practices.
Answers to Sample Questions
1:A; 2:B; 3:A; 4:C; 5:D; 6:A;
- CCI: History March 2 2014
- CCI: About CNOR March 2 2014
- CCI: Frequently Asked Questions March 2 2014
- CCI: CNOR Exam Preparation Resources March 2 2014
- CNOR Certification and Recertification Candidate Handbook March 2 2014
- CNOR Certification Information Booklet March 2 2014
- CCI: CNOR Fees March 2 2014
- CNOR Test Outline 13 June 2014
- CNOR About the Exam 13 June 2014
- CNOR Test Outline 13 June 2014