It used to be that you had to hit on someone’s wife/girlfriend or venture into obscene or racially objectionable slurs to start a bar fight; now all you have to do is walk into any anesthesia break room in the United States and say: “CPC Exam” and suddenly you’re in a battle that makes the Avengers’ movies seem like a romantic romp.

In my 20-plus year career as a nurse anesthetist, I don’t believe that I’ve encountered any topic that caused as much confusion, consternation, and down-right anger. This is despite a reasonably intense advertising effort by the National Board of Certification and Re-certification of Nurse Anesthetists to explain the new system.

So, what happened? How did we go to bed one night with a sane and simple re-certification policy, and wake up the next day with a completely new and seemingly Machiavellian scheme so labyrinthine that professionals with a master’s degree can’t seem to figure out? A little history is necessary, I think, to answer that question.

The NBCRNA is, in essence, a kind of Frankenstein monster who really shouldn’t be blamed entirely for its seemingly wild and dangerous behavior. The NBCRNA was actually created in 1975 as part of the AANA so that we would have a single national certification/re-certification body. It remained a part of the AANA until 2007 when, in response to regulatory pressure, it became a separate entity.

For the first three years, the AANA continued to pay a gradually diminishing portion of its costs. The move made sense in many ways. In particular, it helped silence complaints from another anesthesia organization, which shall remain nameless, that there was an incestuous and potentially collusive relationship between members (paying large annual dues) and the AANA (who decided to award re-certification and, thus, continued dues payment).

I can see the wisdom and the validity of that argument, at least to some degree. And, had the certification/re-certification process remain unchanged, I would imagine that this new found independence of the NBCRNA would have gone mostly unnoticed and, certainly, without much contention. Now comes the kicker. In very short order, the profession underwent two major changes. The first was the decision to change from a master’s degree entry level to a Doctoral degree entry in CRNA education. The AANA made this decision in 2007 with little input from the membership and with seeming disregard of the input from program directors. Instead of vox populi—the voice of the people—it was vox nihili—the voice of nothing.

We jumped on the train with all other advanced practice nurse organizations who all said they, too, were going to switch to doctoral entry by 2025. Now, as 2025 approaches we find ourselves on that train pulling away from the station, staring forlornly through the soot-stained window at all the other organizations who are standing on the platform waving languidly at us as we disappear into the mist. Yes, we are the only advanced practice nurses who are now self-mandated to be doctorally prepared for entry into practice—the other groups all backed away from the idea.

For those of us in the education biz, this was a very major change and even the general CRNA population was somewhat vocal in their opinions and many, including myself, felt that we were not listened to by the AANA on this issue. Well, to continue the analogy, that train has left the station. We are locked in to doctoral entry. Time will tell if the destination is a good one or not.
At any rate, on the heels of that decision, in 2011 the NBCRNA announced without much public warning, its creation of the CPC Program. Had this simply been a modification of the existing CE requirements, it would probably have been unremarkable. But with the inclusion of a mandatory re-certification exam, the response by the CRNA population was very much akin to the angry pitchfork and torch yielding mob scene in your typical Frankenstein movie.

So, what are those changes, really?

First is the new cycle of 4 years for CEs instead of two. I’m okay with that. I’d just as soon pay once every four years as once every two years…although, I have no doubt that the fee will be at least twice as much.

Next, the CEs are broken down into Class A and Class B requirements. Okay. I get it. Most medical certification bodies do this and it’s probably a good idea. Class A content must have some sort of ‘evaluation’ at the end. This can take the form of a simulation demonstration, case study, or self-assessment.

Within the Class A credits are four mandatory modules that must be completed every four year cycle. These are: airway management techniques, applied clinical pharmacology, human physiology and pathophysiology, and anesthesia equipment and technology. These four modules must have a true ‘test’ at the end with content questions that must be answered correctly to receive credit. Okay, I agree with this too; we should be sure that practicing CRNAs are up-to-date on these four topics. You need a total of 20 Class A CE for the four-year cycle. Extra Class A credits can be rolled over to cover Class B credit requirements.

Class B credits require no evaluation and can include mission trips, conferences that you sit in on that have no evaluations, precepting students, being a member of a board or committee or attending hospital in-services. You need 40 of these every four years. All in all, not a bad change, we all know people who got all their re-cert CEs by sleeping through weekly staff meetings and going to conferences where they never actually went to a single presentation.

The Re-certification Exam

Now the real elephant in the room: The Re-certification Exam. I’m sorry, that sounds too scary, so we prefer to call it the Continued Professional Competency Exam. Whew! I feel better already.

Now, the big five questions: When do I have to take it? How much will it cost? What’s on it? What’s the format? What happens if I fail?

The first exam will be in 2024/2025 depending on your re-cert cycle. It is being called a ‘performance standard’ exam and it doesn’t matter if you pass it or not. Basically it’s a dry run for us and for them. We get to see where we are and they get to see how many people are going to fail. For us, it’s kind of like practicing kissing on a mirror, and for them it’s like taking your sister to a dance, you have a date, but it doesn’t mean anything. Eight years later, it will be for real. Fortunately, I’ll be dead by then—sometimes it doesn’t suck to be old.

What’s the cost? They promise it will cost around $300. Not bad, really, for every eight years.

The content is: airway management (34%), applied clinical pharmacology (24%), physiology and pathophysiology (24%), anesthesia equipment and technology (18%). Look familiar? Yep. It’s content for the four core modules, and that content is approved by the AANA before it’s allowed for use. So, if you pay attention to the core modules, you should pass.
It’s going to be a 150 graded question test (with a few experimental questions thrown in like on the board exam). You get four hours to do it, so even if you’re like me and your lips move when you read, you should be able to wallow through it without too much difficulty. You can take it any time in the second 4 year cycle but it’s a good idea take it six months before the end of your 8 year cycle. Why?

If you fail, you can take it 3 more times, but they must all be before the end of your re-cert cycle. If you still don’t pass, you have to go through the Reentry Program. But don’t panic…the exam may not even come to pass. The ASA dropped their re-cert exam requirement this year and the NBCRNA is getting a lot of grief, I mean feedback, and they’ve already started walking back a little bit. I expect a change that looks like what many other nurse practitioners’ re-certification looks like now: practitioners have the option of a lower CE requirement and an exam or a higher CE requirement and no exam—at the discretion of the practitioner.

We’ll see. Here’s a link about this. It’s worth reading: