About CRNFA Certification

The CRNFA certification program is for registered nurse first assistants who wish to validate their competency as a perioperative nurse working closely with the surgeon in an expanded nursing role.  Successful candidates may use the CRNFA credential to gain credibility and recognition from colleagues and patients, achieve their personal and professional goals, and enhance their career development. 

Hospitals and institutions around the world support the CRNFA program because certified healthcare providers are confident in their skills and knowledgeable of the latest standards of practice and care.  CRNFA-certified nurses are leaders in the operating room community. 

The CRNFA credential is recognized by ANCC as a national certification for the Demographic Data Collection Tool (DDCT). 


CRNFA certification is defined as the documented validation of the professional achievement of identified standards of practice by an individual Registered Nurse First Assistant providing care for pateints before, during, and after surgery.

Use of CRNFA

CRNFA is the designation recognizing the nurse who has been certified as a Registered Nurse First Assistant. Holding the CRNFA credential means that an individual registered nurse has demonstrated the knowledge and skills that denote competency in the expanded field of first assisting.

The CRNFA mark is federally registered with the U.S. Patent and Trademark Office, Reg. No. 3564062, and may only be used in accordance with CCI policy by those who have achieved and maintain the designation. CRNFA stands for Certified Registered Nurse First Assistant.

Merged Credentials - CNOR and CRNFA

If you currently hold the CNOR credential and successfully pass the CRNFA exam, then you will hold both the CNOR and CRNFA credentials and may use both designations after your name. For example, Jane Doe, MSN, RN, CNOR, CRNFA. However, for operational purposes these credentials become merged, and you must only meet the CRNFA requirements to recertify both credentials. To maintain the two credentials, you must meet the recertification requirements for the CRNFA credential only. Your recertification period for both credentials is determined by the date in which the CRNFA credential was earned.

Advanced Practice Nurses

If you are an advance practice nurse (CNS, NP, CNM, CRNA) certified in your specialty and successfully pass the CRNFA exam, then you will hold only the CRNFA credential. For example, Jane Doe, MSN, RN, FNP, CRNFA.  To recertify you must meet the CRNFA recertification requirements.

Proper Order for Listing Credentials

The members of AORN's Board of Directors have voted to support the ANA's position statement on standardizing nursing credentials. The position statement states that the following order of credentials should be used to ensure consistency and professionalism across nursing settings:

  • Education (list highest attained degree first)
  • Licensure (state designation or requirement)
  • National certification
  • Awards and honors
  • Other certification

For example, Jane A. Doe, BSN, RN, CRNFA, CNOR or John A. Doe, MSN, RN, ACNS-BC, CRNFA

Role of the RNFA

According to AORN (2012), "The RN first assistant at surgery collaborates with the surgeon and the healthcare team in performing a safe operation with optimal outcomes for the patient. The RN first assistant practices perioperative nursing and must have acquired the necessary knowledge, skills, and judgment specific to clinical practice. The RN first assistant practices in collaboration with and at the direction of the surgeon during the intraoperative phase of the perioperative experience. The RN first assistant does not concurrently function as a scrub nurse.”
-AORN Position Statement on First Assistants. Retrieved Aug. 22, 2012 from http://www.aorn.org/Clinical_Practice/RNFA_Resources/First_Assisting_(RNFA)

Learn More About the CRNFA Exam

The CRNFA exam consists of 180 multiple choice questions and must be completed in 3 hours and 45 minutes.

CRNFA Exam Subject Areas

Knowledge/Skill Subject Area Number of Questions
Basic Sciences 20
Assessment Techniques 25
Intraoperative Techniques 75
General Knowledge/Skills 15
Professional Practice 15
Total 150

CRNFA Exam Content Outline

To learn more about each of these subject areas please download and review the detailed CRNFA Exam Content Outline.

CRNFA Exam Development

A job analysis and test outline have been developed by CCI’s Test Specifications Committee, in cooperation with the CCI’s testing agency, Prometric. The job analysis describes the overall functions and responsibilities as well as the underlying knowledge and skills that are essential to ensure proficiency as a perioperative nurse. The CRNFA Exam Content Outline contains detailed information on the categories covered on the CRNFA exam. The exam items are developed by item writers and reviewed and validated by the Item Review Committee.

CRNFA Exam Details

Important Details about the CRNFA Exam

  • 180 multiple choice questions
  • 3 hours and 45 minutes to complete the exam
  • A knowledge-based exam which assesses the knowledge (what a nurse should know) and tasks (what a nurse should know how to do) of a RNFA with 2,000 hours of clinical practice in the OR.
  • Computer-based test
  • Each question has four answer options
  • Only one answer is correct 
  • No multiple answers, i.e. “A and C”; “A, C, and D”, “All of the Above”
  • Can “mark” and “review” questions to return to later 
  • Allow one minute per question 
  • Answer all questions
  • Complete the entire exam. The CRNFA exam will continue even if you have reached a passing score
  • Current passing score is 620


  • 15 minute tutorial on how to take the CNOR exam is offered at the testing center
  • Provides instructions on how to navigate through the exam
  • No previous computer experience is required

Post Exam Survey

  • Short survey follows the CRNFA exam
  • Answers to these questions do not affect exam results


  • You will receive a pass/no pass result at the end of the exam and survey
  • Current passing score is 620
  • Score is based on the number of correctly answered questions
  • Watch the "What to Expect" video and learn what your experience will be like at the Prometric testing site.

How to Schedule Your CRNFA Exam

You will take the CNOR exam at a Prometric testing facility. Prometric is a leading professional testing company with secure locations nationwide. As seat times quickly fill up, we recommend that you schedule your testing date, time and location as soon as you receive your authorization to test email from CCI.

Testing is available Monday through Saturday, except holidays, at hundreds of locations nationwide.

CRNFA Exam Scoring

Individual scores are based on the number of correct answers. The passing score was established via a systematic procedure known as the Cut-Score Study that employs the judgment of a representative group of CNORs from across the country with the assistance of staff from Prometric. This group recommended a standard of what a minimally competent CRNFA needs to know about the tested content to obtain a passing score. The decision regarding the passing score was made by CCI and was transferred through use of statistical procedures to the exam you were administered. The current cut score is 620.  

Security Measures

Several security measures are enforced before and during the test administration to ensure the integrity of the CRNFA exam. Be aware that you will be observed at all times while taking the examination. This observation may include direct observation by test center staff, as well as video recording of your testing session. Examinations cannot be viewed, copied, or studied by any individuals. Copying or retaining test questions or transmitting the test questions in any form to other individuals, organizations, or study groups will result in forfeiting your right to have your examination scored and may result in civil prosecution and disciplinary action by CCI.