CNOR - Certified Perioperative Nurse

The Certified Nurse - Operating Room (CNOR) credential is the only accredited certification for perioperative registered nurses and is a mark of distinction. It's intended for registered nurses (RNs) who primarily work in an operating room. To qualify, nurses must have two years in a perioperative setting. CNOR certification requires strong knowledge and experience in:

• Intraoperative Nursing

• Infection Control and Prevention

• Perioperative Assessment and Diagnosis

• Communication and Documentation

• Care Planning

• Professional Accountability

The Competency & Credentialing Institute (CCI) awards this credential by exam. Over 40,000 perioperative nurses are certified by CCI. These nurses are highly organized, detail-oriented, skilled communicators. The CNOR certification demonstrates that an OR nurse has the knowledge and expertise to provide the best care for surgical patients.

Test Format

The CNOR examination is a timed (3 hours and 45 minutes), computer-based exam consisting of 200 multiple-choice items. Only 185 items are scored. The remaining 15 are pre-test questions used to gather statistical data for future exams. They don't affect the final results. 

The CNOR certification exam is reviewed annually to prevent overexposure to material and reflect updated content in the primary references.

Test Fees

Applications can't be processed without payment. CNOR Certification options include:

• CNOR Exam Application Fee $395 

• CNOR Take 2 Application Fee $445

The CNOR Exam Take 2 program allows a CNOR-eligible nurse to take the CNOR exam twice within 12 months if the first attempt is unsuccessful. Under either option, applicants may add $50 to the cost and receive the CNOR Exam Prep book.

• Single Take Exam Fee $445

• Single Take Exam Fee + Prep Book $520

• CNOR Take 2 $495

• CNOR Take 2 + Prep Book $570

Results

CNOR certification exams are scored electronically. Pass/Fail results display on the screen immediately upon completion of the exam and CCI emails detailed score results to the candidate within 24 hours. Scores are determined by the number of questions answered correctly converted to a scaled score of 200 to 800. Candidates need a score of 620 to pass.  

Prerequisites:

To sit for the CNOR certification exam, nurses must meet the following eligibility requirements:

• Hold a current, unrestricted RN license in the U.S.

• Currently work full-time or part-time in perioperative nursing practice, education, administration, or research

• Have at least two years and 2,400 hours of experience as a perioperative RN, with at least half those hours in the intraoperative setting

Steps to Obtaining CNOR Certification

• Confirm eligibility

• Apply online by creating a CCI account or log-in to an existing account

  • Applications take about 15 minutes to complete

  • Requires email address to receive CCI communications, legal name as it appears on a valid, government-issued photo ID and RN license information

• Pay testing fees online

• Schedule the CNOR exam within the 90-day testing window

  • Click on the “PSI Exam Scheduling" button that appears after submitting a completed application and exam fee

  • Applicants are taken to PSI’s scheduling system

  • Applicants may also schedule exams by calling PSI at 855-834-8752

  • Exams may be taken in-person or online

• Study for the CNOR exam

• Take the CNOR exam with CCI’s testing partner, PSI Exams.

• Retrieve results

CCI recommend candidates spend at least three months studying and preparing for CNOR exam before attempting certification.

Nurses must renew CNOR certification every five years. Renewal requirements include:

• Active, unrestricted RN license

• Current employment in an intraoperative setting

• A minimum of 500 hours worked during the past five years in education, administration, research, or clinical practice that impacts patient care in the intraoperative setting

• Selection of recertification method (contact hours, points, or examination)

Recertification by continuing education contact hours requires 125 contact hours offered by approved providers, 75 must be related to perioperative nursing. 

Recertification by points requires 300 points. The CNOR Handbook contains a list of activities that earn points, including volunteer hours, participating in professional organization activities, research, and publishing in academic journals. 

Recertification with CRNFA is a renewal option that allows RNs who are dually certified through the National Assistant at Surgery Certification (NASC) as a Certified Registered Nurse First Assist (CRNFA). They don't have to pay for CNOR renewal.

Renewal Fees: $375

CNORs may receive $50 off the standard recertification fee if they recertify between January 1 to July 1 of their recertification year.

Recertifying between July 2nd - December 31st: $425

Recertification by Contact Hours

Current CNOR certificate holders may recertify their credential through continuing education (CE) contact hours. Using this method, they must earn 125 contact hours within the five-year certification period. They must maintain a copy of the certificate of attendance for each approved CE program in case they're audited.

All contact hours must be obtained through programs provided by approved, accredited providers. Candidates may complete contact hours from providers approved by:

• Association of periOperative Registered Nurses

• American Nurses Credentialing Center

• Any agency, organization, or educational institution accredited by ANCC

• American Association of Critical-Care Nurses

• American Association of Neuroscience Nurses

• American Association of Nurse Anesthetists

• Association of Women’s Health, Obstetric, and Neonatal Nurses

• American Academy of Nurse Practitioners

• American Academy of Family Practitioners

• American Academy of Physicians Assistants

• American College of Nurse Midwives

• National Association of Nurse Practitioners in Women’s Health

• National Association of Pediatric Nurse Associates and Practitioners

• Any State Board of Nursing

• Any state nurses’ association

CNORs may use academic credits to partially fulfill their contact hour requirements for recertification. However, no more than half of their 125 contact hours may be earned through academic credits. Academic credits must be earned in courses required for a bachelor's degree or higher, but CNORs don't have to be enrolled in a formal degree program when taking the course.

CNORs may also submit Category 1 CME (continuing medical education) credits to fulfill their contact hour requirements. However, they may not use Category 2 CME for recertification.

Recertification by Points

CNORs who don't earn enough contact hours to recertify through that method may use their CE contact hours in combination with other professional development activities to recertify their CNOR credential by points. They must earn a total of 300 points in any combination of the following categories:

• Continuing Education

• Academic Study

• Teaching in Academic Setting

• Publishing

• Presentations

• Service on a Board or Committee

• Precepting or Mentoring

• CCI Volunteer Committee

• Professional perioperative-related volunteer service

• Earning another accredited perioperative certification

• Professional Organization Activities

• Clinical Inquiry

• Training Certificate

• Reflection

• Games

• Case Study

• Additional Points Activities

Each activity has a cap on the number of points a CNOR may earn in that category. Except academic study. CNORs may earn an unlimited number of points in this activity. The Candidate Handbook provides a thorough breakdown on the point values for each activity and the maximum points allowed.

Reference Materials

Candidates may want to refer to these four references recommended in preparation of the CNOR exam:

• Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; current edition

• Phillips N. and Hornacky A. Berry and Kohn’s Operating Room Technique. 14th ed. St. Louis, MO: Elsevier; 2021

• Rothrock JC, ed. Alexander’s Care of the Patient in Surgery. 16th ed. St. Louis, MO: Elsevier; 2019

• Odom-Forren, J. Drain’s Perianesthesia Nursing: A Critical Care Approach. 7th ed. St. Louis, MO: Elsevier; 2018

CCI Resources

• 5 Free CNOR Practice Questions

• CNOR Exam Study Outline

• CNOR Handbook

• CNOR Certification Webinars

The CCI also offers the following certifications:

• Certified Foundational Perioperative Nurse (CFPN)

• Clinical Nurse Specialist Perioperative Certification (CNS-CP)

• Certified Surgical Services Manager (CSSM)

• Certified Ambulatory Surgery Nurse (CNAMB)

• Nursing Professional Development Advanced – Board Certified (NPDA-BC)

Other related certifications include:

• Registered Nurse First Assistant (RNFA)

• Registered Nurse Assistant at Surgery – Certified (RNAS-C)