Continuing Certification: A Committment to Lifelong Learning

Health care credentialing exists to ensure compliance with high standards for delivery of care in a profession. Credentialing demonstrates that providers remain up-to-date with industry best practices. The research shows that initial certification is just a start. Certification ensures that nurse anesthetists meet rigorous standards to earn and maintain their certification. As a result, nurse anesthetists have a remarkable track record for safe practice. 

Knowledge at one point in time, however, is not enough to ensure currency with evolving knowledge, skills, and technologies or to allow the profession to respond quickly to changing trends. Professional knowledge and skills, especially in anesthesia, require continuous updating and enhancement with the most current evidence that informs practice. Continuing certification is a lifelong learning process of acquiring skills and knowledge and the ability to apply those skills and knowledge to practice.  



CPC Evolution and Development presented by Chuck Vacchiano, PhD, CRNA, FAAN

Limitations of the Former Two-Year Recertification System

Until the CPC Program launched in 2016, credentialing for certified registered nurse anesthetists was a two-stage process: initial certification upon entering the profession and a recertification process that included continuing education on a two-year cycle. Again, before the CPC Program launched, the NBCRNA recertification process that had been established in 1978 saw little to no change. The CPC Program was developed to keep pace with current credentialing best practices and to support lifelong learning. 

The History of Changes to the Continuing Professional Certification (CPC) Program

Designed to evolve with new information, data and technologies, the CPC Program has undergone several revisions since its first (concept) introduction in August 2011. The purpose of the revision process was to ensure that the final criteria reflected a flexible and relevant program for CRNAs, regardless of their practice situation. The changes include:

CPC Criteria Proposed (August 2011); Revision Process Begins

The first proposed criteria for the CPC Program were presented to the CRNA community and the AANA in August 2011.  Shortly after this, the proposed CPC Program was opened for full comprehensive public review and comment. The NBCRNA reviewed and considered over 13,000 comments received from CRNAs and from the AANA. Complementing the CPC public comment period process, NBCRNA representatives attended state meetings to engage with members, CRNAs, and other stakeholders to talk about the proposed CPC Program, as well as answer questions and solicit input.

Following the introduction of the initial draft of the CPC Program at the August 2011 AANA Annual Meeting and the ensuing 3-month open comment period, the NBCRNA established a CPC Committee comprising practicing CRNAs and consultants to collect and review CRNAs' comments, questions, and recommendation.

The CPC Committee, informed by many factors, revised the initial criteria of the CPC Program, including:

  • Feedback from CRNAs and the AANA during the open comment period and subsequently during key stages in the process;
  • Information and research from medical and scientific resources;
  • New standards from the certification community;
  • Benchmarking other anesthesia and nursing recertification programs;
  • Review of a nurse anesthetist professional practice analysis; and
  • The increasing demands of the health care industry and patient safety on educational medical education and continuing competency. 

The revised criteria for the CPC Program were then shared with a panel of individuals identified within the nurse anesthetist profession as leaders in certification, education, and practice development. This panel worked to refine the committee's list of recommendations, using a consensus-building process known as the Delphi Process. 

Changes since concept presentation include:

Evolution of the CPC Program - Revisions

  • Untitled design (41) First Major Revision of CPC Criteria, January 2012

    In January 2012, the CPC Committee presented the information collected and refined recommendations for changes to the CPC Program, based on results from the public comment period. Revisions included:

    • The professional work requirement for a specified number of hours of practice was removed.
    • The continuing education requirement was reduced to 15 assessed CE units per year.
    • Professional development education credits were first introduced to the CPC program.
    • Credit earned from the Core Modules could be applied to meet assessed CE credits. 
    • The CPC Examination would be phased into the CPC Program, with the requirement date for meeting the passing standard moved to 2032. 
    • The CPC Program start date was moved back 1 year, to January 1, 2016.

  • CPC REvision 2 Second Major Revisions of CPC Criteria, January 2014 through August 2014

    In the fall of 2013, a second CPC survey was conducted of the CRNA community.  As a result of direct discussions with the AANA and with members of the CRNA community and a review of survey feedback, additional revisions to the CPC criteria were made.

    • Life support courses will be able to be reported as Class A credits or Class B credits, at the nurse anesthetist’s discretion.
    • For each domain area in which a nurse anesthetist does not meet a performance standard on the CPC Examination administered during the second 4 year cycle (beginning January 2020), the nurse anesthetist will take an additional Core Module (NOTE: This has since been updated beyond just Core Modules to include Class A credits to allow for choice in continuing education type if performance standard is not met; type and amount (minimum one credit) is up to the CRNA).
    • The NBCRNA and the AANA agreed that the AANA Continuing Education Committee will develop the criteria for assessed CE.
    • Core Module delivery mode was expanded beyond web-only and the cap on CE credits was removed. Further, vendors will determine which module performance objectives will be covered in a module based on the latest evidence. 
  • CPC Revision 3 Third Major Revision of CPC Criteria, August 2014 through December 2014

    In the fall of 2014, the NBCRNA Board of Directors approved additional revisions to the CPC program components:


    • At the request of the AANA, on behalf of the membership, NBCRNA Board of Directors approved changes to the terminology of CPC Program components:
      • The term assessed continuing education requirement was changed to Class A credits.
      • The term Professional Activity Unit (PAU) was changed to Class B credits.
      • The term Diagnostic was removed from the CPC Examination description. Both the performance standard and passing standard CPC Examinations will be called CPC Examination.  
    • The CPC Program start date was moved back to August 1, 2016.
    • CPC Core Modules will be voluntary for the first 4-year cycle.
    • Additional options will be explored beyond retaking a CPC module for CRNAs who do not meet the performance standards of the "low stakes" CPC Examination during the 2020-2024 recertification cycle.



  • CPC Revision 4 CPC Program Criteria, December 2014

    Since the initial proposed criteria for the CPC Program, the CPC Committee and NBCRNA Board have continued to refine the components, based on input from the AANA, certificants, and other stakeholders. Every component of the CPC Program has been analyzed and revised to ensure that the CPC Program will have practice-related validity and that the requirements of the CPC Program are essential, regardless of practice setting, patients, and conditions.
  • CPC Revision 5 Core Modules Become a Required Component, September 2017

    The Core Modules were included as an optional component in the first 4-year CPC cycle as feedback and data were gathered by Core Module providers and reported to the NBCRNA. After extensive analysis by the NBCRNA, it was determined that the Core Modules provide not only a successful means to bring evidence-based information to the CRNA, but that it supported the goal of lifelong learning and provided a form of longitudinal assessment. Including the Core Module requirement was also recommended by the AANA Continuing Education Committee to the NBCRNA as a valuable educational component. In September 2017, the Board of Directors voted to include the Core Modules as a required component of the CPC Program beginning in 2020. 
  • CPC Revisons- 6 Removal of Pass/Fail Requirement for the CPC Assessment, Testing Options Added, February 2019

    In February 2019, the NBCRNA announced the removal of the pass/fail requirement for the CPC Assessment following an extensive Beta Research Study and a national benchmarking study. The CPC Assessment will still be required every eight years, but will remain a performance standard assessment only—no pass/fail, allowing the assessment to be a self-evaluation tool to target future continuing education.

    Read the full release here.

    Also in February 2019, the NBCRNA announced that when the CPC Assessment rolls out beginning in 2020, CRNAs will have the option of taking the assessment either remotely in the comfort of their home or place of their choosing, or at a testing center. Providing two assessment options gives CRNAs the flexibility to select the setting that works best for them to minimize travel time and time away from practice, while reducing related costs

    Read the full release here.