1. CNOR Core Study Program: Overview
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2. Disclaimer Page
There is no requirement to purchase any examination preparation product or take any prep course offered by CCI or any other provider; CCI adheres to the National Commission for Certifying Agencies (NCCA) Standards in this regard. Purchasing a preparation product or taking a prep course from CCI does not guarantee a passing score, certification, or any other particular result. Candidates should adopt a comprehensive study plan based on the established criteria and body of knowledge; candidates are fully responsible for their own preparation, course of study, professional services, examination, and meeting recertification requirements. Neither CCI nor its officers, directors, employees, or agents are liable for any loss, damage, or claim with respect to any prep course, examination, or certification; all liabilities, including special, indirect, or consequential damages, are disclaimed. All warranties are expressly excluded. All rights reserved. CCI’s training and educational materials – in print and electronic form - are protected under federal copyright law. No part of this publication may be reproduced, copied, modified, or transmitted in any form by any means – electronic or otherwise – without the prior written permission of CCI. Any unauthorized use of CCI materials is strictly prohibited. Violation of CCI’s valuable intellectual property rights may incur substantial damages, including statutory damages of up to $150,000 for a single willful violation of CCI's copyright. CCI has attempted to ensure that all information in this publication is accurate and consistent with standards of good practice from a health and legal perspective. However, nothing in these presentations should be construed as medical or legal advice or opinion and readers should make their own independent practice decisions based on the particular circumstances and the advice of a licensed professional, as appropriate. CCI does not make any warranties of merchantability or fitness for a particular purpose and is not liable for any claims or damage resulting from use of the information in this publication. Copyright©, 2014 Competency & Credentialing Institute

3. About the Authors
Produced by CCI, the official governing body of the CNOR® certification program. This CNOR Exam Instructor’s Kit has been developed to provide resources and guidance for the perioperative educator who is helping a group of registered nurses prepare for the CNOR certification examination. Author Dawn Whiteside, BSN, RN, CNOR, RNFA Credentialing and Education Project Manager Competency & Credentialing Institute Denver, CO Contributing Author Frances Skupski, MBA, BSN, RN, CNOR Perioperative Clinical Nurse Specialist Randolph Hospital Asheboro, NC Graphic Design Rich Martin, Digital Designer

4. Objectives Define certification Describe certification eligibility
Describe CNOR exam content
Describe the 9 Domains
Describe Core Study outline
Develop a personal study plan
Identify all resource materials
Disclaimer:
Although CCI is sponsoring this presentation, there is no guarantee of passing the exam from participation in this study program. Successful completion and passing of the exam is a combination of study processes you develop and define. Success includes active participation and self study by the individual nurse. This study program will serve as guide to assist the nurse in developing a study plan and identification of resources available to complete an optimal study process for each individual. The objectives of the overview portion of this presentation are:
Define certification
Describe certification eligibility
Describe CNOR exam content
Describe the 9 Domains
Describe Core Study outline
Develop a personal study plan
Identify all resource materials
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5. Certification
The American Board for Specialty Nursing Certification (ABSNC) defines certification as the formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal patient outcomes.
CNOR is a voluntary certification that validates the professional achievement of standards of practice by a registered nurse within the perioperative environment.
“The American Board for Specialty Nursing Certification (ABSNC) defines certification as the formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal patient outcomes.” (CNOR Certification and Recertification Candidate Handbook, 2013)
“CNOR is a voluntary certification that validates the professional achievement of standards of practice by a registered nurse within the perioperative environment.” (CNOR Certification and Recertification Candidate Handbook, 2013)
Although the CNOR exam is voluntary, it is an excellent measure of personal accountability to validate competence within the specialty of perioperative nursing. Throughout the perioperative patient care process, we use an advanced nursing process that includes assessing, planning, implementing, and evaluating the care provided. Certification is a great tool to demonstrate our commitment to proficiency in practice to the public. In addition to professional growth and accountability, achievement of certification is an important part of personal satisfaction.
Certification is maintained for five years. Completion of 125 contact hours every five years is required to maintain your certification. Application for recertification will be required at the end of the five year term.
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6. Certification Eligibility
Three requirements:
RN license that is current and unrestricted
Currently working full time or part time in perioperative nursing
Completion of a minimum of two years and 2,400 hours in the perioperative setting
RN licensure is required to take the CNOR exam. The license must not have any restrictions and be issued in the country where current practice is being performed.
Full time or part time employment is required within the perioperative specialty. Specialties include; nursing education, administration, research and clinical practice.
A minimum of two years and 2,400 hours of perioperative experience is required prior to taking the CNOR exam. The two years must equal at least 2,400 hours. At a minimum, half of those hours (ie, 1,200) must be intraoperative practice.
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7. Certification Exam Application Questions Grading Exam sites
Questions
Grading
Exam sites
Complete your application for certification online at the CCI website. Apply for the exam approximately two months before your desired test date. After you are accepted to take the exam, you will receive a confirmation from CCI. This will be followed by an Authorization To Test (ATT) letter via . You must bring this letter with ID to the testing site. There will be a locker available at the testing site for your personal belongings.
The CNOR exam consists of 200 multiple choice questions. The time frame in which to complete the exam is 3 hours and 45 minutes. There is only one correct answer for each question. The questions are divided between nine subject areas, or what we refer to as Domains. You must answer all questions. Any question left unanswered will be graded as incorrect. Each question is a multiple choice with four options. There is only one correct choice. On average, allow one minute per question.
Grading occurs using 185 of the questions. The other 15 questions are considered pretest questions and are dispersed throughout the exam. These questions are not part of your score. You will immediately be given a pass or no pass grade at the end of the exam. The passing score for the CNOR exam is 620. Once you receive a pass notification at the end of the exam you will not be given a specific score number. If you do not receive a passing score, you will receive a report outlining what areas need further study to help you pass when you retake the exam.
Exam sites throughout the country are contracted through a company called Prometric. Exams are available Monday through Saturday at different locations. Only after you receive the ATT letter, should you contact the Prometric staff to schedule your exam. On their website, you may select the getting started tab and then select schedule your test. A list of sites will be available by state.
The exam is computer based and does not require any previous computer training. You will have the option of a tutorial on the exam process before beginning the exam, if desired. The tutorial will explain the process of answering questions and how to tag questions you want to return to.
Upon successful completion of the exam, passing candidates will receive their CNOR Certificate via their in 5-7 days.
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8. Domains
The subject areas contained within the CNOR exam are based on nine different subjects, which we refer to as domains.
Each domain is further broken down into more specific items called topics that are on the exam.
Topics are then broken down into elements that represent specific perioperative nursing care.
Questions within each domain are written by a panel of experts. The questions are written and triple checked for accuracy with the most up-to-date references. These references are part of your study resources that will be discussed later. A yearly job analysis is completed each year by CCI to ensure the questions reflect the most accurate real life experiences. The domains are divided into a certain percentage of questions within the entire exam. Each domain also has required elements that we will review in these courses. These required elements break down the topics even further in to nursing practice. A detailed list of domains and associated items are located on the CCI website and in the back of your CNOR study guide.
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9. The 9 Domains
1-Preoperative Patient Assessment and Diagnosis (14%-26 Questions)
2-Identify Expected Outcomes and Develop an Individualized Plan of Care (9%-17 Questions)
3-Intraoperative Activities (31%-57 Questions)
The exam breakdown is as follows:
1-Peroperative Patient Assessment and Diagnosis (14%-26 Questions)
2-Identify Expected Outcomes and Develop an Individualized Plan of Care (9%-17 Questions)
3-Intraoperative Activities (31%-57 Questions)
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10. The 9 Domains 4-Communication (9%-17 Questions)
5-Transer of Care (5%-9 Questions)
6-Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies (12%-22 Questions)
4-Communication (9%-17 Questions)
5-Transer of Care (5%-9 Questions)
6-Cleaning, Disinfecting, Packaging, Sterilizing, Transportation, and Storing Instruments and Supplies (12%-22 Questions)
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11. The 9 Domains 7-Emergency Situations (8%-15 Questions)
8-Management of Personnel, Services, and Materials (6%-11 Questions)
9-Professional Accountabilities (6%-11 Questions)
7-Emergency Situations (8%-15 Questions)
8-Management of Personnel, Services, and Materials (6%-11 Questions)
9-Professional Accountability (6%-11 Questions)
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12. CCI Core Study Program Presentations
Overview
Domains 1 and 2
Case study: Domains 1 and 2
Domain 3
Case study: Domain 3
Domains 4 and 5
CNOR Practice exam
Case study: Domains 4 and 5
Domain 6
Case study: Domains 6
Domains 7, 8, and 9
Case study/review: all materials
This core study program will be spread out over twelve weeks. This presentation, the first of eleven, will be specific to the overview of the core study program. This will include a review of required and highly recommended resources for studying. Options for further resources will be given, as applicable throughout the presentations.
In each future presentation we will review one or more domain and focus on the questions within that domain. Each review will include discussing the topics contained within that domain. Then we will review the specific elements, or nursing practices, that fall within that domain. Each week’s domain presentation will be followed by a case study to review and put that domain into practice with sample questions. The final webinar will be a review of the entire study program. The webinar will give you a chance to reinforce your self study and understanding of the material presented. Then you will take the CNOR practice exam to complete a final assessment of your learning needs.
This study presentation is a basis for your own study. The presentations are meant to assist you with understanding the general content and requirements of the exam. The required and recommended resources as suggested within this study plan will help you to achieve your study goals.
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13. CNOR Study Guide CNOR Study Guide is your text book
Self Assessment Tool
Learning Needs Evaluation
CNOR Candidate Handbook
The CNOR study guide will be your text book for this course. There are other required and/or highly recommended resources listed later. The study guide is presented in such a way that it will enhance your learning process for successful completion of the exam. Students who are exposed to information in multiple formats have better recall and understanding of the information. Reading, listening, and interactive participation all help the learner to comprehend educational material better. The point of the study guide is to present you with several formats of studying that will best assist you to attain your goal. Suggestions for a study plan, critical thinking learning skills, and competencies are all contained within the study guide.
The Study Guide has a Self Assessment Tool. This is a way to evaluate your current readiness to take the certification exam. The results will help gauge where you will you need to focus more study time. It has basic questions to rate your level of comfort and experience within the different domains. For example, if you score lower in the preoperative area, you may want to schedule a day or so with a preoperative nurse in your facility to observe and learn the varying techniques for initial patient assessment before intraoperative care. You may also want to focus more of your reading, review, and group study on areas within Domain 1.
The Learning Needs Evaluation lets you score your current knowledge bases within the nine domains. Be honest when evaluating your current level of knowledge. This will guide you in your personal study plan. Domains that you are less certain of will require more of your study time.
The CNOR Candidate Handbook is a resource you may print off from the CCI website. It gives you an overview of the exam, the requirements of taking the exam, some sample test questions, and other helpful information that may answer some of your questions. The handbook also contains a breakdown of the domains, topics, and elements within each category into basic clinical application.
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14. Study Group
A great way to study for the exam is with a study group. You will be surrounded and supported by like-minded peers who share your goal to achieve certification. As a group, you can plan meetings to review the reading, review case studies in the presentations, share real life experiences, and support one another through the process. Develop your own case study based on one of your patients and then apply that weeks Domain Elements. Using the flashcards, your group can review practice questions and discuss the rationale that supports the correct answers. An additional benefit of a study group is to share resource material if purchasing all items is not possible. As you review the correct answers and rationale, it is important to understand why the incorrect answers are wrong. This will help you understand the application of the information. There is a suggested group study time in the sample calendar included in the program.
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15. Plan Resources Study group Test-taking strategies
We will list the required and highly recommended resources in this presentation. Obtain and review those resources. Create a personal study group, if desired, and make a schedule for planned study time and topics to help you stay on task. Additional resources directed at test-taking strategies and specifically for the CNOR exam are also located on the CCI website and are free. They are in the format of webinars. These webinars are presented monthly. If you missed a webinar you wanted to review, you are able to see previously recorded webinars, as well. These are a great resource for future test takers. We will examine how to locate the webinars on the next couple slides.
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16. Plan
On the main CCI website, click on the “CNOR” tab. Then click on the “Prepare for the CNOR Exam” link. Finally, click on the “Exam Preparation Resources” link.
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17. Preparation Material & Webinars
In the middle of the “Exam Preparation Resources” page is a list of free CCI preparation material. The last link under this heading is for “Certification Webinars.” On the webinar page a list of future webinars will be listed. Below that is the option to view previously recorded webinars.
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18. Essentials of CNOR Certification
Webinar trilogy
Essentials of CNOR Certification
An Insider’s Look to the CNOR Exam
CNOR Exam: Last Minute Tips for a Painless Testing Experience
Recorded Webinar on Essentials of CNOR Certification
There is a trilogy of webinars on the CCI website about taking the CNOR exam. They include; Essentials of CNOR Certification, An Insider’s Look to the CNOR Exam, CNOR Exam: Last Minute Tips for a Painless Testing Experience. This is the first webinar in that trilogy. It will give you an overview of the CNOR certification exam.
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19. Resources Required CNOR Study Guide Highly Recommended (one of these)
AORN Perioperative Standards and Recommended Practices, Current Edition
Highly Recommended (one of these)
Rothrock, J. C., (2014). Alexander’s Care of the Patient in Surgery. (15th Ed). Philadelphia, PA: Elsevier Mosby.
Phillips, N. M. (2013). Berry and Kohn’s operating room technique (12th ed.). St. Louis, Missouri: Elsevier Mosby.
(In each domain review we will refer to the above resources by the initials SRP, Alex, and B&K, consecutively)
Included in this program is the CNOR Study Guide as your text book. It is divided into nine chapters that match the nine domains. Each chapter focuses on suggested reading, case studies, activities to help build your knowledge base, and quizzes. The exam is based on the current years AORN Perioperative Standards and Recommended Practices. Other references that are used to write exam questions and validate rationale are the two “highly recommended” books listed. One of these books should be readily available for your review throughout this program. As we review the reading associated with the different domains, the book titles will be abbreviated as SRP, Alex, and B&K.
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20. Resources Highly Recommended
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Camera, I.M., (Eds.). (2011). Medical Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis: Elsevier Mosby.
A pharmacology text
A diagnostic testing text
Human Body Coloring Book by DK (2011)
ISBN-13: 
Highly recommended text books include a medical-surgical book like Lewis et al. This is another reference used to write some of the study questions for the various domains. In addition, a pharmacology and diagnostic testing book are highly recommended to supplement your practice and study regarding medications and laboratory results. The coloring book is a great updated version that contains a lot of information on anatomy and physiology. The format of this coloring book is set up to teach you in multiple ways to ensure your retention of information. Becoming familiar with information in the Perioperative Nursing Data Set (PNDS) will assist you with nursing diagnosis for the perioperative environment. The SRP contains information about PNDS, as well.
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21. CCI Resources Practice Exams and Resources-
CNOR Practice Exam (CD-ROM and On-line) 100 questions
Self-Assessment Exam (On-line) 200 questions
Flashcards 200 questions
Flashcards app 200 questions (same as hard copy)
Contact Hours From Resource Texts
Berry and Kohn’s
Alexander’s
In the CCI bookstore we offer two different practice exams. The CNOR Practice Exam is similar in content and format to the actual exam. You will never have an exact question on the practice exam as those within the actual exam. You will receive a pass or no pass statement at the end of the practice exam. Those individuals who want to experience the exam and time themselves in the most similar circumstance will benefit from using the CNOR Practice Exam. The CNOR practice exam has 100 questions. This practice exam will be given during the last week of this course.
The Self-Assessment Exam (SAE), available July 1, 2014, contains 200 questions and will give you a more detailed result of your answers. The SAE offers rationale as to why the answer is the correct choice. There will be a breakdown of areas that require more focused study. When you receive this breakdown, you will know what areas you need to study in more depth. Suggestions may include reading assignments or contact hour completion within certain chapters [of the resource books?] associated with domains that are located in the bookstore.
Flashcards are a very popular way to study, especially within study groups. There are two hundred questions. The answers are located on the back of the flashcards and have the specific reference for review from the resource text that particular question was taken from. You may have the hard copy of the cards or purchase flashcards as an app on your smart phone. Both formats contain the same questions. The app format randomizes the questions you are viewing. Periodically it may present you with a question you have already reviewed. This is part of the randomization. You do have two hundred total questions in the app.
Two of the highly recommended text books are located in the CCI bookstore with contact hours available for purchase. Every chapter within each of these two text books will eventually be in the bookstore and contain either 20 or 30 questions that are applicable to the exam domains. The contact hour resource is a great way to achieve and maintain your 125 contact hour requirement for recertification of the CNOR certification. We will be starting a program that contains 25 contact hours per year for five years as a simple way for certificants to receive and keep track of their contact hours for recertification. Make sure you are registered on the CCI website to keep track of your contact hours. Any hours received by attending AORN Expo are automatically applied to your CCI account once you are registered on CCI.
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22. Additional On-Line Resources
CCI
AORN
The Joint Commission
The World Health Organization
CCI has many resources on their website to help you prepare for the CNOR exam. They have references that may be downloaded. The study package in the book store includes the study guide, flashcards, and sample exam questions. The book store offers Alex and B&K for sale. Go to the website and explore what is available.
You are able to purchase the required references for the exam and the Perioperative Standards and Recommended Practices for the current year on the AORN website.
The Joint Commission website is a great reference site. Information on the website covers the National Patient Safety Goals and regulatory requirements that your facility policies should cover regarding much of the patient care material within the exam.
The World Health Organization has information related to the universal protocol process and its requirements.
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23. Additional On-Line Resources
Council on Surgical and Perioperative Safety
Agency for Healthcare Research and Quality
Epocrates (free app for smartphones)
MHAUS
Safe surgery resources are available on the Council on Surgical Perioperative Safety website
The Agency for Healthcare Research and Quality has good general information and specific patient safety information and tool kits.
Epocrates is an on-line pharmacology resource. It is free to access and you are able to enter medications into a search engine. You are required to register but there is no purchase required.
MHAUS is the best resource for the most up-to-date information on MH.
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24. Assignments Review the Study Guide
Read and complete the introduction in the CNOR Study Guide and the introduction to chapter 1.
Select one of your patients and create a concept map using the guide on the CD-ROM that is in the back of your study guide.
Use this concept map for your personal patient application throughout all chapters.
Complete the Self Assessment Tool.
Complete the Learning Needs Evaluation.
When creating your concept map, please use the patients initials and no identifying information.
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25. Looking Ahead Study Guide Example: Chapters correspond with domains
Modules correspond to topics and elements
Competencies are listed for each module
Example:
Chapter 1-Preoperative Patient Assessment and Diagnosis (Domain 1)
Module 1-Assess the Health Status of the Patient (Topics 2, 3, 4, 5, 6, 7, & 9)
The study guide is divided into chapters. These chapters correspond to the domains in numeric order. The modules within each chapter cover multiple topics and elements. Topics are the information about which the test questions are written. The topics are further broken down into elements. The elements are the actual nursing activities that you perform every day in your role as a perioperative nurse. Each module contains competencies specific to those topics. Demonstrating the competency listed means you have understood this module and are able to apply those competency outcomes in your practice.
An example of what to expect and how to best understand the organization of the study guide and how it relates to your practice is:
Chapter 1- Preoperative patient assessment and diagnosis. This is the same as domain 1. Domain one has 12 topics. Module one covers seven of the topics. You will have reading assignments and multiple activities to complete for each module. The goal for each module is to achieve the listed competency outcome.
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26. Sample Topic
Chapter 1 Perioperative Patient Assessment and Diagnosis (Domain 1)
Module 4 Obtaining Surgical Consent (Topic 12)
Elements (your nursing intervention):
Verify surgical consent
Competency Outcomes
Identify components of a surgical consent
Define surgical consent
Outline steps for obtaining consent
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27. Sample Question
A consent form signed on admission to the hospital for treatment is what kind of consent?
Informed consent
Basic consent
General consent
Admitting consent
As you consider the options, only one answer is correct just like on the CNOR exam. It is important to consider why answers are not correct as well. Use your critical thinking skills to review the options and choose the best answer.
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28. Answer C. General consent
Your reading assignment in the study guide for module 4 is B&K Chapter 3: Legal, regulatory, and ethical issues.
“This form authorizes the attending physician and the staff to render standard day-to-day treatment or to perform generalized treatments and care as the physician deems advisable” (B&K, 2013, p. 46).
Box 3-2, p. 46 has the differences between general consent and informed consent.
As we apply the topics and elements to patients in our case studies, we will have sample questions to give you an idea of how the test is conducted. Most questions are samples from the 2014 flashcards that are a great learning tool and in the CCI bookstore.
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29. Good Luck
Congratulations on taking the next step in your professional development and being committed to achieving your certification.
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