SRNA, GRNA, CRNA and ARNP:
Making sense of the process of certification and licensure

By Cary N. Carter, CRNA, MS, ARNP

Your efforts to become a CRNA began more than three years ago while working in an ICU or acute care setting. It was there that the drive to excel was born evidenced by the desire to take the most acute patients and challenging assignments. You wanted to put yourself in a position to be competitive with the other applicants for your chosen program. Then one day it arrived either by email, letter, or phone call. You were accepted into the Class of 2010 and the “hardest part” - getting accepted - was over. You were on the road to becoming a CRNA. During this time you may have also realized that getting accepted may have been one of the easier parts of the whole process. Since the day of acceptance you have spent the past 24 to 36 months working countless hours in the OR, studying until the wee hours of the morning for exams, and accumulating enough debt to buy a small farm in Montana. You are now on the verge of achieving your goal of becoming a CRNA. Yes, this is the moment you have been working towards. However, there are a few “hoops” that must be cleared before you deservingly write those coveted initials after your name. The “hoops” of which I speak are your certification by the Council on Certification of Nurse Anesthetists, which grants you the title of CRNA, and licensure by the state in which you intend to practice.

Now let’s first talk about Certification. As we all know, Certification = CRNA. As stated by the AANA website, The Council on Certification of Nurse Anesthetists (CCNA) has four purposes:

1. Formulate and adopt requirements for eligibility for admission to the Certification Examination and for certification of registered nurse anesthetists;
2. Formulate, adopt and administer the Certification Examination to those registered nurse anesthetists who have met all requirements for examination and have been found eligible by the CCNA;
3. Evaluate candidates' performance on the Certification Examination; and
4. Grant initial certification to those candidates who pass the Certification Examination and fulfill all other requirements for certification.

You will receive an application from the CCNA that includes paperwork that must be completed accurately. Your program has documented your didactic education and will include a signed copy of that curriculum that will be sent to the CCNA as proof of your eligibility. During your education you have been keeping a log (case counts) of all the cases in which you administered an anesthetic. It is this log that documents your clinical training and evidence of meeting the minimum requirements set forth for clinical eligibility. During the completion of this application you must follow the instructions to the letter or risk a delay in receiving your proof of eligibility. In addition, it is a requirement by the CCNA that your program (not you) must submit all the applications of eligible students and the applications must all be submitted together. Applications that are submitted with the proper documentation and correct information can take up to 4 weeks from the date of your program completion to receive proof of eligibility. Just imagine the time delay that could occur if it is not done correctly the first time! Your proof of being eligible to take the certification examination will come in the form of a letter and a card. Each one of these will have information specific to you that will allow you to log on to the testing center website and choose the time, day and location of your exam. (Preferably somewhere tropical, RIGHT!) Oh and by the way, don’t forget the check. A money order or cashier’s check is required to pay the examination fee of $725 at the time of application.

The requirements for the application are listed in the CCNA Candidate Handbook and can be found at www.aana.com/Credentialing.aspx?id=115. Below is a brief excerpt of the application process as listed in the handbook with some details I have underlined or placed in bold that deserve special attention.

Application Process

1. A signed, completed application typed or word-processed. All candidates must sign the “Waiver of Liability and Agreement of Authorization, Confidentiality, and Nondisclosure” on the application form.
2. A cashier’s check or money order for the examination fee payable to: “Council on Certification of Nurse Anesthetists.” Checks drawn on bank other than those in the United States must state “Payable in U.S. Funds.”
3. A copy of the candidate’s valid license to practice as a registered professional nurse .The license must be current on the date the candidate takes the examination. Copies of web verification of licensure are accepted only if the state board of nursing no longer issues paper licenses and if the verification page includes the state seal, an expiration date and the date that the verification page is printed.
4. An original official student transcript record that is not handwritten or hand-printed, which documents the candidate’s educational and clinical experiences. The transcript, which must be submitted directly by the program director, must:
   a) Be signed by both the program director and the candidate; (Program directors must submit all student transcripts within 30 days following completion of the program.)
    
   b) Accurately show that all the minimum requirements have been met, and that the candidate completed the program; and have the official seal of the program affixed or be properly notarized.
5. A sealed or notarized Authentication of Applicant Identity Form signed by both the program director and applicant, which includes a passport photo or digitalized photo of the applicant taken within the previous 6 months.

*Overnight mail should be used to confirm that the examination materials were received in the CCNA office. Confirmation by phone is not available.

**The CCNA will send all examination results by Federal Express. A street address must be provided (no PO Box) for receipt of results, because Federal Express does not deliver to a PO Box. Candidates will receive their results as quickly as Federal Express has service to their area. For most metropolitan areas, the service is overnight. In some areas, the service may be two-day. If results are processed on a Friday, candidates should receive them on the following Monday.

In my experience, the application “turn-around” time - when I received my notification of eligibility that allowed me to schedule my exam - was about 3 to 4 weeks. My application was completed the first week in May. I graduated on May 9 and I received my notification via mail by the end of May. From the date of eligibility, you have three months to complete the certification exam or are required to submit another application along with the full fee for the exam.

Now on to licensure! Licensure is a process in which the state board of nursing grants you permission to practice. Since all of us already have a Registered Professional Nursing license, the process is relatively easy. It is just a matter of submitting the proper application, paying the fees, and the state conducting a background check for both criminal and professional clearance. In the state of Florida, you are required to complete an application for Advanced Registered Nurse Practitioner and have it notarized. The fee for licensure in the State of Florida as of May 2009 for an ARNP was $148. The Board will review your application to ensure you have a clear and valid license that is free from any professional disciplinary action. You must also submit a fingerprint card. The Florida Department of Law Enforcement (FDLE) does a criminal background check for any recent arrests or convictions. Note: The fingerprint card is a specific type and others will be rejected and delay your application. If there have been any changes in your criminal history since starting your program that have not been resolved, the Florida Board of Nursing will put your application on hold until the final disposition of all pending criminal action. The application can be placed on hold for up to six months. After six months, you must submit a new application and pay the full fee. So hypothetically, if you are arrested for a minor offense in the last semester of your program and it takes 4 to 5 months to process things through the legal channels you could be waiting that entire time to receive your ARNP license. In the State of Florida, no license means you cannot work as a CRNA.

Once the Florida Board of Nursing grants you the ARNT (temporary) license, you may work as a Graduate Registered Nurse Anesthetist for up to one year without having the CCNA certification. Once you pass your “boards,” you will receive your ARNP licensure usually within three weeks. The Florida Board of Nursing processes each of these applications on a first-come-first-serve basis so it behooves you to submit your application early with all of the requested documentation.

The repeating theme when completing these applications is to make sure you follow the directions in detail and make sure to include the proper documentation. Doing it right the first time will ensure a smooth transition and save you time and anguish in the long run.