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Critical care nursing certifications, by unit

Bedside critical care is not one specialty to the boards that certify it. A stroke unit, a trauma bay, a helicopter, a ground mobile ICU and a coronary care unit each have their own exam, written by a different board with its own hours rule, passing mark and renewal cycle. The board below lists them by setting, with the dates on which an outline or a passing score changed.

ExamsBecoming a flight nurse

Which certification fits which unit

changed in the last 12 months change ahead steady coming

Exam facts as each board publishes them, read November 11, 2026. Coming exams have facts but no study pages yet.
ExamAwarded byTotal questionsTime allowedPassing markExam feeOutline statusPractice
Stroke and neuroscience units
SCRNStroke Certified Registered Nurse exam · ABNNABNN1703 hScaled 200$400SteadyPractice
Trauma care
TCRNTrauma Certified Registered Nurse exam · BCENBCEN1753 h96 of 150$380ChangedPractice
Flight and ground transport
CFRN · CTRNCertified Flight and Certified Transport Registered Nurse exams · BCENBCEN175 (CFRN)3 h102 of 150 (CFRN), 99 (CTRN)$380ChangedPractice
Cardiac units
CMCCardiac Medicine Certification exam · AACNAACN902 h50 of 75$240Change aheadPractice
CSCCardiac Surgery Certification exam · AACNAACN902 h55 / 75$240Comingnew plan coming
Adult and pediatric ICU
CCRN (Adult)CCRN (Adult) acute/critical care nursing certification exam · AACNAACN1503 h83 / 125$375Comingcoming
CCRN (Pediatric)CCRN (Pediatric) acute/critical care nursing certification exam · AACNAACN1503 h83 / 125$375Comingcoming
Related credentials this site does not cover
PCCNProgressive care and step-down · AACNnot covered here
CENEmergency department · BCENnot covered here
CPENPediatric emergency department · BCENnot covered here
CNRNNeuroscience nursing · ABNNnot covered here

Read the rows by where you work, not by which acronym you hear most:

  • Stroke unit or stroke-ready ED: SCRN, from ABNN. It is the only exam here with fixed testing windows (Feb · May · Sep).
  • Trauma center, any department: TCRN, from BCEN. Comparing it with the TNCC course and CEN is on trauma nurse certifications.
  • Rotor-wing or fixed-wing transport: CFRN. Ground critical care transport: CTRN. Both come from BCEN, which runs them as separate credentials.
  • CCU, cardiac step-down, cath lab recovery, heart failure: CMC, the AACN cardiac medicine subspecialty.
  • CVICU, first 48 hours after heart surgery: CSC, also AACN. Its study pages are not written yet.
  • Adult or pediatric ICU: CCRN (Adult) or CCRN (Pediatric), AACN's specialty exams for intensive care. Facts are on the board; study pages come later.

The neonatal ICU has two credentials of its own, CCRN (Neonatal) from AACN and RNC-NIC from the National Certification Corporation, and progressive care has PCCN. They are listed for orientation only.

Order matters: hours, then a specialty, then a subspecialty

The boards disagree on what you need before applying, and that sets the order.

  1. BCEN checks the license only. TCRN, CFRN and CTRN have no hours rule; BCEN recommends about two years in the specialty but does not verify it.
  2. ABNN counts stroke hours. SCRN asks for direct or indirect stroke practice before you apply (RN + 2,080 h in 3 years).
  3. AACN counts acute care hours. The CCRN exams ask for time with acutely or critically ill patients (1,750 h / 2 y).
  4. CMC and CSC sit on top of another credential. Both require a current specialty certification plus cardiac hours, so they come after a specialty credential such as CCRN, PCCN or CEN, not instead of one. The rule and the dash in "PCCN-CMC" are explained on cardiac nursing certifications.

Transport is the exception to "certify when ready": the accrediting body for medical transport now makes CFRN or CTRN a condition of staying on an accredited crew. See how to become a flight nurse.

One question from each live exam

0 of 4 attempted · 0 correct · 0 missed

SCRN · Hyperacute Care · 42 items

A patient 3.5 hours from onset of left hemiplegia has clear hypodensity over more than one-third of the right MCA territory on CT. IV thrombolysis is withheld mainly because

Answer and why, all 4 options

Hemorrhage is bright (hyperdense) on CT; a dark area is infarcted tissue, so the scan shows completed ischemia, not bleeding.

This confuses the treatment window with the 3-hour limit of the Joint Commission STK-4 measure (arrival within 2 hours of last known well, lytic started within 3 hours); at 3.5 hours the patient is still inside the 4.5-hour window.

A proximal clot recanalizes less often with a lytic alone, which is why thrombectomy is added, but it does not bar the drug from an otherwise eligible patient.

Clear hypodensity over more than one-third of the MCA territory means that tissue is already dead; reperfusing it adds little benefit and raises the risk of symptomatic hemorrhage into the infarct, so the lytic is withheld.

Item 1876658

TCRN · Continuum of Care for Trauma · 36 items

A patient with chronic paraplegia has an implanted intrathecal pump for spasticity. The patient now has itching, rebound spasticity, fever, and new confusion, and the pump alarm is sounding. The nurse should suspect:

Answer and why, all 4 options

An interrupted intrathecal baclofen supply (empty reservoir, catheter kink or break, pump failure) causes withdrawal: itching, rebound spasticity, fever, confusion, and autonomic instability that can progress to rhabdomyolysis and death. The alarm is the clue; the provider is called at once and oral baclofen is often given as a bridge.

A UTI can increase spasticity and cause fever, but it does not explain pruritus or the pump alarm; anchoring on infection delays restoring the drug.

There is no expected reaction like this after a refill; new confusion and fever with a sounding alarm signal a delivery failure.

Autonomic dysreflexia occurs with injuries at T6 or above and causes sudden hypertension, pounding headache, and flushing above the level, not itching and fever with a pump alarm.

Item 536140

CFRN · Medical Emergencies · 35 items

The transport nurse is moving a patient with myasthenia gravis who took extra pyridostigmine doses today and now has worsening weakness and dyspnea. Which finding MOST suggests cholinergic crisis rather than myasthenic crisis?

Answer and why, all 4 options

Excess acetylcholinesterase inhibitor adds nicotinic fasciculations and muscarinic signs such as miosis, salivation and bradycardia, which a myasthenic crisis does not produce.

Ptosis comes from fatigable eyelid muscles and appears in both crises, so it cannot tell an underdosed patient from an overdosed one.

A falling vital capacity is the trigger to secure the airway in either crisis, but it does not separate excess from too little anticholinesterase.

Bulbar weakness with a poor cough is shared by both crises; it signals airway risk, not which direction the drug error went.

Item 565609

CMC · Therapeutic Interventions: procedures and devices

Two hours after femoral catheterization, the right foot is cool with a weak pedal pulse, and the patient reports tingling in the toes. Preprocedure pulses were strong and equal. The nurse should NEXT

Answer and why, all 4 options

Warming and rechecking later treats this as vasospasm or a cold room. That waiting period costs limb tissue when the cause is a clot or a dissection.

A pulse that was strong before the procedure and is now weak, with a cool foot and tingling toes, points to arterial occlusion at the access site from thrombus, dissection or embolus. Paresthesia means nerves are already ischemic, so the provider needs to know now for duplex study and possible intervention.

Coolness, a weaker pulse and paresthesia are never routine after catheterization. Charting them as expected confuses mild access-site soreness with limb ischemia.

Leg elevation cuts arterial flow into an underperfused limb. It helps venous swelling, not an arterial occlusion.

Item 2032643

Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →

Pass data and how each board counts it

changed in the last 12 months change ahead steady coming

ExamPass dataNurses certifiedOutline status
SCRNStroke Certified Registered Nurse exam · ABNN67.1% (2024)7,143Steady
TCRNTrauma Certified Registered Nurse exam · BCEN1,260 passed, 884 failed (2025)8,741Changed
CFRN · CTRNCertified Flight and Certified Transport Registered Nurse exams · BCEN930 passed, 680 failed (CFRN, 2025)7,769 CFRN · 669 CTRNChanged
CMCCardiac Medicine Certification exam · AACN71.3% (2025)5,147Change ahead
CCRN (Adult)CCRN (Adult) acute/critical care nursing certification exam · AACN72.0% (2025)102,129Coming
CCRN (Pediatric)CCRN (Pediatric) acute/critical care nursing certification exam · AACN68.7% (2025)8,953Coming
CSCCardiac Surgery Certification exam · AACN52.2% (2025)3,767Comingnew plan

The percentages in this table are not one statistic. For CCRN, CMC and CSC, AACN reports results of first-time candidates only. ABNN publishes counts of everyone tested, repeat candidates included, so the SCRN figure, 67.1% (2024), is a different measure. BCEN publishes only the number of exams passed and failed each year; the TCRN, CFRN and CTRN shares on this site are our arithmetic from those counts (passes over the total of passes and fails), and they include retakes. A share built from BCEN counts and a first-time rate from AACN cannot be ranked against each other to show which exam is harder.

Fees, retests and how long a credential lasts

changed in the last 12 months change ahead steady coming

ExamExam feeAfter a failValid forOutline status
SCRNStroke Certified Registered Nurse exam · ABNN$400Full fee, 3 tries a year5 yearsSteady
TCRNTrauma Certified Registered Nurse exam · BCEN$38090-day wait4 yearsChanged
CFRN · CTRNCertified Flight and Certified Transport Registered Nurse exams · BCEN$38090-day wait4 yearsChanged
CMCCardiac Medicine Certification exam · AACN$2404 tries in 12 months3 yearsChange ahead
CCRN (Adult)CCRN (Adult) acute/critical care nursing certification exam · AACN$3754 / 12 months3 yComing
CCRN (Pediatric)CCRN (Pediatric) acute/critical care nursing certification exam · AACN$3754 / 12 months3 yComing
CSCCardiac Surgery Certification exam · AACN$2404 / 12 months3 yComingnew plan

Every board here prices a member rate, and each ties it to a different association: AANN for SCRN, STN for TCRN, ASTNA for CFRN and CTRN, AACN for CMC, CSC and CCRN. Whether joining pays off depends on the exam fee and the renewal fee together, set against a year of dues; the AACN page works it through for AACN exams, and the BCEN page names each BCEN exam's partner association.

CEN, TCRN or CMC instead of CCRN?

Three pairings come up again and again when ICU nurses compare credentials. Each has a short answer, because each pair tests a different setting.

  • CEN or CCRN. CEN is BCEN's emergency nursing exam; CCRN is AACN's critical care exam with an hours requirement CEN does not have. Pick the one that matches the patients you see now. An ED nurse who floats to the ICU may hold both, and either one counts as the specialty certification CMC requires.
  • TCRN or CCRN. TCRN covers injury from prevention and prehospital care to rehabilitation, CCRN covers the whole adult ICU. A trauma ICU nurse qualifies for both; TCRN has no hours rule, CCRN does.
  • CMC or CCRN. Not either-or. CMC is a subspecialty that needs a current specialty certification first, and CCRN is one of the credentials that satisfies it.

Pages that compare across boards

Choosing a critical care certification

Which certification should an ICU nurse get first?

For a general adult or pediatric ICU, the usual first credential is CCRN, once you have the AACN hours. If your unit has a narrower focus, the matching exam can come first: SCRN for a stroke unit, TCRN for trauma, CMC only after a specialty certification.

Is there one critical care certification that covers every unit?

No. AACN, BCEN and ABNN each certify different settings, and none of their exams stands in for another. The unit table above pairs each exam with its setting.

Which of these exams can I take without experience hours?

TCRN, CFRN and CTRN. BCEN requires only a current RN license and recommends, but does not verify, about two years in the specialty. SCRN, CCRN, CMC and CSC all count practice hours.

Why do the pass rates on this page look so different?

Because the boards measure different things. AACN reports first-time candidates, ABNN reports everyone tested, and BCEN reports counts that we turn into a share. Compare rates only within one board.

Do employers require these certifications?

That is set by each employer, not by the boards. The one written rule we found applies to transport: CAMTS-accredited programs require CFRN or CTRN after two years of employment.

Dated outline and passing-score changes

ahead first, then newest

  1. ahead

    CMC Revised CMC test plan from AACN’s 2025 study of practice [26][27][28]

  2. ahead

    CSC Revised CSC test plan [27][29]

  3. changed

    CFRN New CFRN outline; passing score 108→102 of 150 [5][10][11][13]

    Before: 108

  4. changed

    CTRN New CTRN outline; passing score 92→99 of 150 [5][10][11][13]

    Before: 92

  5. changed

    TCRN New exam content outline; passing score 104→96 of 150 [6][7]

    Before: 104

  6. changed

    CCRN (Pediatric) New CCRN (Pediatric) test plan [20]

  7. changed

    CCRN (Adult) New CCRN (Adult) test plan [20]

Sources

all read Nov 11, 2026

  1. [1]ABNN: 2026 SCRN Candidate Handbook (PDF), pp. 3–4, 11, 14–22 abnncertification.org
  2. [2]ABNN: SCRN exam page (FAQ and exam statistics) abnncertification.org
  3. [3]ABNN: 2027 SCRN Candidate Handbook (PDF), pp. 3–4, 14–16 abnncertification.org
  4. [4]BCEN: About the TCRN exam bcen.org
  5. [5]BCEN: Candidate Handbook (PDF), pp. 5–7, 15 bcen.org
  6. [6]BCEN: TCRN FAQs bcen.org
  7. [7]BCEN blog: updating the TCRN certification exam bcen.org
  8. [8]BCEN: TCRN cost bcen.org
  9. [9]BCEN: About the CFRN exam bcen.org
  10. [10]BCEN: CFRN FAQs bcen.org
  11. [11]BCEN: CTRN FAQs bcen.org
  12. [12]BCEN: CTRN FAQs (Wayback capture of Jun 13, 2025) web.archive.org
  13. [13]BCEN blog: updating the CTRN certification exam bcen.org
  14. [14]BCEN: CFRN cost bcen.org
  15. [15]BCEN: CTRN cost bcen.org
  16. [16]AACN: CMC Exam Handbook, August 2026 (PDF), pp. 1–8, 12–13 aacn.org
  17. [17]AACN: yearly pass-rate table and cut-score page aacn.org
  18. [18]AACN: CMC (Adult) certification page aacn.org
  19. [19]AACN: CSC Exam Handbook (PDF) aacn.org
  20. [20]AACN: CCRN Exam Handbook (Adult, Pediatric, Neonatal), July 2026 (PDF) aacn.org
  21. [21]BCEN: Certification exam statistics, calendar year 2025 bcen.org
  22. [22]AACN: CMC and CSC frequently asked questions aacn.org
  23. [23]AACN: CMC Renewal Handbook, July 2026 (PDF), pp. ii–iii, 3–6 aacn.org
  24. [24]AACN: CCRN Renewal Handbook - Direct Care, July 2026 (PDF) aacn.org
  25. [25]AACN: CSC Renewal Handbook, July 2026 (PDF) aacn.org
  26. [26]AACN: CMC Test Plan for exams on or after November 19, 2026 (PDF), pp. 1–3 aacn.org
  27. [27]AACN newsroom: revised CMC and CSC exams launch November 19, 2026 aacn.org
  28. [28]AACN: CMC study of practice aacn.org
  29. [29]AACN: CSC test plan for exams from Nov. 19, 2026 (PDF) aacn.org