Wait…what is a CEN?

CEN stands for “Certified Emergency Nurse” and is a certification obtained from the Board of Certification for Emergency Nurses (BCEN) signifying mastery in the field of emergency nursing. The BCEN website states, “The CEN exam is for nurses in the emergency department setting who want to demonstrate their expertise, knowledge and versatility in emergency nursing.” Long story short: it’s a difficult certification to obtain and an accomplishment to be extremely proud of. In fact, once obtained, nurses can include CEN as part of their official professional signature.

When can I take it?

To officially qualify to sit for the CEN exam, all you need is a current, unrestricted RN license. The BCEN website also highly recommends 2 years working in the emergency department but I have additional suggested qualifiers. This exam is suppose to signify that you are an EXPERT in your field and is taken very seriously by seasoned nurses. You will be quick to piss us off if you’ve worked in an ER for 5 seconds and have helped with 3 traumas in your entire career. GET OUT OF HERE. In my opinion, before you even think about sitting for the CEN, you better have already earned your BLS, ACLS, PALS and TNCC at an absolute minimum. On top of that you should be 100% comfortable and confident in your ability to competently care for absolutely any patient that could come through your ER’s doors whether it be a trauma, STEMI, stroke, precipitous birth…ANYTHING!! Having your CEN means you are the top of the top; make sure you can walk the walk.

Why should I take it?

Some hospitals actually give you a raise to have your CEN because it makes them look better and, therefore, qualifies the hospital to receive more money. These are usually magnet status hospitals (which are awesome to work at as they represent exceptional nursing care). The initials CEN behind your name also make you more marketable as they ensure your competence to new employers! My main reason for taking the CEN though? It is a professional and personal accomplishment that I did for myself and am extremely proud of. It reminds me that I am a wealth of knowledge, have tons of experience and can handle anything; something even the best nurses need reminded of from time to time.

What does it cost?

ENA members get a huge discount on the CEN exam (and all exams put out by the BCEN). Here are the prices with an ENA membership and without:

Initial licensure: $230/$370
Retest initial licensure: $200/$340
Recertification: $210/$350
Retired recertification: $75

A lot of hospitals will pay for your CEN exam, study materials and recertifications down the road. Make sure to check with your manager or HR about options! Military personnel may also qualify for a full reimbursement; if this applies to you, makes sure to see if you are eligible!

How often do I renew it?

The CEN is renewed every four years either by a retest or by attesting that you have completed a minimum of 100 continuing education hours in those four years. You may be randomly audited so be prepared to prove your hours! According to the BCEN website, 10% of nurses renewing get audited.

What is the test like?

The exam itself is 180 minutes long and includes 175 questions. Of these 175 questions, only 150 are scored (25 are unscored pretest items). In order to pass, you must answer 106 of 150 questions correctly which is around a 70%. All exams are given in a proctored setting at a Pearson VUE testing center and strict rules are enforced to make sure there is no possibility of cheating. Your results are immediate following completion of your test so there isn’t a lot of time to freak out about the unknown! Additionally, don’t be too flipped out if you fail since there is around a 30-40% fail rate on the first try. If that statistic ends up including you, don’t panic: you have an unlimited number of times you can take the exam, you just have to wait 90 days between attempts.

The test itself is divided up between 8 different categories with a set number of questions from each one (unlike the NCLEX which plays off of what subjects you are doing well/poorly on). The exam is set up like this:

Cardiovascular emergencies – 20 questions
Respiratory emergencies – 16 questions
Neurological emergencies – 16 questions
Gastrointestinal, Genitourinary, Gynecology & Obstetric emergencies – 21 questions
Psychosocial & Medical emergencies – 25 questions
Maxillofacial, Ocular, Orthopedic & Wound emergencies – 21 questions
Environment & Toxicology emergencies and Communicable Diseases – 15 questions
Professional Issues – 16 questions

How do I study?

That depends entirely on you and your learning style! There are tons of options: in-person review courses, online review courses, many different study guide and practice test books, online practice exams, privately owned study materials and TONS of YouTube videos (I’m told Mark Boswell has the best ones!).

Here’s what I did: Because I was working as a travel RN when I took my CEN, I had to pay for everything myself out of pocket. Even though I am an ENA member, I still took a fairly cheap route. I purchased the ENA CEN Review Manual 5th Edition directly from the ENA website ($79.95 for non-members/ $63.96 for ENA members); this book is HUGE and contains four full practice exams and codes for 2 online timed exams to really get the idea of what a 3 hour exam feels like. Each of these tests include thoroughly detailed rationales for each questions. I took every bit of information included in these rationales that I didn’t know like the back of my hand and made approximately 1 zillion notecards to study from. I went through these notecards over and over again until I had them memorized. I also utilized a privately-made study guide that was given to me by a coworker; ask around!

Things you HAVE to know:

• Basic COBRA and EMTALA laws
• Basic emergency preparedness & FEMA info
• GI issues and the differences between symptoms
• Types of brain bleeds
• All kinds of overdose symptoms & management (including digoxin, lithium, acetaminophen, tricyclic antidepressants, etc.)
• Biological warfare chemicals, symptoms & antidotes
• OB emergencies
• Preload vs Afterload
• Where different MIs are located based on EKG findings
• All the medical “signs” (Kehr’s, Homan’s, Cullen’s, Battle’s, Chvostek’s, Trousseau’s, etc.)
• Medications! There’s a lot of pharm questions but it’s pretty random; make sure to know your psych meds, reversal meds and psych meds.
• Respiratory issues & treatments (know the difference between and lung sounds associated with croup, asthma, COPD, pulmonary contusion, pulmonary embolism, emphysema, pneumothorax, pneumonia, etc.)

Don’t worry so much about studying…

• Pediatrics
• Cranial nerves
• Spinal cord injuries
• Genitourinary issues

Are there other certifications like the CEN?

The Board of Certification for Emergency Nurses has four other certifications available at this time, none of them as popular as the CEN quite yet. As of the time of publication there are over 39,000 nurses who hold a CEN certification! The other certifications are:

Certified Flight Registered Nurse (CFRN) – 4,415 nurses
Certified Pediatric Emergency Nurse (CPEN) – 5,211 nurses
Trauma Certified Registered Nurse (TCRN) – 4,855 nurses
Certified Transport Registered Nurse (CTRN) – 236 nurses

Alright, you convinced me … now what?

Head on over to www.bcen.org and create a profile! Next fill out an application, submit it and pay the fees, get approved, schedule your exam at one of the designated testing sites and get to studying! Figure out your plan of attack and make your nursing dreams come true. You’ve put in the time, you’ve done the work, you’re ready to become a CEN!!

Focused Travels <3