By Debi Boyle, MSN, RN, AOCNS®-Emeritus, FAAN 

You’ve accumulated the experience, practice hours, and NCPD, and now you’re ready to take the next step in your oncology nursing career and pursue OCN® certification from the Oncology Nursing Certification Corporation (ONCC). But what about the test? If the idea of sitting for the exam fills you with fear, you’re not alone—studies show that nurses often experience moderate stress (42.1%) and mild to moderate anxiety (19.4%–25.1%) about taking tests. 

After nearly four decades of maintaining and progressing my oncology nursing certification status (i.e., OCN®, AOCN®, AOCNS®) and leading review courses, I’ve learned some tips and strategies for success, and I want to share these recommendations to enhance your confidence as you embark on your examination experience.  

Do Your Homework: Know the Process and Specifics 

Read through the comprehensive information about OCN® certification on ONCC’s website, including:  

  • Logistics for establishing your eligibility for the exam  
  • Timeline for registering to take the exam 
  • Sample exam questions with rationale for correct answers 

The exam content addresses standardized practice for the profession. All questions must be supported by a current (within the past five years) published reference, so you will not see questions about very recent clinical practice findings and new norms. Questions also do not ask about modifications to care protocols that can vary from one institution or agency to another (e.g., red blood cell transfusion parameters, age to begin mammography screening).  

You are allotted three hours to answer 165 questions. Because your score is based on the number of items you answer correctly, even if you don’t know the answer to the question, it is best to guess because you have a 25% chance of answering correctly.  

When you submit your exam, you will be notified immediately whether you passed. You will also receive a Likert-like graph of how you fared in each of the six major test categories (see sidebar). ONCC will use the results to compile your Individualized Learning Needs Assessment (ILNA) plan for your next certification renewal. 

Critique the Test Content Outline and Create a Study Strategy 

The test content outline will help you determine your strengths and weaknesses in the exam’s six major content categories (see sidebar). Take time to look at this breakdown. It offers you the needed perspective to determine the scope of questions in particular areas and how you need to plan your dedicated study periods. You can also download a detailed overview of each of the domains’ subtopics.  

The Symptom Management and Palliative Care content area has the greatest number of questions and focuses on the etiology, presentation, anatomical and surgical implications, pharmacologic interventions, and nursing care for 12 alterations in functioning. It also includes integrative approaches, palliative care, and pain management.  

Critique Your Study and Test-Taking Skills 

The oncology nurses I have known personally who did not pass the OCN® exam had certain factors in common: 

  • Limited test-taking proficiency 
  • Difficulty with multiple choice questions 
  • Nursing education outside of the United States or a primary language other than English 

If any of those relate to you, I strongly advise that you pursue additional learning on test taking prior to sitting for the OCN® exam, such as: 

I also have known nurses who did not study before the exam and did not pass. They relied on their extensive knowledge relative to their specific area of practice and failed to consider that the exam tests basic oncology nursing tenets across numerous areas of cancer care.  

Case study: Maria, an experienced infusion clinic nurse, felt very knowledgeable about medical oncology. She assumed she would easily pass the OCN® exam and was shocked when she learned she did not. Preparing to retake the test, she uses the test content outline as a guide to review the areas where she did poorly and realizes that she was least knowledgeable about radiation therapy, quality improvement and research, and cancer prevention and detection. After she passes the exam on her second try, Maria advocates to her peers that undertaking a personal learning inventory is absolutely critical for OCN® exam preparation. 

ONCC also offers a 50-item (free) or 100-item ($75) practice test that you can use to ease any test-taking anxiety and foster your comfort with the style and format of questions you can expect on the exam. And don’t forget about ONCC’s DoubleTake and FreeTake® programs for extra reassurance. 

Reflect On How You Learn Best 

Is your learning enhanced by group discussion where others’ critical thinking influences your test-taking skills, or are you a solo learner?  

If you benefit from collective discussion about how others solve problems and determine correct test answers, then prepare in a team atmosphere. One group of ONS members spent a few hours on three subsequent Saturdays to review sections of the test content outline where they felt least confident. Another group of nurses in a multispecialty surgical oncology office setting chose to stay an hour after work for six Tuesdays to focus solely on reviewing symptom distress and its management with two of their practice’s nurse practitioners offering rationale for the correct answers. Alternatively, if you are a solo learner or easily distracted by noise and activity, plan for study time alone.  

Whether in a group or by yourself, you may need to lobby proactively for your study time in the context of your other commitments. An oncology nurse with school-age children shared the following message as an example of how they communicated their study priorities to their family:  

“I’m taking a special test related to my work that I need to study for, and I’m asking for your help. For the next six weeks, I will be studying on Sunday nights from 7–9 pm, and I need to have that uninterrupted time. It’s only for six weeks, so it’s a short-term need, but I am asking for your support to help me be able to pass this exam, which is very important to me.” 

Studying from a resource that comprehensively addresses all the exam topics is very helpful. The Core Curriculum for Oncology Nursing (seventh edition) and its companion study guide, developed by Elsevier in collaboration with ONS, addresses all components of the OCN® exam.  

Timing Is Everything 

Purposefully plan the timing of your exam around life commitments that might distract your dedicated study time. Consider the following example: 

Case study: It is early January, and Dan is in the process of planning to take the OCN® certification exam. He attended a review course in October and wants to take the exam as soon as possible after that. He submits his application in early December and expects to hear back from ONCC by the end of the year. While awaiting word that his application has been accepted, Dan reviews the OCN® Test Content Outline and highlights the content areas where he feels he needs to build on his existing knowledge base. Once he hears his application is accepted, he has 90 days to sit for the exam. He is planning to take the exam at the end of February so he will be finished with the process before his brother’s wedding on April 1. This timeline gives Dan approximately six weeks to study intensively (mid-January through the last week of February).  

Spread the Good News! 

Taking the step to seek certification is a testament to your commitment to excellence in cancer nursing. Upon your successful exam completion, market your accomplishment! Put ONCC’s plaques in your common areas. Let your peers, managers, and mentors know through newsletters and other institutional print media so they can applaud your achievement. 

Celebrated annually on March 19, Certified Nurses Day collectively showcases nurses’ professionalism and excellence and serves as a platform to elevate the importance of nurse certification. The ONCC office can also provide you with other items that you can use to promote specialty certification (e.g., pins, business cards). 

The OCN® exam is a platform to demonstrate your basic oncology nursing expertise. Do your homework, use a structured study plan, and talk positively to yourself on exam day to contain your anxiety. By validating your highly specialized proficiency in the care of patients with cancer, you’ll also serve as a role model for your colleagues. Best of luck!