How hard is the CFRN exam?

You must answer 108 of the 150 scored items correctly, a high bar. BCEN does not publish a pass-rate percentage, only counts. The difficulty concentrates in critical-care management and flight-specific physiology and operations. A question-bank-driven plan that front-loads ventilator management, drips, and altitude physiology is the most reliable approach.

Do I need flight hours to take the CFRN?

No. BCEN requires only a current unencumbered RN license. It recommends at least 2 years of specialty experience before testing, but that is a recommendation, not a requirement.

How much does the CFRN exam cost?

The initial exam is $285 for professional-association members (such as ASTNA) and $380 for non-members; a retest is $200. Confirm current pricing with BCEN.

How do I recertify the CFRN?

Every 4 years, by earning 100 CE contact hours during the cycle or by retaking the exam. Confirm the current requirements with BCEN.

CFRN vs CTRN: which should I take?

CFRN is for air medical (flight) transport; CTRN is for ground critical-care transport. The content overlaps heavily. Choose based on your role; many transport nurses earn both. An updated CFRN content outline takes effect in late 2026, so use current prep materials.

How to Pass the CFRN Boards

Certified Flight Registered Nurse · BCEN · Last reviewed June 21, 2026

Built by Keegan, a travel RN · verified against official board sources

CFRN is the credential for flight and transport nurses, who deliver critical care in the air. It is a demanding exam for a demanding role. Here is the format, who qualifies, a realistic study plan, and how recertification works.

Exam quick facts

Exam	BCEN Certified Flight Registered Nurse (CFRN)
Format	175 items (150 scored, 25 unscored pretest); computer-based at a PSI center or via Live Remote Proctoring
Time	180 minutes (3 hours) total seat time
Passing standard	Answer 108 of the 150 scored items correctly (raw score)
Pass rate	Not published as a percentage; BCEN reports counts only (930 exams passed in 2025; 7,769 active CFRN certificants)
Exam fee	$285 for professional-association members, $380 for non-members; retest $200
Recertification	Every 4 years: 100 CE contact hours or retake the exam

Exam specifications and fees change, so always confirm current details with BCEN before registering.

About the credential

The CFRN certifies knowledge in flight nursing, the critical care of patients during rotor- and fixed-wing air medical transport. It is administered by the Board of Certification for Emergency Nursing (BCEN). Like BCEN's other exams, it requires only an active RN license, though transport experience is strongly recommended. This guide covers the exam, who qualifies, an efficient study plan, fees, and recertification.

Who pursues it

Flight and critical-care transport RNs validating their specialty knowledge
ED and ICU nurses moving into air medical transport
RNs whose program offers a certification differential or requires the credential

Does the CFRN actually raise your pay? (The honest answer)

~60%

of nurses got no direct pay bump for certifying

$1-2/hr (~$2,000-4,000/yr full-time)

typical raise when employers do pay

$1,000-2,000 one-time at some employers

one-time bonus where offered

Here is the part prep vendors and certifying bodies will not lead with: in a large national compensation survey, about 60% of nurses got no direct pay increase for becoming certified. When it does pay, it is typically $1-2/hr or a one-time bonus, set by your employer, not by BCEN. Many flight programs require CFRN to hold the role at all, so for transport nurses it often functions as a gate to the job rather than a raise on your current one. Confirm the role requirement and pay with the program before assuming a bump.

When it's worth it anyway

A flight or transport program you want requires CFRN (many do).
Your program has a clinical ladder or certification differential; confirm the amount first.
You are using it as a resume differentiator into air medical transport.
You want the structured knowledge and confidence for safe critical-care transport.

Verified June 21, 2026. Sources:Medscape RN/LPN Compensation Report (about 60% received no reward for certification)

Eligibility

A current, unencumbered RN license in the US, a US territory, Canada, or Australia
No required practice hours: BCEN recommends, but does not require, at least 2 years of flight or transport specialty experience before testing

A study plan that works

1Weeks 1-2: Map the BCEN CFRN content outline and benchmark. Flight nursing blends critical care with transport physiology, so let the blueprint set your schedule and take a full-length practice set early. (Note: an updated CFRN content outline takes effect August 31, 2026, so use current materials.)
2Weeks 1-6: Run a question bank daily. Flight questions are critical-care and scenario-based, so daily reps with rationale review are the spine of the plan.
3Weeks 2-4: Front-load critical-care management by system. Advanced cardiac, respiratory (ventilator management and ABGs), neuro, and shock and hemodynamics, plus the trauma resuscitation content that dominates transport practice.
4Weeks 3-5: Drill the flight-specific physiology and operations. Altitude physiology and the gas laws (Boyle's, Dalton's), stresses of transport, aircraft safety and crew resource management, and the management of invasive lines, devices, and drips in the transport environment.
5Weeks 4-6: Cover special populations and specialty transports. Obstetric, neonatal, and pediatric transport, burns, environmental emergencies, and the IABP, ventricular-assist, and ECMO considerations seen on specialty teams.
6Weeks 4-6: Add the professional and safety domain. Scene and interfacility transport, documentation, legal and ethical issues, and the operational and survival content unique to air medical work.
7Weeks 7-8: Switch to timed, mixed practice. Build stamina for 175 items in 3 hours and rehearse pacing.
8Final week: Consolidate, do not cram. Work your error log and a high-yield ventilator, drips, and altitude-physiology sheet, taper new material, and confirm your PSI or LRP logistics.
9Throughout: Keep one error log. The final-week review of your specific missed questions is the highest-return activity.

Best CFRN review courses & question banks

BoardVitals CFRN Question Bank
Subscription qbank
Board-style flight and transport question pool with rationales; a strong primary qbank for application-level reps.
View BoardVitals
ASTNA Flight & Ground Transport Core Curriculum
Review course / books
The Air & Surface Transport Nurses Association's core curriculum, the foundational transport-nursing reference the exam draws on. (Listed for completeness; no affiliate relationship.)

Some links are affiliate links. If you buy through them, RenewRN may earn a commission at no extra cost to you. Courses listed without a link are included for completeness; we have no affiliate relationship with them.

Recommended CFRN books

ASTNA Patient Transport: Principles and Practice
The core transport-nursing reference the CFRN content draws on.
View on Amazon
CFRN Certification Review
An outline-plus-questions review resource for the BCEN CFRN exam.
View on Amazon

As an Amazon Associate, RenewRN earns from qualifying purchases, at no extra cost to you.

Before committing to a full qbank, take a set of flight and transport practice questions to see where you stand, especially on ventilator management, drips, and altitude physiology.

Try free CFRN practice questions

Which exam to take

CFRN certifies flight (air medical) nursing. BCEN also offers the CTRN for ground critical-care transport and the CEN for emergency nursing. The CFRN and CTRN share much content; choose CFRN for air transport, CTRN for ground, or CEN for the general ED credential. Many transport nurses hold more than one.

Keeping it current

BCEN certification is valid for 4 years. You can recertify by earning 100 CE contact hours within the cycle or by retaking the exam (at a test center or via Live Remote Proctoring). Confirm the current contact-hour rules with BCEN.

Frequently asked questions

How hard is the CFRN exam?: You must answer 108 of the 150 scored items correctly, a high bar. BCEN does not publish a pass-rate percentage, only counts. The difficulty concentrates in critical-care management and flight-specific physiology and operations. A question-bank-driven plan that front-loads ventilator management, drips, and altitude physiology is the most reliable approach.
Do I need flight hours to take the CFRN?: No. BCEN requires only a current unencumbered RN license. It recommends at least 2 years of specialty experience before testing, but that is a recommendation, not a requirement.
How much does the CFRN exam cost?: The initial exam is $285 for professional-association members (such as ASTNA) and $380 for non-members; a retest is $200. Confirm current pricing with BCEN.
How do I recertify the CFRN?: Every 4 years, by earning 100 CE contact hours during the cycle or by retaking the exam. Confirm the current requirements with BCEN.
CFRN vs CTRN: which should I take?: CFRN is for air medical (flight) transport; CTRN is for ground critical-care transport. The content overlaps heavily. Choose based on your role; many transport nurses earn both. An updated CFRN content outline takes effect in late 2026, so use current prep materials.

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