Oncology Certified Nurse · ONCC · 2026 test content outline · read November 14, 2026
OCN certification, exam rules with their sources
The OCN® is the credential ONCC awards to registered nurses in adult oncology, in clinical practice, administration, education, research or consultation. Eligibility requires an RN license plus recent adult oncology hours. The exam itself is 165 questions long, taken in a PSI test center seat, and each certification period runs 4 years before renewal. Each rule below cites ONCC's 2026 Certification Test Registration Manual or the 2026 OCN Test Content Outline, with page number and reading date. The 2026 outline moved the weights; the table further down shows the change area by area.
Read November 14, 2026 in ONCC's 2026 Certification Test Registration Manual, its examination statistics, its 2025 annual report and the OCN pages of oncc.org. Fees are the 2026 schedule.
Fact
Value
Source · read
Awarded by
Oncology Nursing Certification Corporation (ONCC)ONCC awards the OCN credential. The Oncology Nursing Society (ONS) is a separate membership society; its members pay the lower exam fee, but ONS does not give the exam.
Active, unencumbered RN license (US, its territories or Canada); 24 months as an RN in the last 48 months; 2,000 hours of adult oncology nursing practice in the last 48 months; 10 contact hours of oncology continuing education in the last 36 monthsUp to 5 of the 10 contact hours may be CME or CPE; an academic oncology nursing elective also counts.
2026 OCN Test Content Outline, used on tests from January 1, 2026The manual says the outline comes from a role delineation study completed in 2024 (ONCC’s OCN web page still mentions a 2020 study).
On computer at a PSI test center, year-round in the United States, US territories and CanadaThe manual describes testing at centers and mentions no home option. Outside North America there is one window a year: June 1–30, 2026, $75 extra, applications due March 1, 2026.
Scaled 55 (scores run from 25 to 75)Scores are equated between forms. The center’s screen gives pass or fail; the emailed report breaks results down by content area, and after a fail it also gives your scaled score.
A second attempt for $100 more, bought with the first applicationThe retest application is due no later than 180 days after the first attempt; the extra $100 stays with ONCC if you pass. International and beta sittings are excluded.
After a failed attempt you can reapply once the current 90-day window ends, and take the test no more than once per window; three failures within three years mean a one-year wait
In 2025, 65% of first-timers passed (1,999 of 3,071 candidates)First-time candidates only: 65% in 2024 (1,744 of 2,663), 65% in 2023 (1,661 of 2,546) and 62% in 2022 (1,491 of 2,394). Repeat candidates passed at 41% in 2025.
A free 50-question OCN practice test; one more practice test is sold separatelyONCC does not sell study materials; it publishes a reference list instead.
ONCC’s reference list includes the Core Curriculum for Oncology Nursing (7th ed., 2023) and the ONS Chemotherapy and Immunotherapy Guidelines (2nd ed., 2023)
The ONS/ONCC Chemotherapy Immunotherapy Certificate is an online ONS course with a post-test, and the ONS course page says it is not a professional certification. Completing it does not make you OCN-certified. How the three names fit together is set out on the home page.
How many pass on the first try
65%
passed on a first sitting in 2025
41%
41% of repeat candidates (2025)
Sources:5ONCC pass-rate statistics for 2025 (PDF, p. 1) · 6ONCC pass-rate statistics for 2024 (image PDF, p. 1) · 7ONCC test statistics, 2023 (PDF, p. 1) · 8ONCC exam statistics, 2022 (PDF, p. 1) · read
OCN first-time pass rate, 2022–2025
Who can apply: one license and three look-back windows
ONCC checks each requirement against the day you apply and again at the test itself (manual p. 6). The three time limits run backward from the application date:
RN experience:24 months as an RN in the last 48.
Oncology practice:2,000 hours of adult oncology practice in the last 48 months. Both direct and indirect patient care qualify, as do nursing administration, education, research and consultation in adult oncology, provided the job requires an RN or APRN (manual p. 7).
Continuing education:10 contact hours in oncology in the last 36 months, from an accredited provider of nursing continuing education; the share that may be CME or CPE is in the table row above.
A lapsed OCN means reapplying on the same terms as anyone new (manual p. 6). After ONCC approves the application, PSI sends your Authorization to Test, which opens a window of 90 days for the exam.
Counting back from your application
24 months as an RN
24 months
2,000 hours of adult oncology practice
2,000 h within 48 months
10 contact hours in oncology
10 h within 36 months
48 months36 monthsYou apply
Each window ends the day you apply; where the shorter spans fall inside it is up to you. 12
Six content areas and their 2026 weights
These are ONCC's weights for the six areas of the 2026 outline. A topic page shares the weight of its area and has none of its own; the table lists each topic page under the area or areas it draws on.
Down 2 points; the standards list was cut from 14 lines to 7, genomic testing (NGS) and performance status were added, and burnout and substance use now sit under self-care.
Up 1 point; chemotherapy, biotherapy and immunotherapy became one “systemic therapy” line (hormonal added), with new lines for localized and oral therapy and bispecific antibodies under targeted therapy; vascular access devices moved out to Domain IV.
IVSymptom Management and Supportive Careheavier in 2026
Up 4 points and renamed from “Symptom Management and Palliative Care”; vascular access devices moved in, and fatigue and cognition are no longer separate lines.
Down 2 points; the distress list was shortened and financial concerns moved to the end.
2026 outline2025 outline
Sources:2312 the two outline PDFs; "what changed" is our line-by-line comparison of them, not an ONCC summary.
Topics planned as pages of their own: mucositis, immunotherapy toxicities, extravasation and vesicants, nutrition and cachexia, screening and prevention, clinical trials, genetic and genomic testing, vascular access devices, and pain management. Until each one opens, it is covered inside the topic page listed above.
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What changed in 2026
From January 1, 2026 the symptom domain grew to 25% and became “Supportive Care” instead of “Palliative Care”; emergencies rose to 16%; the care continuum fell to 14%Our comparison of the 2025 and 2026 outline PDFs, not an ONCC summary.
For study planning, two shifts matter more than the rest. Symptom management and supportive care is now a quarter of the test (25%), and emergencies went up to 16%, so together they outweigh any other two areas. A prep book written to the 2025 outline can miss the new lines (bispecific antibodies, oral and localized therapy, next-generation sequencing) and gives the care continuum more room than the 2026 test does.
Keeping the OCN: hours, points or a retest
From ONCC's Certification Renewal Manual effective 2026, its ILNA page and its 2026 renewal fee page, read November 14, 2026.
Every 4 years, two of three: 1,000 adult oncology practice hours in the last 30 months, ILNA renewal points, or a passing test; plus 12 months as an RN in the last 36Option 1 is hours plus points; Option 2 is hours plus the test; Option 3 is points plus the test. Everyone renewing by points submits at least 25 points.
ONCC asks for two of three components: adult oncology practice hours, renewal points, or a passing test. Options 1 and 2 rest on the hours; Option 3 replaces them with points plus the test; ONCC describes it as the option for nurses who do not meet the practice-hour requirement (Certification Renewal Manual, 2026, pp. 4 and 14). The ILNA sets the point targets subject by subject. ONCC's ILNA page advises taking it as soon as possible in the first year of the four-year cycle, which leaves time to earn the points; the hard deadline is January 31 of the year renewal is due. Option 2, hours plus the test, is priced like an initial application, $420 at the standard rate or $300 for members. Option 3 costs more, $620, or $500 for ONS and APHON members, with $100 off by the September 15 early deadline (renewal manual, p. 4). A separate renewal page is planned; until then this section is the reference.
Practice before test day
Looking for an OCN practice test? ONCC's own offer is a free 50-question test on oncc.org, with a second test sold separately. On this site, the ten topic pages above each carry their own question set, and a full-length OCN practice test page is planned. The questions below are a first sample from across the outline. ONCC's tests name drugs by generic name only, and so do these questions.
A first set of 5 questions across the outline
Worked 0 of 5, with 0 right
Care continuum
Which occupational history is most strongly linked to malignant pleural mesothelioma?
Show the answer without choosingThe case for and against each choice
Flight crews have more cosmic radiation exposure, which is not linked to mesothelioma.
Uranium mining exposes workers to radon, a cause of lung cancer rather than mesothelioma.
Coal dust causes pneumoconiosis, not mesothelioma.
Asbestos insulation in shipyards is the classic mesothelioma exposure, with a latency of 20 to 40 years or more.
Radiation & transplant
As neutrophil counts recover after stem cell transplant, a patient develops fever, a rash, and non-cardiac fluid retention. What should the nurse suspect?
Show the answer without choosingThe case for and against each choice
Tumor lysis follows the start of cytotoxic therapy, not engraftment, and is a laboratory disorder.
Chronic GVHD develops months after allogeneic transplant, not at engraftment.
As neutrophils return, cytokine release can cause fever, red rash, and capillary leak; it usually responds to a short course of steroids.
Veno-occlusive disease causes weight gain with jaundice and a painful enlarged liver, without fever and rash.
Blood counts
A patient taking palbociclib for metastatic breast cancer has an ANC of 1,100/mm³ on day 15, no fever, and feels well. Which action does the nurse anticipate?
Show the answer without choosingThe case for and against each choice
Neutropenia is expected with CDK4/6 inhibitors and is rarely febrile; under the palbociclib label an ANC of 1,000/mm³ or more needs no hold or dose change.
Antibiotic prophylaxis is not used for the mild, noncomplicated neutropenia of CDK4/6 inhibitors.
Growth factor is not used for this expected, rarely febrile neutropenia; the label manages lower counts with holds and dose reductions.
The palbociclib label calls for no hold or dose change at an ANC of 1,000/mm³ or more; holds are reserved for lower counts or febrile neutropenia.
Safe administration
An IV bag of carboplatin leaks onto the floor of an infusion room. What is the nurse's first action?
Show the answer without choosingThe case for and against each choice
Cleaning without PPE and spill kit absorbents exposes the nurse and spreads contamination.
Keeping people out of the spill comes first, so no one else is exposed; then the nurse puts on spill kit PPE and contains it.
Water spreads the drug over a larger area.
Hazardous drug spills are handled by trained staff with a spill kit, not by routine mopping.
Psychosocial
A patient with prolonged neutropenia after induction chemotherapy for AML says, "I feel so cut off from everyone." Which action by the nurse is most appropriate?
Show the answer without choosingThe case for and against each choice
Video contact eases isolation without exposing the patient to infection, and it keeps the people who matter involved during a long admission.
Solo activities can fill time but leave the loneliness the patient describes unaddressed.
A mask does not make a visitor with a respiratory infection safe for a severely neutropenic patient.
Loneliness from isolation is not by itself depression; a medication request skips assessment and simpler support.
The OCN next to ONCC's other exams
The OCN is the general adult credential. Nurses whose practice hours are in a narrower field have an ONCC exam of their own, tested separately with the same hour minimum in that field: TCTCN™ for transplant and cellular therapy, CBCN® for breast care and ROCN™ for radiation oncology. For pediatric hematology and oncology the exam is CPHON®. Their facts are in the exam table on the home page.
The AOCNP is a different case. It is ONCC's credential for oncology nurse practitioners, with eligibility rules of its own, and it has no pages here.
OCN exam questions, answered from ONCC's documents
How many items does the OCN have, and how many count?
165 in all, of which 145 count toward the score and 20 are pretest items with no marker. You have 180 minutes for the whole sitting, tutorial included.
What scaled score passes the OCN?
A scaled score of 55 (scale 25–75). The result shows on screen at the center as pass or fail; the emailed report then breaks results down by content area.
What is the OCN pass rate?
For first-time candidates, 65% (2025). The same group passed at 65% in 2024, 65% in 2023 and 62% in 2022. ONCC reports repeat candidates separately; they passed at 41% in 2025.
How much does the OCN cost?
$420 at the standard rate; ONS and APHON members pay $300. ONCC also sells a second attempt for $100 more, bought with the first application.
Can I take the OCN from home?
ONCC's 2026 manual describes no way to sit it other than a PSI test center seat. The facts table above lists the countries and the once-a-year window for candidates outside North America.