In 1942, the National Association of Nurse Anesthetists established a voluntary certification program to safeguard the interests of surgeons, hospitals and the public. Prerequisites for certification included minimum training standards, a valid nursing license and successful completion of a national certification examination. In 1975, the Council on Certification of Nurse Anesthetists was established as an autonomous decision-making body. Certification for nurse anesthetists is now recognized in two-thirds of the states and required by most employers–a factor that makes it vital to establish the job-relatedness of the examination. An innovative and responsible certification process will continue to be needed to address health care issues and advances in testing.