The certified postanesthesia nurse (CPAN) and certified ambulatory perianesthesia nurse (CAPA) certifications were developed when surgical, preanesthesia, and postanesthesia patient care moved from the inpatient hospital setting to outpatient clinics or centers (Niebuhr & Muenzen, 2001). CPAN certification examinations were first offered by the American Board of Perianesthesia Nursing Certification (ABPANC) in 1986, and the CAPA certification examination was first offered in 1994. The current versions of these exams were developed after an extensive study, initially conducted by ABPANC in 1999 and 2000. This role delineation study (RDS) was conducted to determine patient needs and nursing knowledge necessary to care for these needs in both ambulatory and inpatient perianesthesia settings. The results of the 1999-2000 RDS determined that patient care needs were the same in ambulatory and inpatient settings, but that they varied in amount of nursing time spent meeting these needs (Niebuhr & Muenzen, 2001). In 2005 and 2006, another RDS was conducted and the examinations were updated as follows: the CPAN exam placed greater emphasis on behavioral/cognitive and safety patient needs, and the CAPA exam placed more emphasis on advocacy needs (Niebuhr & Muenzen, 2008). Both exams included four areas of patient need, physiologic, behavioral, cognitive, and advocacy (ABPANC, 2016). Another RDS was conducted in 2010-2011 and the need for two (CAPA and CPAN) exams was reaffirmed, though the four domains were reduced to three, incorporating advocacy throughout the other three domains (Niebuhr & Siano, 2011).