Curriculum Map
p Illustratin
ng Integratio
on of Comp
petency an
nd Practice Standardss
for the Pe
ediatric Clin
nical Nurse
e Specialistt Role
Inttroduction
Witth the release of the Consen
nsus Model forr APRN Regula
lation: Licensu
ure, Accreditatition, Certificatio
on & Education
on (LACE) in
200
08, programs offering
o
degrees for the clinical nurse spe
ecialist (CNS) have appraise
ed their curricu
ulum to ensure
e alignment
with
h one or morre of the six population
p
foc
ci: family/indiviidual across the
t
life span, adult-gerontology, pediatricc, neonatal,
wom
men’s health/g
gender-related
d or psych/me
ental health. Such
S
self-app
praisal can be
e challenging not only due to specific
req
quirements of the
t Consensus Model but also
a
because of
o specific com
mpetency stand
dards of vario
ous organizatio
ons that are
inte
egral to program accreditatio
on.
The
e following three pages inclu
ude a curriculu
um map with recommended
r
d coursework tthat integratess Clinical Nurse
se Specialist
Cor
ore Competenccies (2008), the
e ANA Scope and Standard
ds for Pediatricc Clinical Nurse
se Specialist P
Practice (2008), the AACN
Sco
ope and Stan
ndards for Acu
ute and Critica
al Care Cliniccal Nurse Spe
ecialist Practice
ce (2010) and the requirem
ments in the
Con
onsensus Mode
el for APRN Regulation:
R
Liccensure, Accre
editation, Certitification & Eduucation (2008)), as well as sstandards in
The
e Essentials of
o Master’s Ed
ducation in Nu
ursing (2011) and
a
the Nation
nal Council off State Boardss of Nursing’s Criteria for
AP
PRN Certificatio
ion Programs (2009). The specific
s
course
e titles provide
ed in this currriculum map a
are not a requ
uirement for
elig
gibility to sit forr AACN Certifiication Corporation’s pediatrric (wellness th
hrough acute ccare) clinical n
nurse specialisst ACCNS-P
exa
am. The sample course desc
criptions are presented
p
as examples
e
of co
ourses that wo
ould demonstra
ate adequate d
didactic and
pra
actical content of core APRN
N, CNS role an
nd population (pediatric) and
d wellness thro
ough acute ca
are to the exte
ent that was
valiidated by AAC
CN Certification
n Corporation’s
s 2011 Study of
o Practice of th
he Pediatric C NS.
The
e remainder off this documen
nt consists of a table that de
emonstrates the alignment off entry-level co
ompetencies a
and practice
standards identifiied by contentt experts focus
sed on the de
evelopment needs and practtice requireme
ents of the CN
NS providing
carre to the pediatric population
n along the con
ntinuum of wellness through acute care; a list of referen
nce documentss and where
the
ey can be found
d online (Guide
e to the Table of Standards Alignment,
A
pag
ge 5); and a G lossary of Term
ms (pages 35--39).
American Association of Critical‐Care Nurses AACN Certification Corporation Sample Curriculum for the Pediatric CNS
Other than the three required core courses (the “3 Ps”*) listed in The Essentials of Master’s Education in Nursing (2011), the
titles listed below are suggested. It is understood that programs may choose to organize curricula in a different manner.
Required competencies should, however, be clearly evident within the course description, syllabus or detailed course outline.
As the location of healthcare delivery is rapidly changing with technological innovations and reimbursement approaches,
practicum sites are also suggested, not required. Clinical sites and preceptor/faculty supervision should appropriately reflect
the population spectrum and align with content in the didactic course.
Course
*Advanced Pharmacology
Course Content
Pharmacological management of disease and symptom management, including
pharmacokinetics, pharmacotherapeutics and prescriptive issues, pharmacogenomics,
evidence-based efficacy studies, clinical case applications and patient-related factors such
as age, socioeconomic status and behavioral aspects that support the selection of
commonly used drugs
A complete description of content can be found in The Essentials of Master’s Education in Nursing.
*Advanced Pathophysiology
Focus on understanding complex physiological concepts significant for advanced practice
nursing. The interrelationships between clinical pathophysiology, physiology and genetics
are included.
A complete description of content can be found in The Essentials of Master’s Education in Nursing.
*Advanced Physical
Assessment and
Diagnostic Reasoning
Evidence-based advanced assessment skills including systematic collection, organization,
interpretation, formulation of diagnostic hypothesis and communication of health data
A complete description of content can be found in The Essentials of Master’s Education in Nursing.
2 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Course
Course Content
Conceptual, theoretical, ethical and empirical knowledge as a basis for nursing research
Evidenced-Based Practice
and Research Methodologies questions, identifying research designs, selecting sampling and data collection strategies,
and proposing analytic methods to answer a research question and evaluate completed
research for its scientific adequacy and applicability to practice. Approaches to
understanding and expanding the scientific body of knowledge in nursing
Role and Scope of the CNS
Analysis of the spheres of influence and the practice domains of the CNS in relationship to
current healthcare trends, models of care delivery and advanced nursing practice,
evaluation of care and key issues influencing CNS practice including the CNS leadership
role, interprofessional collaboration, healthcare policy and advocacy
Principles of Healthcare
Systems
Organizational culture, organizational assessment, patient safety initiatives, problem
identification, and quality improvement team building, change theory, process improvement
techniques, product value analysis, quality and performance indicators (e.g., NDNQI, core
measures, HCAP, etc.) as well as integration of healthcare technologies and informatics
systems.
Pediatric Care I: The Well
Child (health promotion,
disease prevention and
wellness)
CNS role in wellness (physical and mental), health promotion and disease prevention, risk
assessment and reduction, individual and community screening measures, and alternative
health practices through the life span from infancy through adolescent populations, including
but not limited to growth and development, developmental milestones, lifestyle management
(nutrition, weight, exercise, infection prevention), spinal disease, seizure disorders, fluid
volume imbalances, child/parental/caregiver assessment for injury and risk prevention,
congenital disorder and disease screening, vaccination scheduling, child abuse/neglect
screening, etc.
Pediatric Care I Practicum
Possible clinical areas: primary care/family practices, special-needs day camps, day care
centers, long-term care for pediatric populations, public health department, school health
programs, wellness facilities that provide care to pediatric populations, etc.
3 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Course
Course Content
Pediatric Care II: The Acutely CNS role in acute care (emergent, trauma, acute disease management) including but not
limited to the care needs of patients with structural heart defects, aspiration, traumatic
Ill Child
injuries, infectious diseases, systemic inflammatory response syndrome (SIRS)/sepsis/
septic shock/multiple organ dysfunction syndrome (MODS), etc. from infancy through
adolescence populations.
Pediatric Care II Practicum
Possible clinical areas: acute care facilities that provide acute care to pediatric populations
Pediatric Care III: The
Chronically Ill Child (chronic
and acute chronic care)
CNS role in management of chronic problems as well as management/prevention of acute
progression/exacerbation of chronic problems including but not limited to assessment and
management of asthma and reactive airway disease, diabetes, chronic renal failure, sickle
cell, oncological and hematological disorders, behavioral disorders, etc., from infancy
through adolescence populations. ++
Pediatric Care III Practicum
Possible clinical areas that provide care to pediatric populations: disease management
(e.g. emergency facilities, community hospitals, teaching hospitals, children’s hospitals).
clinics (diabetes, dialysis, sickle cell, etc.), outpatient facilities (oncology, short-term
rehabilitation, adolescent drug and alcohol centers), parish nursing, home healthcare,
hospice and palliative care facilities, special care needs facilities.
++
AACN Certification Corporation’s Study of Practice, Pediatric Acute Care Clinical Nurse Specialist Competencies and
Patient Care Needs and the test plan for the ACCNS-P certification exam include those patient care problems that met a
statistical level of significance common across major demographic areas. Program directors may, however, analyze survey
or other pertinent community data results to drill down and incorporate additional content into the curriculum based on
community/patient care needs.
4 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Guide to the Table of Standards Alignment
National CNS
Competency Task Force
Core Competencies
10/31/2008
American Nurses
Association (ANA)
Scope and Standards for
Pediatric Nursing Practice*
2008
American Association of
Critical-Care Nurses
(AACN)
Scope and Standards for
Acute and Critical Care
Clinical Nurse Specialist
Practice
4/7/2010
Available online at:
www.nacns.org/docs/CNSC
oreCompetenciesBroch.pdf
Available online at
www.nursesbooks.org/MainMenu/Standards/O-Z/Pediatric-Nursing-Scopeand-Standards-ofPractice.aspx
Available online at
www.aacn.org/APRNresources
*Includes only the Additional
Measurement Criteria for the
Advanced Practice Pediatric
Nurse
5 Copyright ©2012 AACN Certification Corporation AACN
Certification Corporation
Study of Practice Pediatric
(wellness through acute care)
Clinical Nurse Specialist
Competencies and
Patient Care Needs
6/10/2011
Available online at
www.aacn.org/APRNresources
American Association of Critical‐Care Nurses AACN Certification Corporation Table of Standards Alignment
National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
DIRECT CARE/CLINICAL JUDGMENT
Study of Practice – 61% related to Direct Care/Clinical Judgment competencies
Direct Care Competency
A.1. Conducts
comprehensive, holistic
wellness and illness
assessments using known
or innovative evidencebased techniques, tools and
direct and indirect methods
A.2. Obtains data about
context and etiologies
(including both non-disease
and disease-related factors)
necessary to formulate
differential diagnoses and
plans of care, and to identify
and evaluate outcomes
A.3. Employs evidencebased clinical practice
guidelines to guide
screening and diagnosis
A.4. Assesses the effects of
interactions among the
individual, family,
Standards of Practice
Clinical Judgment (61%)
Assessment
Clinical Judgment
1. Conducts comprehensive,
holistic assessments using
evidence-based techniques
and tools
2. Elicits comprehensive
history and performs
physical exams based on
patient’s presenting signs
and symptoms
3. Obtains data (including both
non-disease and diseaserelated factors) necessary to
formulate differential
diagnoses
4. Assesses impact of multiple
variables (e.g., among the
individual patient,
community, hospital and
social systems) that affect
health and illness
1. Conduct comprehensive, holistic
wellness/illness assessments
2. Obtain data necessary to formulate
differential diagnoses/plans of care
and evaluate outcomes
3. Use evidence base to guide clinical
practice
4. Synthesize data/advanced
knowledge/experience using critical
thinking to formulate differential
diagnoses
5. Determine diagnoses considering:
a. physiologic/pathophysiologic
changes
b. morbidities/co-morbidities
c. events across life span
d. patient’s pharmacologic history
with particular attention to issues of
polypharmacy
6. Use reliable and valid age-appropriate
Standard 1. Assessment

Initiates and interprets ageappropriate and conditionspecific laboratory tests and
diagnostic procedures
Standard 2. Diagnosis



Systematically compares
and contrasts clinical
findings with normal and
abnormal variations and
developmental events in
formulating a differential
diagnosis
Determines diagnoses
related to disease and injury
prevention and health
promotion, restoration and
maintenance
Utilizes complex data and
information obtained during
6 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
community and social
systems on health and
illness
A.5. Identifies potential risks
to patient safety, autonomy
and quality of care based on
assessments across the
patient, nurse and system
spheres of influence
A.6. Assesses the impact of
environmental/system
factors on care
A.7. Synthesizes
assessment data, advanced
knowledge and experience,
using critical thinking and
clinical judgment to
formulate differential
diagnoses for clinical
problems amenable to CNS
intervention
A.8. Prioritizes differential
diagnoses to reflect those
conditions most relevant to
signs, symptoms and
patterns amenable to CNS
interventions
A.9. Selects interventions
that may include, but are not
limited to:
A.9.a. Application of
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
5. Identifies potential risks to
patient safety, autonomy and
quality of care based on
assessments
6. Performs system-level
assessments to identify
variables that influence
patient outcomes and
nursing practice
7. Assesses interdisciplinary
practice for collaboration and
use of evidence based on
best practice guidelines
assessment instruments to assess
acute and chronic health concerns,
including but not limited to mental
status, delirium, dementia and pain
7. Assess for manifestation of health
disorders/disruptions, e.g., infection,
adverse drug effect, dehydration,
ischemia
8. Evaluate for mental health disorders
such as depression, dementia, anxiety
or substance-related disorders
9. Conduct pharmacologic assessment
including polypharmacy, drug
interactions, over-the-counter and
herbal product use and the ability to
safely and correctly store and selfadminister medications
10. Interpret values/results of
lab/diagnostic tests with consideration
of age, ethnicity and health status
11. Assess patient/caregiver/family ability
to implement complex plans of care
12. Assess patient/caregiver/family
preferences in relation to
cultural/spiritual/quality of life/lifestyle
choices
13. Prioritize differential diagnoses
14. Design strategies to meet multifaceted
needs of complex patients/groups of
patients
15. According to legal restrictions in the
Additional Measurement Criteria
for the AP Pediatric Nurse



interview, examination and
diagnostic procedures
Revises diagnoses as
appropriate to the ongoing
evaluation
Conforms diagnoses to an
accepted classification
system
Assists staff in developing
and maintaining competency
in the diagnostic process
Standard 3. Outcomes
Identification



Identifies expected
outcomes with consideration
of the associated risks,
benefits and costs for the
child and family
Identifies expected
outcomes that incorporate
cost and clinical
effectiveness, the child’s and
family’s satisfaction, and
continuity and consistency
among providers
Supports the use of the
clinical guidelines linked to
positive outcomes for the
child
1.
2.
3.
4.
5.
Diagnosis
Synthesizes data from
relevant sources to
formulate differential
diagnosis for clinical
problems
Makes decisions and
recommendations based on
data that range from simple
to complex
Analyzes benefits and costs
of care for programs,
organizations and society
Collaborates with patients,
families and other disciplines
to prioritize diagnosis
Identifies gaps in translation
7 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
advanced nursing therapies
A.9.b. Initiation of
interdisciplinary team
meetings, consultations and
other communications to
benefit patient care
A.9.c. Management of
patient medications, clinical
procedures and other
interventions
A.9.d. Psychosocial support
including patient counseling
and spiritual interventions
A.10. Designs strategies,
including advanced nursing
therapies, to meet the
multifaceted needs of
complex patients and
groups of patients
A.11. Develops evidencebased clinical interventions
and systems to achieve
defined patient and system
outcomes
A.12. Uses advanced
communication skills within
therapeutic relationships to
improve patient outcomes
A.13. Prescribes nursing
therapeutics, pharmacologic
and nonpharmacologic
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
Standard 4. Planning




Identifies assessment,
diagnostic strategies and
therapeutic interventions
within the plan of care that
reflect current pediatric
healthcare practice,
including data, research,
literature and expert clinical
knowledge
Devises a comprehensive
plan of care that reflects the
responsibilities of the
advanced practice nurse, the
child and the family; may
include delegation of
responsibilities and
consultation to assist others
in implementing the plan of
care
Participates in the design
and development of
multidisciplinary and
interdisciplinary processes to
address the situation or
issue
Formulates the
comprehensive plan of care
that includes educational
interventions related to the
1.
2.
3.
4.
5.
of evidence into practice
Outcome Identification
Identifies expected
outcomes that incorporate
scientific evidence and
translational research
and are achievable through
implementation of evidencebased practices
Collaborates with patients
and other healthcare
providers to identify
expected outcomes that are
consistent with the patient’s
present and potential
capabilities, as well as his or
her values, culture and
environment
Establishes incremental
indicators of progress in
achieving expected
outcomes
Identifies expected
outcomes for nurse and
system
Identifies and prioritizes
clinical and systems
problems using education,
evidence, expertise and
experiential knowledge
8 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
state, prescribe and/or recommend:
a. pharmacologic interventions
b. nonpharmacologic interventions
c. diagnostic measures
d. equipment
e. procedures
f. treatments
16. Provide direct care to selected patients
based on needs of patient and CNS’s
specialty knowledge and skills
17. Evaluate nursing practice that
considers safety, timeliness,
effectiveness, efficiency, efficacy and
patient/family centered care
18. Determine when evidence-based
guidelines/policies/procedures/plans of
care need to be tailored to individual
19. Manage or refer patient with
signs/symptoms of physical/mental
health disorders across the life span
20. Intervene to prevent/minimize
iatrogenesis
21. Differentiate between outcomes that
require care process modification at
the patient vs. system-level
22. Lead development of evidence-based
plans for meeting individual, family,
community and population needs
23. Provide leadership for collaborative,
evidence-based plans for meeting
individual, family, community and
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
interventions, diagnostic
measures, equipment,
procedures and treatments
to meet the needs of
patients, families and
groups, in accordance with
professional preparation,
institutional privileges, state
and federal laws and
practice acts
A.14. Provides direct care to
selected patients based on
the needs of the patient and
the CNS’s specialty
knowledge and skills
A.15. Assists staff in the
development of innovative,
cost-effective programs or
protocols of care
A.16. Evaluates nursing
practice that considers
safety, timeliness,
effectiveness, efficiency,
efficacy and patientcentered care
A.17. Determines when
evidence-based guidelines,
policies, procedures and
plans of care need to be
tailored to the individual
A.18. Differentiates between
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse




child’s health status,
conventional and alternative
therapies, self-care
activities, and appropriate
referrals and coordination of
comprehensive services to
ensure continuity of care
Documents the
comprehensive plan of care
in a manner that allows
access by the child, the
family, and healthcare
providers, and provides
direction for the family and
the healthcare team as they
focus on attaining expected
outcomes
Selects or designs strategies
to meet the multifaceted
needs of the complex
pediatric patient
Includes the synthesis of the
child’s and family’s values
and beliefs regarding
nursing and medical
therapies within the plan of
care
Contributes to the
development and continuous
improvement of the
organizational systems that
6. Identifies and analyzes
factors that enhance or
hinder the achievement of
desired outcomes
1.
2.
3.
4.
Planning
Designs evidence-based
strategies to meet the
multifaceted needs of
patients (e.g., safety, cost,
quality)
Develops age- and
population-specific clinical
standards, algorithms,
policies, procedures,
protocols and guidelines
Designs or selects health
information and patient
education appropriate to
developmental level, health
literacy level, learning
needs, readiness to learn,
preferred learning style and
cultural values and beliefs
Develops, implements and
modifies plans of care or
projects within all spheres
Implementation
1. Prescribes, orders and/or
9 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
population needs
24. Provide consultation to interdisciplinary
colleagues
25. Provide consultation to the
interdisciplinary team regarding the
patient’s mental status, home
environment, mobility, functional
status, self-care and caregiver’s
abilities
26. Coordinate care with other healthcare
providers and community resources,
with special attention to the needs of
the non-verbal, developmentally and
cognitively impaired patient
27. Initiate consultation to obtain resources
to facilitate progress toward achieving
identified outcomes
28. Design a comprehensive,
individualized, age- and diseaseappropriate plan for health promotion
29. Develop age-specific, individualized
treatment plans and interventions with
consideration of cognitive status,
sensory function, perception and the
environment
Patient Care Problems
A. Cardiovascular
1. Acute inflammatory disease (e.g.,
myocarditis, endocarditis,
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
outcomes that require care
process modification at the
individual patient level and
those that require
modification at the systemlevel
A.19. Leads development of
evidence-based plans for
meeting individual, family,
community and population
needs
A.20. Provides leadership
for collaborative, evidencebased revision of diagnoses
and plans of care, to
improve patient outcomes
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse

support the plan of care
process
Supports the integration of
clinical, human, and financial
resources to enhance and
complete the decisionmaking processes
Standard 5. Implementation





Facilitates utilization of
systems and community
resources to implement the
plan of care
Supports collaboration with
nursing colleagues and other
disciplines to implement the
plan of care
Incorporates new knowledge
and strategies to initiate
change in nursing care
practices if desired
outcomes are not achieved
Implements interventions
and treatments that are
based on current clinical
evidence and theory
Performs interventions and
treatments for which the
nurse has received
appropriate training and has
2.
3.
4.
5.
6.
7.
implements pharmacologic
and nonpharmacologic
interventions, treatments
and procedures as identified
in the plan of care within the
framework of state licensure,
credentials and privileges
Facilitates implementation of
an integrated plan of care
collaboratively with patients
and the healthcare team
Documents consultations,
assessments,
recommendations,
interventions and
evaluations in the patient
record
Leads system change to
promote health outcomes,
system efficiency and a
healthy work environment
through evidence-based
practice
Initiates appropriate referrals
and performs consultations
Implements evidence-based
algorithms, clinical
guidelines, protocols and
pathways for populations
Facilitates learning among
patients, staff, other
10 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
pericarditis)
Cardiac surgery
Cardiac tamponade
Cardiogenic shock
Cardiomyopathies (e.g.,
hypertrophic, dilated, restrictive,
idiopathic)
6. Decompensated heart failure
7. Dysrhythmias
8. Heart failure
9. Hypertension
10. Hypertensive crisis
11. Pulmonary edema
12. Structural heart defects and
diseases (acquired and congenital)
B. Pulmonary
1. Acute life-threatening events
(ALTE)
2. Acute respiratory failure
3. Air-leak syndromes (e.g.,
pneumothorax, pulmonary
interstitial emphysema [PIE],
pneumopericardium)
4. Acute lung injury (ALI) (e.g.,
ARDS)
5. Aspirations
6. Asthma and reactive airway
disease
7. Chronic lung disease
8. Exacerbation of chronic lung
disease
2.
3.
4.
5.
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse


demonstrated competency in
the skill or procedure being
performed
Implements the plan of care
using principles and
concepts of project or
systems management
Fosters organizational
systems that support
implementation of the plan of
care
Standard 5 A. Coordination of
Care and Case Management



Provides leadership in the
coordination of
multidisciplinary healthcare
for integrated delivery of
pediatric care services
Delegates appropriate
monitoring, assessments
and interventions according
to the condition of the child
and the relative skill and
scope of practice of the
caregiver
Provides case management
and clinical coordination of
care using sophisticated
data synthesis with
disciplines and
organizational leaders
1.
2.
3.
4.
5.
Evaluation
Bases the evaluation
process on advanced
knowledge, expertise, quality
indicators, benchmarking
and research
Evaluates all spheres to
ensure care is safe, timely,
effective, efficient, equitable
and patient-centered
Revises diagnoses,
expected outcomes and
interventions based on
information gained in the
evaluation process
Formally and informally
evaluates the clinical
practice of other healthcare
team members (e.g., nursing
staff, medical staff, other
healthcare providers)
Evaluates evidence-based
algorithms, clinical
guidelines, protocols and
pathways for populations
11 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
9. Pulmonary hypertension
10. Pulmonary infections
11. Thoracic surgery (e.g., fractured
ribs, hemothorax, lobectomy,
tracheal surgery)
12. Thoracic and pulmonary trauma
13. Upper airway obstruction
C. Endocrine
1. Diabetes insipidus
2. Diabetes mellitus
3. Diabetic ketoacidosis/
hyperglycemic hyperosmolar
nonketotic coma (HHNK)
4. Hyperglycemia
5. Hypoglycemia
6. Inborn errors of metabolism
7. Syndrome of inappropriate
secretion of antidiuretic hormone
(SIADH)
D. Musculoskeletal
1. Congenital abnormalities
2. Functional issues (e.g., immobility,
gait disorders)
3. Infections
4. Spinal disease (e.g., scoliosis,
kyphosis, disc disease)
5. Sports injuries
6. Traumatic fractures
E. Hematology/Immunology/Oncology
1. Anemia
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse


AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
2. Autoimmune diseases
3. Coagulopathies (including
thrombocytopenia)
4. Congenital and acquired
immunosuppression
5. Leukemia and tumors
6. Sickle cell disease
F. Neurology
1. Encephalopathy
2. Head and brain trauma
3. Hydrocephalus
4. Increased intracranial pressure
5. Intracranial and intraventricular
hemorrhage
6. Neurologic infectious diseases
7. Neuromuscular disorders
8. Seizure disorders
9. Space-occupying lesions
10. Spinal cord injury
11. Stroke
12. Vascular malformation
G. Gastrointestinal
1. Abdominal trauma
2. Acute GI hemorrhage
3. Bowel infarction, obstruction,
perforation
4. Gastro-esophageal reflux
5. Gastrointestinal infectious diseases
6. GI motility disorders
7. GI surgeries
consideration of the child’s
and family’s complex needs
and desired outcomes
Coordinates system and
community resources to
achieve optimal quality of
care, delivered in a costeffective manner within an
interdisciplinary team
approach
Negotiates health-related
services and additional
specialized care with the
child, the family, appropriate
systems, agencies and
providers across continuums
of care
Standard 5B. Health-Teaching
and Health Promotion,
Restoration and Maintenance
The pediatric nurse employs
strategies to promote health and
a safe environment

Employs diverse and
complex strategies,
interventions, and teaching
with the child and the family
to promote, maintain,
restore, and improve health,
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American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
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ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse



AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
8. Hepatic failure and coma
9. Hepatitis
10. Malnutrition
11. Nausea and vomiting
H. Renal/Genitourinary
1. Acute renal failure
2. Chronic renal failure
3. Electrolyte imbalances
4. Fluid volume imbalances
5. Infections (e.g., UTI, PID, STDs)
I. Integumentary
1. Pressure ulcers
2. Wounds (surgical and non-surgical)
J. Multisystem
1. Burns (e.g., management of
superficial, pre-transport of
partial/full thickness)
2. Compartment syndrome
3. Distributive shock (e.g.,
anaphylaxis, neurogenic)
4. End-of-life issues
5. Hypovolemic shock
6. Hypoxic ischemic encephalopathy
7. Infectious diseases (e.g., viral,
bacterial, hospital-acquired)
8. Multisystem trauma
9. Near-drowning
10. Pain (e.g.,
pharmacologic/therapeutic
interventions)
and to prevent illness and
injury
Synthesizes empirical
evidence on risk behaviors,
learning theories, behavioral
change theories,
motivational theories,
epidemiology, and other
related theories and
frameworks when designing
health information and
pediatric education
Bases anticipatory guidance
and teaching on current
scientific knowledge,
research, epidemiological
principles and the family’s
health beliefs and practices
Provides the child and the
family information regarding
the interventions including
potential benefits, risks,
complications and
alternatives
Standard 5C: Consultation

Bases consultative activities
on theoretical frameworks,
including those that focus on
family systems and family13 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
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Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse





AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
11. Palliative care issues (e.g.,
symptom management)
12. Patient safety issues
13. Sensory impairment (e.g., hearing
loss)
14. Systemic inflammatory response
syndrome (SIRS)/sepsis/septic
shock/multiple organ dysfunction
syndrome (MODS)
15. Toxic ingestions and inhalations
K. Psychosocial/Behavioral/Cognitive
Health
1. Age-related developmental issues
2. Anxiety disorders (e.g., PTSD,
OCD, fears)
3. Attention Deficit–Hyperactivity
Disorder (ADHD)
4. Failure to thrive
5. Maltreatment (abuse/neglect)
6. Medical nonadherence
7. Mood disorders (e.g., depression)
8. Substance abuse
9. Suicidal behavior
centered care, and on
evidence for best practice
Bases consultation on
mutual respect among the
child, the family and other
primary caregivers
Initiates consultation through
mutual identification of the
needs for intervention and
problem identification
Initiates appropriate
consultation to implement
the interdisciplinary plan of
care for the child with
consideration given to the
child’s unique developmental
needs and abilities and the
family’s level of adaptation
and ability to cope with the
child’s health concerns
Communicates consultation
recommendations in terms
that facilitate change
Supports the child and the
family in their decision
making regarding
implementation of the plan of
care
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Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Standard 5D: Prescriptive
Authority and Treatment





Skills and Procedures
If skills or procedures are incorporated into
exam items, knowledge about the skill or
procedure would be limited to its purpose
and would not require in-depth knowledge
of the performance of the skill or
procedure.
Prescribes evidence-based
treatments, therapies and
procedures considering the
child’s comprehensive
healthcare needs and based
on current pediatric
knowledge, research and
practice
Prescribes appropriate nonpharmacological
interventions, including
complementary and
alternative therapies
Performs procedures as
needed in the delivery of
comprehensive care to the
child
Prescribes pharmacologic
agents based on current
knowledge of
pharmacological and
physiological principles that
are both universal and
unique to the care of children
at each stage in their
development
Prescribes specific
pharmacologic agents and
I.
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Cardiovascular
 Interpret ECG rhythms
 Interpret 12-lead ECGs
 Determine lead selection for ECGs
 Interpret hemodynamic values
 Interpret noninvasive
hemodynamic values
 Manage transcutaneous (external)
pacemakers
 Manage temporary transvenous
pacemakers
 Manage permanent transvenous
pacemakers
 Manage epicardial pacemakers
 Manage implantable cardioverter
defibrillators (ICDs)
 Manage cardiac assist devices
(e.g., RVAD, BVAD, LVAD,
ECMO)
 Direct cardiopulmonary
resuscitation
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse





AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
treatments based on clinical
indicators, the child’s status
and needs, and the results of
diagnostic and laboratory
tests
Provides the child and family
with information about
diagnostic and laboratory
results, as well as effects
and potential adverse effects
of proposed prescriptive
therapies
Evaluates therapeutic and
potential adverse effects of
pharmacological and nonpharmacological treatments
Provides information to the
family regarding agents the
child should refrain from
taking because of the
potential adverse effects on
the child
Provides the child and family
with information about costs,
alternative treatments and
procedures as appropriate
Monitors current issues
related to pharmacological
agents, including off-label
use and pediatric safe
 Insert pulmonary artery pressure
catheters
 Adjust pulmonary artery pressure
catheters
 Perform elective cardioversion
 Disconnect pacer wire
16 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
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II.
Pulmonary
 Order nasal/facial CPAP/BiPAP
 Initiate mechanical ventilation
 Manage mechanical ventilation
 Wean mechanical ventilation
 Interpret pulmonary function tests
 Disconnect chest tube
III.
Gastrointestinal
 Remove PEG/JT/drainage
catheters
IV.
Renal/Genitourinary
 Initiate renal replacement
therapies
V.
Integumentary
 Provide wound care
VI.
Multisystem
 Interpret diagnostic imaging
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
 Provide nonpharmacological
interventions for pain
 Manage (i.e., recommend/
prescribe) pharmaceutical
interventions
 Prescribe durable medical
equipment
dosage for medications
Standard 5E: Referral




Discusses referrals with the
child and family
Makes referrals to other
healthcare providers and
community service agencies
as appropriate to the needs
of the child with
consideration of benefits and
costs
Ensures continuity of care
throughout the healthcare
referral process by
implementing
recommendations from
referral sources
Identifies and coordinates
access to appropriate
community resources
Standard 6: Evaluation


Evaluates the accuracy of
the diagnosis and
effectiveness of the
interventions in relationship
to the child’s attainment of
expected outcomes
Bases the evaluation
17 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
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American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse



AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
process on advanced
knowledge, practice and
research about child
healthcare
Utilizes results of evaluation
analyses to revise or resolve
the diagnoses, expected
outcomes and plan of care
Synthesizes the results of
the evaluation analyses to
determine the impact of the
plan of care on the affected
child, family, groups,
communities, institutions,
networks and organizations
Utilizes the results of the
evaluation analyses to make
or recommend process or
structural changes including
policy, procedure or protocol
documentation as
appropriate
18 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
STANDARDS OF PROFESSIONAL PERFORMANCE
Study of Practice – 39% related to Professional Practice competencies
Consultation Competency
B.1. Provides consultation to
staff nurses, medical staff
and interdisciplinary
colleagues
B.2. Initiates consultation to
obtain resources as
necessary to facilitate
progress toward achieving
identified outcomes
B.3. Communicates
consultation findings to
appropriate parties
consistent with professional
and institutional standards
B.4. Analyzes data from
consultations to implement
practice improvements
Standard 10: Collegiality




Models expert practice to
interdisciplinary team
members and healthcare
consumers
Participates on
interdisciplinary teams that
contribute to role
development, advanced
pediatric nursing practice
and healthcare
Contributes to an
environment that is
conducive to clinical
education of other
healthcare providers,
including teaching,
mentoring and precepting
Contributes to the
professional development of
others to improve child
healthcare and to foster the
profession’s growth
Collegiality
Caring Practices
1. Contributes to the
advancement of the
profession as a whole by
disseminating outcomes of
practice through
presentations and
publications
2. Promotes career
development in students,
nurses and other healthcare
providers
3. Promotes the role and scope
of practice of the CNS (e.g.,
to legislators, regulators,
other healthcare providers,
the public)
4. Facilitates development of
clinical judgment in
healthcare team members
through role modeling,
teaching, coaching and/or
mentoring
1. Use advanced communication skills to
improve patient outcomes
2. Assess the effects of interactions
among the
individual/family/community/social
systems
3. Identify potential risks to patient
safety/autonomy and quality of care
based on assessments across all
spheres of influence
4. Determine nursing practice and system
interventions that promote
patient/family/community safety
5. Select interventions that may include,
but are not limited to:
a. application of advanced nursing
therapies
b. initiation of interdisciplinary team
meetings/consults/other
communications to benefit patient
care
c. management of pain meds/clinical
procedures/other interventions
d. psychosocial support including
19 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
patient counseling and spiritual
interventions
6. Create therapeutic health-promoting,
aging-friendly environments
7. Provide leadership to address threats
to healthcare safety/quality
8. Use behavioral, communication and
environmental-modification strategies
with individuals who have
cognitive/psychiatric impairments
Quality of Care,
Resource Utilization,
Authentic Leadership
Research Competency
C.1. Facilitates the provision
of clinically competent care
by staff/team through
education, role modeling,
team building and quality
monitoring
C.2. Performs system-level
assessments to identify
variables that influence
nursing practice and
outcomes, including but not
limited to:
C.2.a. Population variables
(age distribution, health
status, income distribution,
culture)
Standard 14. Resource
Utilization



Utilizes organizational and
community resources to
formulate multidisciplinary or
interdisciplinary plans of
care
Develops innovative
solutions for child healthcare
problems that address
effective resource utilization
and maintenance of quality
Develops evaluation
strategies to demonstrate
cost effectiveness, cost
1.
2.
3.
4.
Quality of Care
Leads clinical inquiry
through quality improvement
activities
Uses systems thinking and
theoretical frameworks to
initiate changes in practice,
process and delivery
Identifies and develops
strategies to enhance quality
care and promote a healthy
work environment
Synthesizes quality
improvement data and
formulates evidence-based
20 Copyright ©2012 AACN Certification Corporation Systems Thinking
1. Perform system-level assessments to
identify variables that influence nursing
practice and outcomes, including but
not limited to:
a. population variables (age
distribution, health status, income
distribution, culture)
b. environment (schools, community
support services, housing
availability, employment
opportunities)
c. system of healthcare delivery
d. regulatory requirements
e. internal and external political
influences/stability
f. healthcare financing
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
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Core Competencies
C.2.b. Environment (schools,
community-support
services, housing
availability, employment
opportunities)
C.2.c. System of healthcare
delivery
C.2.d. Regulatory
requirements
C.2.e. Internal and external
political influences/stability
C.2.f. Healthcare financing
C.2.g. Recurring practices
that enhance or compromise
patient or system outcomes
C.3. Determines nursing
practice and system
interventions that will
promote patient, family and
community safety
C.4. Uses effective
strategies for changing
clinician and team behavior
to encourage adoption of
evidence-based practices
and innovations in care
delivery
C.5. Provides leadership in
maintaining a supportive
and healthy work
environment
ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Additional Measurement Criteria
for the AP Pediatric Nurse






benefit and efficiency factors
associated with pediatric
nursing practice
Develops evaluation
methods to measure safety
and effectiveness for
interventions and outcomes
Promotes activities that
assist others, as appropriate,
in becoming informed about
costs, risks and benefits of
care or the plan of care and
solution
Initiates ongoing activities to
analyze patient care
systems in an effort to
improve the quality of care
provided to children and
their families
Uses aggregate data, in
cooperation with others, to
develop or revises systems
to avoid duplication of or
gaps in service
Advocates for the removal of
barriers to care and for
optimal care for the child and
family
Develops innovative
solutions and applies
recommendations to
improve quality care and
practice
5. Conveys the tangible
benefits of advanced
practice nursing to the
organization, system and
community
2.
3.
1.
2.
3.
4.
5.
6.
Resource Utilization
Considers fiscal and
budgetary implications in
decision making regarding
practice and system
modifications
Conducts cost/benefit and
cost avoidance analysis of
programs, processes and
technologies
Evaluates impact of
introduction or withdrawal of
products, services and
technologies
Facilitates access for
patients to appropriate
healthcare services
Assists staff in the
development of innovative,
cost-effective programs or
protocols of care
Interprets and facilitates
21 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
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4.
5.
6.
7.
8.
9.
g. recurring practices that enhance or
compromise patient or system
outcomes
Use effective strategies for changing
clinician and team behavior to
encourage adoption of evidence-based
practices and innovations in care
delivery
Provide leadership in maintaining a
supportive and healthy work
environment
Evaluate use of products and services
for appropriateness and cost/benefit in
meeting care needs
Conduct cost/benefit analysis of new
clinical technologies
Evaluate impact of introduction or
withdrawal of products, services and
technologies
Assess the impact of
environmental/system factors on care
Coordinate the care of patients with
use of system and community
resources to assure successful
health/illness/wellness transition,
enhance delivery of care and achieve
optimal patient outcomes
Manage patient’s transitions of care in
collaboration with individual/family/
caregivers/interdisciplinary team
members including:
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
C.6. Provides leadership in
promoting interdisciplinary
collaboration to implement
outcome-focused patient
care programs meeting the
clinical needs of patients,
families, populations and
communities
C.7. Develops age-specific
clinical standards, policies
and procedures C.8. Uses leadership, team
building, negotiation and
conflict resolution skills to
build partnerships within and
across systems, including
communities, system
modifications
C.9. Coordinates the care of
patients with use of system
and community resources to
assure successful
health/illness/wellness
transitions, enhance delivery
of care and achieve optimal
patient outcomes
C.10. Considers fiscal and
budgetary implications in
decision making regarding
practice and system
modifications: ANA Scope and Standards
for Pediatric Nursing Practice
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
integration of organizational
mission, goals and systems
into patient care practices
7. Role models and mentors
innovative systems thinking
and resource use among the
healthcare team
8. Develops strategies to
facilitate transition of
patients through the
healthcare system
9. Assesses and facilitates
understanding of the impact
of social, political, regulatory
and economic forces on the
delivery of care
a. analyzing the readiness of the
patient and family to transition
b. determining the appropriate level
and/or setting of care
c. coordinating implementation of
transition
10. Provide leadership in conflict
management/negotiation to address
problems in the healthcare system
11. Lead system change to improve health
outcomes through evidence-based
practice by:
a. specifying expected clinical and
system-level outcomes
b. designing programs to improve
clinical and system-level processes
and outcomes
c. facilitating the adoption of practice
change
12. Evaluate impact of CNS and other
nursing practice on systems of care
using nurse-sensitive outcomes
13. Disseminate outcomes of system-level
change internally and externally
14. Assess system barriers and facilitators
to adoption of evidence-based
practices
15. Promote healthcare policy and system
changes that facilitate access to care
and address biases (e.g.,
socioeconomic, ethnic, ageism,
Additional Measurement Criteria
for the AP Pediatric Nurse

strategies to obtain
appropriate resources for
nursing initiatives
Secures organizational
resources to ensure a work
environment conducive to
completing the identified
plan of care and outcomes
Standard 15: Leadership
The pediatric nurse provides
leadership in the professional
practice setting and the
profession.




Works to influence decisionmaking bodies to improve
child healthcare, health
services and policies
Provides direction to
enhance the effectiveness of
the multidisciplinary
healthcare team
Initiates and revises
protocols or guidelines to
reflect evidence-based
practice, accepted changes
in care management or to
address emerging problems
Promotes communication of
information and
1.
2.
3.
4.
Authentic Leadership
Uses authentic leadership,
team building, negotiation
and conflict-resolution skills
Leads system-level change
Provides leadership in
implementation of quality
improvement and innovation
Understands the
requirements and dynamics
at the point of care and,
within this context,
successfully translates the
vision of a healthy work
22 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
C.10.a. Evaluates use of
products and services for
appropriateness and
cost/benefit in meeting care
needs
C.10.b. Conducts
cost/benefit analysis of new
clinical technologies
C.10.c. Evaluates impact of
introduction or withdrawal of
products, services and
technologies
C.11. Leads system change
to improve health outcomes
through evidence-based
practice:
C.11.a. Specifies expected
clinical and system-level
outcomes
C.11.b. Designs programs to
improve clinical and systemlevel processes and
outcomes
C.11.c. Facilitates the
adoption of practice change
C.12. Evaluates impact of
CNS and other nursing
practice on systems of care
using nurse-sensitive
outcomes
C.13. Disseminates
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse

advancement of the
profession through writing,
publishing and presentations
for professional or lay
audiences
Designs innovations to effect
change in practice and
improve health outcomes
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
environment
5. Role models standards for
healthy work environment
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sexism, cultural, mental health stigma)
16. Integrate information technology into
systems of care to enhance safety and
monitor health outcomes
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
True Collaboration
Collaboration
1. Facilitates the provision of
clinically competent care
2. Promotes a culture of
collaboration
3. Masters and employs skilled
communication
4. Effectively partners with
interdisciplinary colleagues
in the care of patients and
patient populations
5. Fosters an
intra/interdisciplinary
approach to safety, quality
improvement, evidencebased practice, research
and translation of research
into practice
6. Provides mentoring to
nursing students, specifically
in the area of acute and
critical care and CNS
preparation in collaboration
with schools of nursing
7. Mentors healthcare team
1. Communicate consultation findings, as
appropriate
2. Facilitate the provision of clinically
competent care through education, role
modeling, team building and quality
monitoring
3. Provide leadership in promoting
interdisciplinary collaboration to
implement outcome-focused patient
care programs
4. Use leadership, team building,
negotiation and conflict resolution skills
to build partnerships within and across
systems, including communities
5. Establish collaborative relationships
within and across departments that
promote patient safety, culturally
competent care and clinical excellence
6. Provide leadership for establishing,
improving and sustaining collaborative
relationships
7. Practice collegially with members of
the healthcare team
8. Facilitate intra-agency and inter-
outcomes of system-level
change internally and
externally
Collaboration Competency
D.1. Assesses the quality
and effectiveness of
interdisciplinary, intraagency and interagency
communication and
collaboration
D.2. Establishes
collaborative relationships
within and across
departments that promote
patient safety, culturally
competent care and clinical
excellence
D.3. Provides leadership for
establishing, improving and
sustaining collaborative
relationships to meet clinical
needs
D.4. Practices collegially
with medical staff and other
members of the healthcare
team so that all providers’
unique contributions to
health outcomes will be
Standard 11: Collaboration



Partners with other
disciplines to enhance
pediatric healthcare through
interdisciplinary activities,
such as education,
consultation, development of
new management and
therapeutic strategies or
research
Facilitates an interdisciplinary process with
other members of the
healthcare team
Documents plans,
communication,
management plan changes
and collaborative discussion
to improve pediatric
healthcare
24 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
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ANA Scope and Standards
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enhanced
D.5. Facilitates intra-agency
and inter-agency
communication
AACN
Scope and Standards
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CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
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members to understand and
use the expertise of others
8. Role models professional
leadership and
accountability for nursing’s
role within the healthcare
team and community
9. Facilitates the creation of a
common vision for care
within the healthcare team or
system
agency communication
9. Foster an interdisciplinary approach to
quality improvement, evidence-based
practice, research and translation of
research into practice
Education
Facilitation of Learning
1. Proactively seeks and
participates in professional
development and learning
opportunities on an ongoing
basis
2. Uses information gained in
educational activities to
improve professional
performance
3. Develops and refines skills
in teaching and mentoring
others
4. Acquires and maintains
professional certifications
5. Maintains professional
records that provide
1. Design health information and patient
education appropriate to the patient’s
developmental level, health literacy
level, learning needs, readiness to
learn and cultural values and beliefs
2. Provide education to individuals,
families, groups and communities to
promote knowledge, understanding
and optimal functioning across the
wellness-illness continuum
3. Mentor staff nurses, graduate students
and others to acquire new knowledge
and skills, and develop their careers
4. Mentor health professionals in applying
the principles of evidence-based care
5. Coordinate formal and informal
Coaching Competency
E.1. Coaches patients and
families to help them
navigate the healthcare
system
E.2. Designs health
information and patient
education appropriate to the
patient’s developmental
level, health literacy level,
learning needs, readiness to
learn and cultural values
and beliefs
E.3. Provides education to
individuals, families, groups
and communities to promote
knowledge, understanding
Standard 9. Education (cont.)

Supports the education and
role development of other
practitioners by serving as
preceptor, role model and
mentor
25 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
and optimal functioning
across the wellness-illness
continuum
E.4. Participates in preprofessional, graduate and
continuing education of
nurses and other healthcare
providers:
E.4.a. Completes a needs
assessment as appropriate
to guide interventions with
staff
E.4.b. Promotes
professional development of
staff nurses and continuing
education activities
E.4.c. Implements staff
development and continuing
education activities
E.4.d. Mentors nurses to
translate research into
practice
E.5. Contributes to the
advancement of the
profession as a whole by
disseminating outcomes of
CNS practice through
presentations and
publications
E.6. Mentors staff nurses,
graduate students and
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
evidence of competency and
lifelong learning
26 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
education for healthcare providers to
improve pediatric healthcare outcomes
6. Advise patients/families/caregivers on
how to address sensitive issues such
as STDs, suicide prevention,
substance use, driving, independent
living, potential for abuse, end-of-life
concerns, advance care planning and
finances
7. Participate in pre-professional,
graduate and continuing education of
nurses and other healthcare providers
by:
a. completing a needs assessment as
appropriate to guide interventions
with staff
b. promoting professional
development of staff nurses and
continuing education activities
c. implementing staff development
and continuing education activities
d. mentoring others to use research
findings in practice
8. Modify health information, patient
education programs and interventions
for patients with sensory, perceptual,
cognitive and physical and mental
illness limitations
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
Research/Clinical Inquiry,
Individual Practice Evaluation
Clinical Inquiry
others to acquire new
knowledge and skills and
develop their careers
E.7. Mentors health
professionals in applying the
principles of evidence-based
care
E.8. Uses coaching and
advanced communication
skills to facilitate the
development of effective
clinical teams
E.9. Provides leadership in
conflict management and
negotiation to address
problems in the healthcare
system
Research Competency (cont.)
I. Interpretation, Translation
and Use of Evidence
F.I.1. Analyzes research
findings and other evidence
for their potential application
to clinical practice
F.I.2. Integrates evidence
into the health, illness and
wellness management of
Standard 9. Education (cont.)

Utilizes current healthcare
research findings and other
evidence to expand clinical
knowledge, enhance role
performance and increase
knowledge of professional
issues
Research/Clinical Inquiry
1. Analyzes research findings
and other evidence for
potential application to
practice
2. Synthesizes evidence to
determine the need for
practice and/or process
improvement
27 Copyright ©2012 AACN Certification Corporation 1. Assess the quality and effectiveness of
interdisciplinary, intra-agency and
inter-agency communication and
collaboration
2. Contribute to the advancement of the
profession by disseminating outcomes
of CNS practice
3. Analyze research findings and other
evidence for potential application to
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
patients, families,
communities and groups
F.I.3. Applies principles of
evidence-based practice
and quality improvement to
all patient care
F.I.4. Assesses system
barriers and facilitators to
adoption of evidence-based
practices
F.I.5. Designs programs for
effective implementation of
research findings and other
evidence in clinical practice
F.I.6. Cultivates a climate of
clinical inquiry across
spheres of influence:
F.I.6.a. Evaluates the need
for improvement or redesign
of care delivery processes to
improve safety, efficiency,
reliability and quality
F.I.6.b. Disseminates expert
knowledge
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
3. Participates in conducting or
implementing
research/clinical inquiry
4. Evaluates existing and
innovative patient care
practices based on current
research findings and
experiential knowledge and
integrates changes into
practice
5. Chooses, applies or
withholds interventions in a
manner that is substantiated
by evidence and
appropriate to the needs of
the patient, nurse, or system
6. Identifies clinical problems
amenable to research
7. Role models and mentors
staff regarding the use,
implementation and
evaluation of research
findings
8. Communicates research
results, and develops a
means to incorporate
research findings into
practice
9. Evaluates and facilitates
incorporation of new
products, techniques and
clinical practice
4. Integrate evidence into the health,
illness and wellness management of
patients, families, communities and
groups
5. Apply principles of evidence-based
practice and quality improvement to all
patient care
6. Design programs for effective
implementation of research findings
and other evidence in clinical practice
7. Develop evidence-based clinical
interventions to achieve defined patient
and system outcomes
8. Assist staff in the development of
innovative, cost-effective programs or
protocols of care
9. Cultivate a climate of clinical inquiry
across spheres of influence by:
a. evaluating the need for
improvement or redesign of care
delivery processes to improve
safety, efficiency, reliability and
quality
b. disseminating expert knowledge
10. Participate in establishing quality
improvement agenda for unit,
department, program, system or
population
11. Provide leadership in planning data
collection and quality monitoring
28 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
technologies into practice
10. Advances the science of
nursing practice
II. Evaluation of Clinical
Practice
F.II.1. Fosters an
interdisciplinary approach to
quality improvement,
evidence-based practice,
research and translation of
research into practice
F.II.2. Participates in
establishing quality
improvement agenda for
unit, department, program,
system or population
F.II.3. Provides leadership in
planning data collection and
quality monitoring
F.II.4. Uses quality
monitoring data to assess
the quality and effectiveness
of clinical programs in
meeting outcomes
F.II.5. Develops quality
improvement initiatives
based on assessments
F.II.6. Provides leadership in
the design, implementation
and evaluation of process
Standard 7: Quality of Practice
The pediatric nurse
systematically enhances the
quality and effectiveness of
nursing practice.





Designs quality improvement
initiatives
Implements initiatives to
evaluate the need for
change
Evaluates the practice
environment and quality of
nursing care rendered in
relation to existing evidence,
identifying opportunities for
the generation and
translation of research
findings
Obtains and maintains
professional certification in
advanced practice pediatric
nursing
Provides leadership in
establishing and monitoring
standards of practice to
improve care of children and
Individual Practice Evaluation
1. Evaluates his or her own
clinical and professional
performance according to
the CNS role competencies
and standards of the
appropriate professional and
regulatory agencies
2. Leads the development and
evaluation of criteria for CNS
practice within the 3 spheres
3. Seeks feedback of individual
clinical practice from others
to facilitate professional
growth
4. Engages in reflective
learning of individual
practice and role
performance on a routine
basis
5. Complies with the
credentialing and privileging
process within the
organization or system
29 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
12. Use data to assess the quality and
effectiveness of clinical programs in
meeting outcomes
13. Develop quality improvement initiatives
based on assessments
14. Provide leadership in the design,
integration and evaluation of process
improvement initiatives
15. Provide leadership in the system-wide
integration of quality improvement and
innovation
16. Engage in a formal self-evaluation
process, seeking feedback regarding
own practice from patients, peers,
professional colleagues and others
17. Analyze data from consultations to
implement practice improvements
18. Participate in conduct/implementation
of research by:
a. identifying questions for clinical
inquiry
b. critiquing literature during literature
reviews
c. synthesizing literature during
literature reviews
d. designing and implementing
studies
e. collecting data
f. analyzing data
g. disseminating findings
19. Apply ethical principles in safeguarding
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
improvement initiatives
F.II.7. Provides leadership in
the system-wide
implementation of quality
improvements and
innovations
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse



AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
their families in collaboration
with other healthcare team
members
Participates in efforts to
minimize costs and
unnecessary duplication of
tests and diagnostic
services, and facilitates the
timely provision of services
for the child and the family
Analyzes factors related to
safety, satisfaction,
effectiveness and costbenefit options with the child,
family and other healthcare
providers as appropriate
Identifies and works to
remove barriers in
organizational systems that
may hinder the quality of
pediatric nursing care
the confidentiality, dignity and safety of
all research participants including the
vulnerable and those with impaired
decision-making capacity
Standard 8. Professional
Practice Evaluation
The pediatric nurse evaluates
one’s own nursing practice in
relation to professional practice
standards and guidelines,
relevant statutes, rules and
regulations.
30 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse

III. Conduct of Research
F.III.1. Participates in
conduct and implementation
of research, which includes
one or more of the following:
F.III.1.a. Identification of
questions for clinical inquiry
F.III.1.b. Conduct of
literature reviews
F.III.1.c. Study design and
implementation
F.III.1.d. Data collection
F.III.1.e. Data analysis
F.III.1.f. Dissemination of
findings
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Engages in a formal process
seeking feedback regarding
one’s own practice from the
child, family, peers,
professional colleagues and
others
Standard 13. Research,
evidence-based practice and
clinical scholarship


Contributes to nursing
knowledge by conducting or
synthesizing research that
discovers, examines, and
evaluates knowledge,
theories, criteria and creative
approaches to improve
healthcare practice
Formally and informally
disseminates research
findings through practice,
education, presentations,
publications, consultations
and journal clubs
31 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
Ethics
Advocacy/Moral Agency,
Response to Diversity
Ethical Decision Making,
Moral Agency and Advocacy
G.1. Engages in a formal
self-evaluation process,
seeking feedback regarding
own practice from patients,
peers, professional
colleagues and others
G.2. Fosters professional
accountability in self or
others
G.3. Facilitates resolution of
ethical conflicts:
G.3.a. Identifies ethical
implications of complex care
situations
G.3.b. Considers the impact
of scientific advances, cost,
clinical effectiveness, patient
and family values and
preferences and other
external influences
G.3.c. Applies ethical
principles to resolving
concerns across the three
spheres of influence
G.4. Promotes a practice
climate conducive to
Standard 12: Ethics






Ensures that the care
provided is consistent with
the child’s and family’s
needs and values, and with
codes of ethical practice
Informs the child and family
of the risks, benefits and
outcomes of healthcare
regimens
Makes decisions and
initiates actions on behalf of
children and their families in
an ethical manner, taking
into consideration the values
of the child and family
Ensures informed consent or
age-appropriate assent for
procedures, treatment and
research, as appropriate
Serves as an advocate for
the child and family in
developing policies and in
providing care to the child
and family
Contributes to the creation of
1. Fosters the establishment
and maintenance of an
ethical environment
2. Facilitates resolution of
ethical conflicts and moral
distress to promote a healthy
work environment
3. Serves as a mentor and role
model to others in
developing moral agency
4. Fosters professional
accountability in self and
others
5. Implements interventions
that consider the impact of
scientific advances, cost,
clinical effectiveness, patient
values and preference,
diversity and other external
influences on healthcare
2.
3.
4.
5.
6.
7.
8.
32 Copyright ©2012 AACN Certification Corporation 1.
Advocacy/Moral Agency
Coach patients and families to help
them navigate the healthcare system
Use coaching and advanced
communication skills to facilitate the
development of effective clinical teams
Foster professional accountability in
self and others
Promote a practice climate conducive
to providing ethical care
Facilitate interdisciplinary teams to
address ethical concerns, risks or
considerations, benefits and outcomes
of patient care
Promote the role and scope of practice
of the CNS to legislators, regulators,
other healthcare providers and the
public
Communicate information that
promotes nursing, the role of the CNS
and outcomes of nursing and CNS
practice through the use of the media,
advanced technologies and community
networks
Facilitate patient/family understanding
of risks/benefits/outcomes of proposed
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
providing ethical care
G.5. Facilitates
interdisciplinary teams to
address ethical concerns,
risks or considerations,
benefits and outcomes of
patient care
G.6. Facilitates patient and
family understanding of the
risks, benefits and outcomes
of proposed healthcare
regimen to promote
informed decision making
G.7. Advocates for equitable
patient care by:
G.7.a. Participating in
organizational, local, state,
national or international
level of policy-making
activities for issues related
to their expertise
G.7.b. Evaluating the impact
of legislative and regulatory
policies as they apply to
nursing practice and patient
or population outcomes
G.8 Promotes the role and
scope of practice of the CNS
to legislators, regulators,
other healthcare providers
and the public:
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse

AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
individual and system
responses to resolution of
ethical dilemmas
Advocates for a process of
ongoing ethical inquiry into
patient care practices where
varying perspectives are
acknowledged and validated
healthcare regimens to promote
informed decision making
9. Facilitate decision making regarding
treatment options with the
patient/family/caregivers/healthcare
proxy
10. Advocate for equitable patient care by:
a. participating in organizational,
local, state, national or international
level of policy-making activities for
issues related to their expertise
b. evaluating the impact of legislative
and regulatory policies as they
apply to nursing practice and
patient or population outcomes
11. Facilitate resolution of ethical conflicts
by:
a. identifying ethical implications of
complex care situations
b. considering the impact of scientific
advances/cost/clinical
effectiveness/patient and family
values and preferences/other
external influences
c. applying ethical principles to
resolve concerns
12. Advocate for access to hospice and
palliative care services for patients
across the age spectrum
Standard 16. Advocacy
The pediatric nurse is an
advocate for the pediatric client
and family.

Advances the profession
through enhancing public
awareness and health
professional familiarity with
advanced practice pediatric
nursing role and scope of
practice
33 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
American Association of Critical‐Care Nurses AACN Certification Corporation National CNS
Competency Task Force
Core Competencies
ANA Scope and Standards
for Pediatric Nursing Practice
Additional Measurement Criteria
for the AP Pediatric Nurse
AACN
Scope and Standards
for Acute and Critical Care
CNS Practice
Response to Diversity
1. Develop age-specific clinical
standards, policies and procedures
2. Promote system-wide policies and
protocols that address cultural, ethnic,
spiritual and intergenerational/age
differences among patients, healthcare
providers and caregivers
3. Design educational programs that
enhance the knowledge of families and
caregivers regarding normal
developmental changes
G.8.a. Communicates
information that promotes
nursing, the role of the CNS
and outcomes of nursing
and CNS practice through
the use of the media,
advanced technologies and
community networks
G.8.b. Advocates for the
CNS/APRN role and for
positive legislative response
to issues affecting nursing
practice
34 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation
Study of Practice
Pediatric CNS
(wellness through acute care)
American Association of Critical‐Care Nurses AACN Certification Corporation GLOSSARY OF TERMS
Advanced Nursing Practice – Builds on the competencies of the registered nurse and is characterized by the integration and application of a
broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education.
American Nurses Association. Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010:18.
Advocacy and Moral Agency - Working on another’s behalf and representing the concerns of the patient/family and nursing staff; serving as
a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting.
Hardin S, Kaplow R. In: Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:64-65.
Authentic Leadership - A pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive
ethical climate, to foster greater self-awareness, an internalized moral perspective, balanced processing of information, and relational
transparency on the part of leaders working with followers, fostering positive self-development.
Walumbwa FO, Avolio BJ, Gardner WL, Wernsing TS, Peterson SJ. Authentic leadership: development and validation of a theory-based measure. J Manage.
2008;34(1):89–126.
Kernis MH. Toward a conceptualization of optimal self-esteem. Psychol Inquiry. 2003;14:1-26.
Caring Practices - Nursing interventions that create a compassionate, supportive and therapeutic environment for patients and staff, with the
aim of promoting comfort and healing and preventing unnecessary suffering. Includes compassion, vigilance, engagement and
responsiveness to the patient, family and healthcare personnel.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:7.
Clinical Inquiry (Innovator/Evaluator) - The ongoing process of questioning and evaluating practice, providing informed practice and creating
practice changes through evidence-based practice, research utilization and experiential knowledge.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:227.
35 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Clinical Judgment - Clinical reasoning, which includes clinical decision-making, critical thinking and global grasp of the situation, coupled
with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence-based guidelines.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:59.
Coaching – Skillful guidance and teaching to advance the care of patients, families, groups of patients and the profession of nursing.
Spross JA. Expert coaching and guidance. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO:
Elsevier; 2008:159-190.
Collaboration - Working with others in a way that promotes/encourages each person’s contributions toward achieving optimal/realistic
patient/family goals. Involves intra- and interdisciplinary work with colleagues and community.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:228.
Collaboration – A dynamic, interpersonal process in which two or more individuals make a commitment to each other to interact authentically
and constructively to solve problems and to learn from each other to accomplish identified goals, purposes or outcomes. The individuals
recognize and articulate the shared values that make this commitment possible.
Hanson CM, Spross JA. Collaboration. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier;
2008:283-314.
Collegiality – Professional relationships, which are characterized by equal trust, power and respect.
Schmalenberg C, Kramer M. Nurse-physician relationships in hospitals: 20 000 nurses tell their story. Crit Care Nurse. 2009;29(1):74-83.
Competency – An expected and measurable level of nursing performance that integrates knowledge, skills, abilities, and judgment that is
based on established scientific knowledge and expectations for nursing practice.
American Nurses Association. Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010:40.
Consultation – Patient, staff or system-focused interaction between professionals in which the consultant is recognized as having specialized
expertise and assists consultee with problem solving.
Barron AM, White PA. Consultation. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier;
2008:191-216.
36 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Direct Clinical Practice – Direct interaction with patients, families and groups of patients to promote health or well-being and improve quality
of life. Characterized by a holistic perspective, formation of therapeutic partnerships with patients, expert clinical thinking and skillful
performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches in the advanced nursing
management of health, illness, and disease states.
Tracy MF. Direct clinical practice. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier;
2008:126.
Ethical Decision-Making, Moral Agency and Advocacy – The process of identifying, articulating and taking action on ethical concerns at the
patient, family, healthcare provider, system, community and public policy levels.
Hamric AB, Delgado SA. Ethical decision making. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO:
Elsevier; 2008:315-346.
Evidence-Based Practice – A problem-solving approach to clinical practice that integrates the conscientious use of the best available
research evidence, clinical expertise, and patient preferences and values.
Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:10.
Facilitation of Learning - The ability to promote the education of patients/families, nursing staff, other members of the healthcare team and
community. Includes both formal and informal facilitation of learning.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:6.
Indirect Care – The provision of care through activities that influence the care of patients, but do not involve direct engagement with patients.
Examples include developing evidence-based guidelines or protocols for care and staff development activities.
Tracy MF. Direct clinical practice. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier;
2008:123-126.
Nonpharmacologic (and Integrative) Interventions - Nonpharmacologic and integrative interventions includes a range of conventional and
less commonly used non-medication, complementary and alternative therapies for the alleviation of symptoms, stress, suffering and other
human responses.
National Center for Complementary and Alternative Medicine. What Is Complementary and Alternative Medicine? http://nccam.nih.gov/health/whatiscam. Accessed April
25, 2010.
37 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Nurse Characteristics – As described in the AACN Synergy Model, nursing care reflects an integration of knowledge, skills, experience and
attitudes needed to meet the needs of patients and families. Thus, continuua of nurse characteristics are derived from patient needs.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:5-9.
Nurses/Nursing Practice – The CNS advances nursing practice and improves patient outcomes by updating and improving norms of care
and by using standards of care that direct actions of nurses and nursing personnel.
National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse
Specialists; 1998.
Nurse Sensitive Outcomes – Expected changes that reflect nursing care or care rendered in collaboration with other healthcare providers.
Oncology Nursing Society. Nursing-Sensitive Patient Outcomes. http://www.ons.org/Research/NursingSensitive/. Accessed April 25, 2010.
Organization/System – The CNS articulates the value of nursing care at the organizational, decision-making level and influences system
changes that facilitate improvement of quality cost-effective patient outcomes.
National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse
Specialists; 1998.
Outcomes - Refers to the expected changes in predetermined factors such as the patient’s behavior, health status or knowledge following
the completion of nursing care.
Redfern SJ, Norman IJ. Measuring the quality of nursing care: a consideration of different approaches. J Adv Nurs. 1990;15(11):1260-1271.
Patient Outcomes – An immensely complex construct. Spans a range of effects or presumed effects of nursing and, in a broader
conceptualization, healthcare interventions. Outcomes are measured both directly and indirectly, over different periods of time and from
vastly different sources of information. They vary according to perspective and have different degrees of reliability and validity.
Bond S, Thomas LH. Issues in measuring outcomes of nursing. J Adv Nurs. 1991;16(12):1492-1502.
Response to Diversity - The sensitivity to recognize, appreciate and incorporate differences into the provision of care. Differences may
include but are not limited to cultural differences, spiritual beliefs, gender, race, ethnicity, lifestyle, socioeconomic status, age and values.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:6.
38 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Sphere of Influence – A model for CNS practice, articulated by the National Association of Clinical Nurse Specialists, based on three spheres
of influence (Patient, Nurse, System) to reflect CNS practice as consistently targeted toward achieving quality, cost-effective outcomes
through patient/client care, by influencing the practice of other nurses and nursing personnel, and by influencing the healthcare organization
to support nursing practice.
National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse
Specialists; 2004:17-18.
Synergy - Results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004.
Systems Leadership – The ability to manage change and empower others to influence clinical practice and political processes both within
and across the system.
Hamric AB, Spross JA, Hanson CM. Advanced Practice Nursing: An Integrative Approach. St Louis, MO: Elsevier; 2008:252.
System Outcomes - The observed effects of interventions, healthcare practices, procedures or programs on departments, institutions,
agencies or health systems on costs (savings, avoidance, reimbursement or revenue), resource use, risk avoidance or reduction, meeting
quality and accreditation benchmarks and other institutional/agency/system impacts.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004.
Systems Thinking - Body of knowledge and tools that allow the nurse to manage whatever environmental and systems resources exist for
the patient/family and staff, within or across healthcare and non-healthcare systems.
Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:86.
True Collaboration – An ongoing process that builds over time, eventually resulting in a work culture where joint communication and decision
making between nurses and other disciplines and among nurses themselves becomes the norm. In true collaboration, the unique knowledge
and abilities of each professional are respected to achieve safe, quality care for patients. Skilled communication, trust, knowledge, shared
responsibility, mutual respect, optimism and coordination are integral to successful collaboration.
American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, CA:
American Association of Critical-Care Nurses; 2005:20.
39 Copyright ©2012 AACN Certification Corporation