MISSION
AACN Certification Corporation contributes to consumer health and safety through
comprehensive credentialing of nurses to ensure their practice is consistent with established
standards of excellence in caring for acutely and critically ill patients and their families.
VISION
As the undisputed leader in credentialing nurses, the AACN Certification Corporation has
demonstrated that certification contributes to achieving optimal outcomes that are consistent
with the goals and values of acutely and critically ill patients and their families.
VALUES
As the Corporation works to advance its mission and vision and fulfill its purpose and inherent
obligation to ensure the health and well being of patients experiencing acute and critical illness,
the Corporation is guided by a set of deeply rooted values.
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Providing leadership to bring all stakeholders together to create and foster cultures of
excellence and innovation.
Acting with integrity and upholding ethical values and principles in all relationships
and in the provision of sound, fair and defensible credentialing programs.
Committing to excellence in credentialing programs by striving to exceed industry
standards and expectations.
Promoting leading edge, research-based credentialing programs that reach diverse
certificants.
Demonstrating stewardship through fair and responsible management of resources
and cost-effective business processes.
ETHICS
AACN and AACN Certification Corporation consider the American Nurses Association
(ANA) Code of Ethics for Nurses foundational for nursing practice, providing a framework for
making ethical decisions and fulfilling responsibilities to the public, colleagues and the
profession. AACN Certification Corporation’s mission of public protection supports a standard
of excellence that certified nurses have a responsibility to read, understand and act in a manner
congruent with the ANA Code of Ethics for Nurses.
The following AACN Certification Corporation programs have been accredited by the National Commission
for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence (ICE):
∙ Adult CCRN® and CCRN-ETM
∙ Pediatric and Neonatal CCRN®
∙ Adult, Pediatric and Neonatal CCNS®
∙ Adult ACNPC®
∙ Adult CMC®
∙ Adult CSC®
Our advanced practice certification programs, CCNS and ACNPC, have also been recognized by the National
Council of State Boards of Nursing (NCSBN).
Study of Practice Summary
for the
Pediatric
Clinical Nurse Specialist
and
New ACCNS-P Test Plan
June 2011
Prepared for AACN Certification Corporation by:
Lawrence J. Fabrey, PhD
Senior Vice President, Psychometrics
Jennifer L. Benavente, BA/BEd
Research Assistant
Applied Measurement Professionals, Inc. (AMP)
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Table of Contents
Introduction ................................................................................................................................ 1
Methodology .............................................................................................................................. 3
Formation of the Practice Analysis Task Force ....................................................................... 3
Development of the Job Analysis Inventory ............................................................................ 3
Sample Selection.................................................................................................................... 6
Results ....................................................................................................................................... 6
Return Rate ............................................................................................................................ 6
Reliability of Ratings ............................................................................................................... 6
Description of the Rating Sample ........................................................................................... 7
Mean Ratings ........................................................................................................................10
Examination Specifications .......................................................................................................10
Application of Decision Rules and Criteria .............................................................................11
Development of Test Plans ....................................................................................................16
Cognitive Complexity .............................................................................................................19
Summary ..................................................................................................................................20
List of Tables
Table 1. Overview of Adult/Gerontology Clinical Nurse Specialist Certification Test Plan ..........16
Table 2. Overview of Pediatric Clinical Nurse Specialist Certification Test Plan ........................17
Table 3. Overview of Neonatal Clinical Nurse Specialist Certification Item Allocation................18
List of Figures
Figure 1. Region ........................................................................................................................ 7
Figure 2. Years of Experience as RN ......................................................................................... 8
Figure 3. Years of Experience as Advanced Practice Nurse ...................................................... 9
Figure 4. Years of Experience in Acute/Critical Care Setting ...................................................... 9
Table of Appendices
Appendix A: Significance Ratings in Survey Order ....................................................................21
Appendix B: Significance Ratings in Descending Mean Order ..................................................41
Appendix C: ACCNS-P Test Plan..............................................................................................55
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Introduction
AACN Certification Corporation frequently conducts national studies examining the practice of
nurses who work with acutely ill patients. In order to distinguish the roles of acute care nurses
caring for patients with similar illnesses and diseases, these nurses are surveyed so similarities
and differences in patient populations, nursing roles and practices among AACN Certification
Corporation credentials (CCRN, PCCN, CCRN-E, CMC, CSC, CCNS, ACNPC) can be
identified.
The purpose of conducting this job analysis, also known as a Study of Practice (SOP) or a
practice analysis, was to describe the job activities of AACN Certification Corporation Certified
Clinical Nurse Specialists in sufficient detail to provide a basis for the Certified
Adult/Gerontology Clinical Nurse Specialist, Certified Pediatric Clinical Nurse Specialist and
Certified Neonatal Clinical Nurse Specialist examinations covering the spectrum of wellness
through acute care. AACN Certification Corporation requested the services of Applied
Measurement Professionals, Inc. (AMP) to design and conduct a study that would provide the
support necessary to develop specifications upon which certification examinations with
substantial evidence of content validity could be developed.
As with all AACN Certification Corporation job analyses, several steps were undertaken to
develop a comprehensive inventory of patient care problems encountered by and skills,
procedures, and synergy competencies performed by the Adult/Gerontology, Pediatric and
Neonatal Clinical Nurse Specialist. First, a Practice Analysis Task Force (PATF) comprised of a
diverse group of experienced practitioners was selected. The PATF membership represented
diversity that was reflective of the intended candidate population in terms of relevant
demographic characteristics and took into account expertise related to the current role and
knowledge needed for the anticipated evolution of the Clinical Nurse Specialist‟s scope of
practice, including those with expertise in gerontology.
While developing the survey, the Practice Analysis Task Force (PATF) consulted a number of
references regarding the role and competencies of the CNS and CCNS including: the American
Association of Critical-Care Nurse's Standards of Practice and Professional Performance for the
Acute and Critical Care Clinical Nurse Specialist (2010); the Consensus Model for APRN
Regulation: Licensure, Accreditation, Certification & Education (2008); the 2004 Hartford Nurse
Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care; Changes in
Healthcare Professions’ Scope of Practice: Legislative Considerations (2007); AACN
Certification Corporation’s CCNS Synergy Competencies (2006); the national Clinical Nurse
Specialist Core Competencies 2010; and the Adult-Gerontology Clinical Nurse Specialist
Competencies (2010).
An inventory of patient care problems – both population-specific and those seen across the
lifespan – skills and procedures, and synergy competencies was developed by considering the
current Clinical Nurse Specialist Test Plans, as well as the recently revised CCRN Test Plan
(2009), the PCCN Test Plan (2008), the Cardiac Medical Subspecialty Certification Test Plan
(2010) and the Cardiac Surgery Subspecialty Test Plan (2010), as well as the Center for
Disease Control's (CDC) National Health Statistics Reports/National Hospital Discharge Data
Set, the CDC's Health, United States, 2010, and the CDC's Summary Health Statistics for U.S.
Adults: National Health Interview Survey, 2009.
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This inventory was sent to the members of the PATF who were asked for their review and
comment. The PATF then revised and finalized the inventory and survey instrument, distributed
the instrument to at least 3,534 individuals, reviewed the results, and established the test
specifications for the examinations.
The job analysis survey was distributed to persons throughout the United States according to
the sampling plan developed by the PATF. The data returned were evaluated to determine the
degree of consensus among these experts on the significant aspects of the Adult/Gerontology
Clinical Nurse Specialist‟s, Pediatric Clinical Nurse Specialist‟s and Neonatal Clinical Nurse
Specialist‟s job. Specifically, the data were analyzed to answer the following questions:
Is there a common knowledge base and a set of core activities that is
significant to the effective performance of the Certified Adult/Gerontology
Clinical Nurse Specialist, Certified Pediatric Clinical Nurse Specialist and
Certified Neonatal Clinical Nurse Specialist?
What percentage of Certified Adult/Gerontology Clinical Nurse
Specialists, Certified Pediatric Clinical Nurse Specialists, and Certified
Neonatal Clinical Nurse Specialists encounter each patient care problem
and perform each skill, procedure and synergy competency?
The purpose of these questions was to identify the more significant topics to be considered for
inclusion in the assessment procedure.
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Methodology
Formation of the Practice Analysis Task Force
The Practice Analysis Task Force (PATF) was established to ensure that expert judgment was
available to AMP staff at every stage of the project. Members of the PATF were experienced
practitioners selected by AACN Certification Corporation, and included members who were
familiar with the duties and activities of the Clinical Nurse Specialist‟s job. Additionally, AACN
Certification Corporation consulted with the Pediatric Nursing Certification Board (PNCB) for
recommendations of pediatric experts who could provide advice regarding the incorporation of
wellness aspects of the pediatric population in the survey. As a result three PNCB experts
became members of the PATF.
The PATF membership represented diversity that was reflective of the intended candidate
population in terms of relevant demographic characteristics and took into account expertise
related to the current role and knowledge needed for the anticipated evolution of the scope of
practice of Clinical Nurse Specialist on the continuum of wellness through acute care. This study
could not have been successful without the significant time involvement of the PATF. AMP is
grateful to each of these individuals for their guidance and expertise, as well as their devotion to
this project. Listed below are the responsibilities of the PATF.
Responsibilities of the Task Force
1. Developing a definition of the Certified Clinical Nurse Specialist
2. Developing a sampling plan for the survey
3. Identifying patient care problems, skills, procedures, and synergy
competencies for the survey instrument
4. Determining rating scales
5. Determining the relevant demographic variables of interest
6. Integrating the definitions, problems, tasks, competencies, rating
scale, and demographics into a survey instrument
Development of the Job Analysis Inventory
Defining the Clinical Nurse Specialist. The first step in survey development was to
operationally define the Clinical Nurse Specialist. For the purposes of the survey, the PATF
defined the Clinical Nurse Specialist as follows:
An entry level acute or critical care nurse is eligible for CCNS certification
through completion of graduate advanced practice education program offered by
an accredited college or university that offers a Master’s degree or higher in
nursing with a concentration as an acute and/or critical care clinical nurse
specialist.
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Development of the Patient Care Problem, Skills and Procedures (Actions), and Synergy
Competency List.
The PATF, with the assistance of AMP project staff, prepared a comprehensive inventory of
patient care problems, actions, and competencies using all of these materials. The survey was
designed to assess the job-related competencies needed for entry-level practices as a clinical
nurse specialist. A pilot test of the survey instrument included several components, as
discussed further in this report. The complete inventory consisted of 101 patient care problems
from across the lifespan, 43 adult-specific, 45 pediatric-specific and 14 neonatal-specific patient
care problems, 104 skills and procedures organized into eleven body systems, and 144
synergy competencies as listed below. Respondents were also encouraged to suggest
additional patient care problems, skills and procedures, and synergy competencies that were
not included in the survey.
Clinical Nurse Specialist Content Areas
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
Clinical Judgment
A.
Cardiovascular
B.
Pulmonary
C. Endocrine
D. Musculoskeletal
E.
Hematology/Immunology
F.
Neurology
G. Gastrointestinal
H. Renal/Genitourinary
I.
Integumentary
J.
Multisystem
K.
Psychosocial/Behavioral/Cognitive
Advocacy
Caring Practices
Collaboration
Systems Thinking
Diversity
Clinical Inquiry
Facilitation of Learning
Selection of the Rating Scale. The PATF also assisted in the development of the rating scale
to be used with the inventory. The significance scale was used by respondents and was
included as part of the inventory. This scale was recommended by AMP project staff and based
on similar scales used in previous national job analysis studies. The scale helps to ensure that
the PATF can conclude with confidence that the problems, actions, and competencies that
remain viable for the examination specifications are clearly a part of practice, as well as
significant enough to practice from a variety of perspectives to warrant inclusion on a national
examination.
Significance. This scale is designed to identify those patient care problems,
skills and procedures, and synergy competencies that are more significant to the
achievement of the objectives of the Clinical Nurse Specialist‟s job. Thus, the
following question was used:
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How significant is this problem/task/action to entry level CNS practice
in your setting?
Not Necessary
Minimally Significant
Moderately Significant
Significant
Quite Significant
Of Maximum Significance
Selection of Background Information Questions. This section of the inventory was designed
to gather information concerning the respondents‟ background characteristics. The PATF
reviewed and adapted background information that had been used in previous job analysis
studies, and selected the following areas to include:
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state of employment setting,
size of community,
primary employment setting,
number of beds in facility,
highest level of formal education,
primary position,
units/areas worked,
percentage of patients from various age groups,
percentage of patients from various levels of care,
percentage of time directed to various areas,
years of experience as RN, advanced practice nurse and in an acute care setting,
prescriptive authority,
hours worked per week,
patients seen each day,
highest degree in nursing,
Clinical Nurse Specialist (CNS) certification,
other specialty certifications,
and gender, race and age.
Several of these demographic variables were used to create subgroups, which the PATF would
be able to analyze to ensure that the resulting specifications were applicable to the intended
candidate population. For example, the state of employment setting was used to identify
regional subgroups for separate analysis of the significance ratings for the Adult-Gerontology
Clinical Nurse Specialist, to ensure that remaining problems, actions, and competencies were
appropriate for a national examination.
Integration of Definition, Patient Care Problems, Skills and Procedures, Synergy
Competencies, Rating Scale, and Demographics into a Survey Instrument. Following the
first meeting with the PATF, all components of the survey were combined and designed into a
draft survey instrument. Prior to distributing the survey to the full sample of professionals, the
draft survey was distributed to the PATF for review and comment. The purpose of this review
was to determine if any significant activities were missing from the survey, if the directions were
clear, and if the rating scale was easy to use and understand. Comments from the PATF were
reviewed with the PATF representatives, and minor changes were made prior to sending the
survey invitations. Following the PATF‟s review, the survey was sent to Clinical Nurse
Specialists credentialed by the Medical-Surgical Nursing Certification Board. These participants
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were asked to review the survey specifically looking for inclusion of topics from the wellness
spectrum of care. In addition, other subject matter experts were consulted to ensure that the
competencies appropriately reflected practice with Gerontological patients. Both aspects of the
additional reviews were summarized and discussed with representatives of the PATF. This
supplement to the pilot test confirmed that the survey was well-structured and no additional
changes were needed.
Sample Selection
In an effort to obtain information from representative groups of respondents, 3,534 Adult,
Pediatric, and Neonatal Clinical Nurse Specialists throughout the United States as well as those
AACN members who held the American Nurses Credentialing Center (ANCC) CNS-BC
certification for Adult, Gerontological and/or Pediatric populations were identified by AACN
Certification Corporation and emailed a survey invitation. In addition, other Adult ACNPs were
contacted via e-news blasts, AACN Certification Corporation‟s website and social media
website. Respondents were offered an incentive to complete and return the survey by the
published deadline.
Results
Return Rate
Of the 3,534 survey invitations distributed, 432 invitations were returned as undeliverable,
leaving 3,102 individuals who did receive the survey invitation. In addition, responses from 118
individuals who responded to less than 10% of patient care problems were removed prior to
analysis. Eight hundred ten (810) individuals provided usable responses in time for data
analysis. This resulted in an approximate 27.1% usable response rate (810/2,984), and this
response rate is considered to be quite acceptable for similar studies
Reliability of Ratings
To determine the extent to which the respondents were consistent in rating inventory tasks, a
statistic known as the intraclass correlation (Guilford, 1978) was used. Separate reliability
estimates were calculated for each content area, and each of scales can be consider reliable,
with most coefficients exceeding 0.90; and the few that did not exceed that value were based on
a small number of problems, actions, or competencies, therefore, lower values can be expected.
In addition, coefficient alpha was calculated for each content area, and the resulting values were
all quite acceptable, providing an indication that the items within the area represented a
homogeneous set of content. Based on these data, it is likely that a different sample from the
same population would have produced similar ratings.
After completing the ratings, respondents were asked to indicate how well they thought the
survey covered the job of a clinical nurse specialist. Three choices were provided for response:
"completely," "adequately," and "inadequately." Among the 669 individuals who responded,
50.1% (N=335) indicated the survey completely covered the problems and tasks associated
with the practice of a clinical nurse specialist and 48.7% (N=326) said it adequately covered the
problems and tasks. Eight respondents (1.2%) indicated that coverage was inadequate. Thus,
98.8% of the job experts who responded said the problems, skills, procedures, and synergy
competencies in the survey completely or adequately described the job of the clinical nurse
specialist.
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Description of the Rating Sample
The Background Information section of the survey provides descriptive information about the
rating sample. The data show that the most typical respondent is a 49-year-old, white female,
practicing in the Midwest. Her highest degree in nursing is a Master‟s degree. She does not hold
the any of the CCNS certifications nor does she hold prescriptive authority but she does hold
the CCRN credential. She has over 24 years of experience as an RN, nearly 12 years as an
advanced practice nurse, and 23 years in an acute/critical care setting. She works full-time as a
Unit-based CNS at a community hospital in an urban setting with more than 500 beds. On
average, she sees approximately ten primarily adult, critical patients per day. The majority of her
work day is devoted to teaching and she spends most of her teaching time educating nursing
personnel. More detailed about selected demographic responses follows.
Figure 1. Region
East – CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV; South – AL,AR, FL, GA, LA,
MS, NC, OK, TN, TX, SC; Midwest – IA, IL, IN, KY, MI, MN, MO, OH, WI;
West – AK, AZ, CA, CO, HI, ID, KS, MT, ND, NE, NM, NV, OR, SD, UT, WA, WY
Figure 1 shows the geographical region of practice for respondents. Eleven (11) respondents
did not answer the question. These data show that all regions were well represented, and the
largest group of respondents resides in the Midwestern states. Over half of respondents
(53.9%) practice in urban settings, 36.9% practice in suburban settings and 9.3% practice in
small towns or rural settings. Although the largest group of respondents works in a Community
Hospital (45.7%), a substantial number work in a University Medical Center (27.8%). Remaining
respondents practice in a variety of settings including Children‟s Hospital, College/University,
and Military/Government Hospital. As noted, many respondents (34.6%) work in large facilities
with more than 500 beds, but a substantial number work in smaller facilities, with 29.0% in
facilities with 301-500 beds, 20.2% in 201-300, and 16.2% in smaller facilities. As expected, a
majority (64.1%) holds a position as a CNS, either unit- or population-based, but other positions
with more than three percent of the respondents included manager/director, nurse practitioner,
nurse educator, staff nurse, or other.
Some respondents occasionally spent time with neonatal and pediatric patients, but as
expected most respondents work primarily with Adult patients (mean = 45.7%, median =
49.0%), followed by Geriatric patients (mean = 41.9%, median = 50.0%). Respondents devote
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the majority of their time (mean = 27.2%, median = 25.0%) teaching although this nursing task
was followed very closely by providing consultation (mean = 22.9%, median = 20.0%) and
providing direct patient care (mean = 22.1%, median = 10.0%) with administration (mean =
17.5%, median = 10.0%) and research (mean = 10.2%, median = 10.0%) comprising the
smallest portion of respondents‟ work time. Most of the respondents‟ teaching time (mean =
58.6%) is spent with nursing personnel, with a mean of 22.2% of their time teaching nursing
personnel, and approximately 10% each with patient populations and other
disciplines/organizations/systems.
Three figures that follow depict the experience of the respondent group. Figure 2 shows
respondents‟ years of experience as a Registered Nurse (mean = 24.6, median = 26 years).
Figure 3 shows respondents‟ years of experience as an Advanced Practice Nurse (mean =
11.87, median = 11 years). Figure 4 shows respondents‟ years of experience in an
Acute/Critical Care setting (mean = 22.7, median = 24 years).
Figure 2. Years of Experience as RN
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Figure 3. Years of Experience as Advanced Practice Nurse
Figure 4. Years of Experience in Acute/Critical Care Setting
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Most respondents do not hold prescriptive authority and of the 29.4% of respondents who do
hold it, approximately fourteen percent do not use it. Most respondents hold more than one
certification, including 62.5% holding the CCRN certification, with much smaller numbers
holding a variety of others.
The PATF reviewed the demographic data and concluded that none of the results could be
considered atypical. Therefore, they judged that the results were representative of Clinical
Nurse Specialists.
Mean Ratings
Descriptive data for each of the 101 patient care problems from across the lifespan, 43 adultspecific, 45 pediatric-specific, and 14 neonatal-specific patient care problems, 104 skills and
procedures, and 144 synergy competencies are presented in Appendix A. Included are the
descriptive label for that task, number of respondents, mean significance rating, standard error,
standard deviation, and the percentage of respondents not performing the task. For example,
Patient Problem #1, from the Cardiovascular body system “Acute coronary syndromes” is listed
as "AllProb01" Seven hundred, thirty-four (734) respondents rated the task with a mean rating of
3.48, a standard error of the mean of 0.049, and a standard deviation of 1.33. The percentage
of respondents who rated it as “not performed” was 8.82%. The standard error indicates the
"accuracy" of the mean. In this case, the “real mean” is likely to lie between 3.38 and 3.58, 95%
of the time (mean +/- 2 standard errors).
The Clinical Nurse Specialist PATF reviewed the results separately for each patient care
problem, skills, procedures, and synergy competency. They concluded that, in general, the
ratings obtained in the practice analysis study were in agreement with their own judgments
based on their experience in the field. Consequently, it was concluded that the job analysis
survey data was adequate for defining the jobs of the Adult/Gerontology, Pediatric and Neonatal
Clinical Nurse Specialist on a national basis. Moreover, the data were judged to be sufficient for
the purpose of delineating the structure and content of a voluntary national credentialing
examination for AACN Certification Corporation.
The PATF also evaluated the responses from various subgroups, based on responses to
pertinent demographic questions. For each subgroup analysis, the valid number of respondents
in each subgroup was displayed, along with the mean rating, standard error, and an indication
of the number of subgroups with a mean rating below a specified threshold for each item on the
survey.
Examination Specifications
In developing the test plan (i.e., examination specifications or detailed content outline) for the
examinations, the judgment of the PATF was used to interpret the data gathered from the
practice analysis survey. Of particular significance to a certification examination program is that
the test specifications appropriately reflect the responsibilities of all groups who will participate
in that program. Therefore, it is important to ensure that the test plan and the resulting
examination forms sample patient care problems, skills and procedures, and synergy
competencies that are considered to be significant responsibilities of the individuals for whom
the examination is intended.
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Several decision rules were proposed for consideration by the PATF in determining which topics
should be considered ineligible for assessment, and therefore, excluded from the test content
outline. The general areas for consideration are shown below:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Overall mean significance ratings for the total sample
Overall percent of "not performed" ratings
Comparison of mean significance ratings by region
Comparison of mean significance ratings by community
Comparison of mean significance ratings by position
Comparison of mean significance ratings by setting
Comparison of mean significance ratings by beds
Comparison of mean significance ratings by years of experience
as an Advance Practice Nurse
Comparison of mean significance ratings by hours worked
Comparison of mean significance ratings by Adult CCNS
Certification
Comparison of mean significance ratings by Pediatric CCNS
Certification
Comparison of mean significance ratings by Neonatal CCNS
Certification
The specific decision rules adopted by the PATF and their impact on inclusion of topics are
discussed in detail in the following section. The first two decision rules are general and involve
an analysis of all respondents. The decision rules 3 through 12 involve comparing mean ratings
by subgroups. Applying these rules ensures that the resulting examination reflects the
responsibilities of the Adult/Gerontology, Pediatric and Neonatal Clinical Nurse Specialist on a
national basis and is representative of the typical Adult/Gerontology, Pediatric and Neonatal
Clinical Nurse Specialist‟s activities.
The PATF decided items from the Clinical Judgment area would be written to assess patient
care problems. In addition, items should be written to reflect approved skills and procedures and
synergy competencies. Synergy competencies, skills, and procedures deemed critical to
practice are eligible for assessing knowledge of content underlying an item.
Application of Decision Rules and Criteria
Rule 1. Is the patient care problem seen by and skill, procedure, and synergy
competency performed by a majority of entry level Clinical Nurse Specialists?
By consensus, the PATF decided that a patient care problem must be seen by at least 80% of
the respondents in order to be included in the final test specifications, nursing actions must be
seen by at least 40% and synergy competency must be performed by at least 90% of the
respondents to remain eligible for in-depth assessment. Eighteen patient care problems
(Allprob45, 79, Adultprob15, 22, 24, 28, 29, 30, 31, 32, 35, 38, 39, Pedsprob02, 04, 17, 26, and
29) were eliminated from the test specifications. Seventy-eight skills and procedures
(Cardiotask07, 09, 11, 14, 16, 17, 19, 21, 22, 23, 25, 26, 27, 29, 31, 32, 33, Endotask01,
Gastrotask01, 02, 03, 04, 05, 06, Hemtask01, 02, 03, 04, 05, 06, 07, 08, Integ01, 03, 04, 05, 06,
Multitask01, 03, 05, Musculotask01, 02, 03, 04, 05, 06, 07, Neurotask01, 02, 03, 04, 05, 06, 07,
08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, Psychtask01, Pulmtask05, 06, 07, 08, 10, 11,
Renaltask01, 02, 03, 04, 05, 06) and 6 competencies (ClinJudgComp18, 19, 20, 21, 22, 23)
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were considered to be less important to entry level clinical nurse specialist practice and were
excluded. The PATF reviewed each excluded patient care problem, skill, and procedure and
determined that three patient problems (AdultProb30, 32, and PedProb29), two skills and
procedures (Gastrotask06, Renaltask01) were critical to practice and were retained by
unanimous agreement. Additionally, the wording of one procedure (Multitask 05) and six
competencies (ClinJudgComp18, 19, 20, 21, 22, and 23) was edited and they were also
retained. Details of the edited content can be found below.
Rule 2. Is the patient care problem seen by and skill, procedure, and synergy
competency considered significant to the practice of an entry level Clinical Nurse
Specialists?
By consensus, the PATF decided that a mean significance rating of 2.50 would be used to
examine patient care problems, skills and procedures, and synergy competencies. Forty-six
additional patient care problems (Allprob20, 27, 33, 34, 40, 41, 42, 44, 64, 73, 78, 80, 81, 95,
Adultprob12, 13, 14, 16, 17, 18, 19, 20, 25, 26, 27, 41, Pedsprob01, 05, 08, 15, 19, 20, 24, 25,
27, 28, 30, 34, 35, 36, 38, 39, 40, 41, 42, 43) fell below the established threshold. One
additional skill and procedure (Cardiotask12) was also considered to be less significant to entry
level clinical nurse specialist practice and was excluded. No synergy competencies were
affected. Again, the PATF reviewed each excluded patient care problem, skill, and procedure
and determined that four of the patient care problems (Pedsprob19, 35, 36, 42) were critical to
practice and were retained by unanimous agreement. Additionally it was determined that
content from two patient care problems (Allprob40, 42) was critical to pediatric practice and was
retained for the Pediatric Clinical Nurse Specialist examination specifications. Similarly
Allprob41 was deemed critical to neonatal practice and was retained for the Neonatal Clinical
Nurse Specialist examination specifications.
Rule 3. Is the patient care problem considered significant regardless of geographic
region?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by geographic region, a comparison of the mean significance ratings between regions
was made. The PATF decided to review patient care problems that had mean ratings of less
than 2.40 in any of the four geographic subgroups. Application of this criterion helps to ensure
that the examination reflects uniform practice across regions. Ten additional patient care
problems (Allprob100, Adultprob10, Pedsprob03, 09, 12, 18, 22, 23, 37, 44) were removed as a
result of this rule. Again, the PATF reviewed each excluded patient care problem and
determined that one patient care problem (Pedsprob18) was critical to practice and was
retained by unanimous agreement.
Rule 4. Is the patient care problem considered significant regardless of community
size?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by community size, a comparison of the mean significance ratings between rural,
suburban, and urban communities was made. The PATF decided to review patient care
problems that had mean ratings of less than 2.40 in any of the three community subgroups.
Application of this criterion helps to ensure that the examination reflects uniform practice across
communities. Seven additional patient care problems (Allprob43, 48, 77, Pedsprob13, 16, 21,
45) were removed as a result of this rule. Again, the PATF reviewed each excluded patient care
problem, and determined that four patient care problems (Pedsprob13, 16, 21, 45) were critical
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 12 ~
to practice and were retained by unanimous agreement. Additionally, content from Allprob48
was deemed critical to pediatric and neonatal practice and was retained for the Pediatric and
Neonatal Clinical Nurse Specialist examination specifications.
Rule 5. Is the patient care problem considered significant regardless of position?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by position, a comparison of the mean significance ratings between position
subgroups was made. The PATF decided to review patient care problems that had mean ratings
of less than 2.40 in any of the CNS position subgroups (Population based CNS, Unit-based
CNS, CNS Free Responses). Application of this criterion helps to ensure that the examination
reflects uniform practice across different positions. No additional patient care problems were
removed as a result of this rule.
Rule 6. Is the patient care problem considered significant regardless of setting?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by setting, a comparison of the mean significance ratings between settings was
made. The PATF decided to review patient care problems that had mean ratings of less than
2.40 in any of the setting subgroups. Application of this criterion helps to ensure that the
examination reflects uniform practice across different settings. No additional patient care
problems were removed as a result of this rule.
Rule 7. Is the patient care problem considered significant regardless of facility size?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by facility size, a comparison of the mean significance ratings between various sized
facilities was made. The PATF decided to review problems that had mean ratings of less than
2.40 in any of the four facility size subgroups. Application of this criterion helps to ensure that
the examination reflects uniform practice across different sized facilities. No additional patient
care problems were removed as a result of this rule.
Rule 8. Is the patient care problem considered significant regardless of years of
experience as an advanced practice nurse?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by those with various levels of experience, a comparison of the mean significance
ratings was made. The PATF decided to review patient care problems that had mean ratings of
less than 2.40 in 0-2 years of experience subgroups to ensure problems were critical to entry
level Clinical Nurse Specialists. Application of this criterion helps to ensure that the examination
reflects uniform practice across years of experience. One additional patient care problem
(Adultprob01) was removed as a result of this rule however; the PATF considered this topic to
be of critical importance and it was retained by unanimous agreement.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 13 ~
Rule 9. Is the patient care problem considered significant regardless of hours worked
per week?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by those who worked different hours per week, a comparison of the mean
significance ratings between those who worked full- and part-time was made. The PATF
decided to review patient care problems that had mean ratings of less than 2.40 in either of the
position subgroups. Application of this criterion helps to ensure that the examination reflects
uniform practice across time worked per week. One additional patient care problem (AllProb38)
was removed as a result of this rule.
Rule 10. Is the patient care problem considered significant regardless of Adult CCNS
certification?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by those who did and did not hold the Adult CCNS certification, a comparison of the
mean significance ratings was made. The PATF decided to review the patient care problem
ratings of those who held the Adult CCNS certification. Application of this criterion helps to
ensure that the examination reflects population-specific practice as determined by those who
are most familiar with the population. No additional changes were made as a result of this rule.
Rule 11. Is the patient care problem considered significant regardless of Pediatric
CCNS certification?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by those who did and did not hold the Pediatric CCNS certification, a comparison of
the mean significance ratings was made. The PATF decided to review the patient care problem
ratings of those who held the Pediatric CCNS certification. Application of this criterion helps to
ensure that the examination reflects population-specific practice as determined by those who
are most familiar with the population. Three additional patient care problems (Allprob01, 12, 61)
were removed from the Pediatric Clinical Nurse Specialist examination specifications as a result
of this rule.
Rule 12. Is the patient care problem considered significant regardless of Neonatal
CCNS certification?
To determine if patient care problems seen by the Clinical Nurse Specialist were viewed
differently by those who did and did not hold the Neonatal CCNS certification, a comparison of
the mean significance ratings was made. The PATF decided to review the patient care problem
ratings of those who held the Neonatal CCNS certification. Application of this criterion helps to
ensure that the examination reflects population-specific practice as determined by those who
are most familiar with the population. Eleven additional patient care problems (Allprob01, 07, 11,
12, 24, 25, 58, 61, 68, 84, 99) were removed from the Neonatal Clinical Nurse Specialist exam
specifications as a result of this rule.
Final Approval of Problems, Activities, and Competencies. In addition to reviewing the
statistics for the survey, the PATF examined the respondents' comments regarding the patient
problems, activities, and competencies included in the survey. The PATF considered
suggestions for additional content, and for changes to existing content. Based on this review,
the PATF did not add any patient problems, activities, or competencies.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 14 ~
Two patient care problems were edited by the PATF following survey distribution. Allprob25 –
“Pulmonary Problem – Thoracic and pulmonary trauma and injuries” was edited to remove “and
injuries”. Allprob47 – “Neurology Problem – Head and brain trauma and injury” was similarly
edited. Three additional patient care problems were edited for the Neonatal Clinical Nurse
Specialist examination specifications. Allprob18 – “Pulmonary Problem - Asthma and reactive
airway disease” was edited to remove “Asthma” because the condition is not seen in neonates.
Similarly, Allprob67 – “Gastrointestinal Problem – Hepatic failure and coma” was edited to
remove „and coma‟. Allprob76 – “Renal Problem – Infections (e.g., UTI, PID, STDs)” was edited
to remove the list of examples. Multitask05 – “Multisystem Task – Prescribe pharmaceutical
interventions” appears on all Clinical Nurse Specialist examination specifications and was edited
to read “Manage (i.e., recommend/prescribe) to account for states in which Clinical Nurse
Specialists do not have prescriptive authority. Similarly, synergy competencies ClinJudComp18
through 23, which all began with the verb “Prescribe”, were edited to read “Prescribe, according
to legal restrictions in the state”.
Following consideration of all sources of input from the survey, 101 patient care problems
remained for the Adult/Gerontology Clinical Nurse Specialist, 98 for the Pediatric Clinical Nurse
Specialist, and 85 for the Neonatal Clinical Nurse Specialist. Of the 103 skills and procedures,
twenty-eight are eligible for assessment. All synergy competencies remain available for
assessment as well. Appendix C presents the Detailed Content Outline (DCO) content outline
for the multiple choice examination developed after the application of the decision rules and
review of respondent comments.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 15 ~
Development of Test Plans
The PATF reviewed the patient care problems, skills, procedures, and synergy competencies
that remained after application of the above decision rules. They considered the mean
significance ratings for each of the content categories, as well as the number of remaining
patient care problems and synergy competencies in each category. Table 1 presents the results
from the content allocation question on the survey. The PATF used this information, along with
current test specifications to guide their final decisions regarding the number of items for each of
the areas of practice.
Table 1. Overview of Adult/Gerontology Clinical Nurse Specialist Certification Test Plan
# of
Items
Section Title
I. Clinical Judgment
92
A. Cardiovascular
19
B. Pulmonary
17
C. Endocrine
5
D. Musculoskeletal
3
E. Hematology/Immunology/Oncology
5
F. Neurology
10
G. Gastrointestinal
8
H. Renal/Genitourinary
7
I. Integumentary
3
J. Multisystem
10
K. Psychosocial/Behavioral/Cog. Health
5
II. Advocacy/Moral Agency
7
III. Caring Practices
10
IV. Collaboration
8
V. Systems Thinking
10
VI. Response to Diversity
4
VII. Clinical Inquiry
10
VIII. Facilitation of Learning
9
Total
150
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 16 ~
Table 2. Overview of Pediatric Clinical Nurse Specialist Certification Test Plan
# of
Items
Section Title
I. Clinical Judgment
92
A. Cardiovascular
13
B. Pulmonary
15
C. Endocrine
5
D. Musculoskeletal
5
E. Hematology/Immunology/Oncology
7
F. Neurology
10
G. Gastrointestinal
9
H. Renal/Genitourinary
5
I. Integumentary
3
J. Multisystem
12
K. Psychosocial/Behavioral/Cog. Health
8
II. Advocacy/Moral Agency
7
III. Caring Practices
10
IV. Collaboration
8
V. Systems Thinking
10
VI. Response to Diversity
4
VII. Clinical Inquiry
10
VIII. Facilitation of Learning
9
Total
150
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 17 ~
Table 3. Overview of Neonatal Clinical Nurse Specialist Certification Item Allocation
# of
Items
Section Title
I. Clinical Judgment
92
A. Cardiovascular
13
B. Pulmonary
15
C. Endocrine
4
D. Musculoskeletal
5
E. Hematology/Immunology/Oncology
7
F. Neurology
9
G. Gastrointestinal
9
H. Renal/Genitourinary
6
I. Integumentary
3
J. Multisystem
15
K. Psychosocial/Behavioral/Cog. Health
6
II. Advocacy/Moral Agency
7
III. Caring Practices
10
IV. Collaboration
8
V. Systems Thinking
10
VI. Response to Diversity
4
VII. Clinical Inquiry
10
VIII. Facilitation of Learning
9
Total
150
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 18 ~
Cognitive Complexity
After the number of items was determined, the next step involved defining the cognitive
complexity of the content. As described in Table 4, it was decided that items will normally
require that the candidate apply knowledge underlying the patient care problem (or other topic)
to be able to select the correct response. Some items will also require analysis on the part of
the candidate. Rarely will items be written to require only recall, and recall items will normally
only be approved when a higher cognitive process is not applicable to practice and/or for
knowledge that is highly essential for practice.
Table 4. Cognitive Complexity Scale
Recall
Requires only the identification, recall, or recognition of
isolated information, such as specific facts, generalizations,
concepts, principles, or procedures. The information generally
does not vary relative to the situation.
Application
Requires comprehension, interpretation, or manipulation of
limited concepts or data, in which the response or outcome is
situationally dependent, but not overly complex (e.g.,
application of knowledge which varies based on patient
characteristics and environment). Tasks that require
candidates to recognize elements and relationships among
data and to classify, explain, or differentiate are usually
application level.
Analysis/Evaluation
Requires the integration or synthesis of a variety of concepts
or elements to solve a specific problem situation (e.g.,
evaluating and rendering judgments on complex problems
with many situational variables).
The test plan included in Appendix C will be used by item writers and Examination Committee to
develop the Pediatric Clinical Nurse Specialist Certification examination. Using the results
obtained from this study, the PATF, with direction from AMP project staff, developed the test
specifications. The PATF based the test specifications on the empirical results of this study as
well as the members' many years of experience. The detailed content outline specifies what
areas are to be assessed, and their representation (weighting) on the examination. The detailed
content outline provides the rationale for test development and can be used in the
demonstration of the content validity of the examination.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 19 ~
Summary
The practice analysis described in this report was undertaken to serve as the basis for
documenting the content validity of the Clinical Nurse Specialist certification examinations for
AACN Certification Corporation. The purpose of this study was twofold: (1) to determine and
comprehensively describe the job of the Clinical Nurse Specialist, and (2) to evaluate these
descriptions through the ratings of job experts to define areas that should be assessed on a
certification examination.
A Practice Analysis Task Force was formed to prepare a comprehensive list of patient care
problems, skills and procedures and synergy competencies describing the role of the Clinical
Nurse Specialist caring for patients along the continuum of wellness through acute care. This
inventory was completed by a representative sample of job experts throughout the United
States, and the rating results were reviewed by the Clinical Nurse Specialist PATF.
These results were used to develop test plans (examination specifications) directly related to the
significant activities performed by the Clinical Nurse Specialist. These specifications, empirically
derived from a national practice analysis study, represent the plan for development of criterionreferenced examinations. Each form of each examination will contain the specified number of
items, with a representative sampling of patient care problems, skills and procedures, and
synergy competencies within each domain. Therefore, each test form developed to match these
job-related test specifications will demonstrate substantial content-related evidence in support of
the validity of examination results.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 20 ~
Appendix A
Significance Ratings in Survey Order
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 21 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
AllProb001
Cardio- Acute coronary syndromes
AllProb002
Cardio- Acute inflammatory disease
AllProb003
Cardio- Cardiac surgery
AllProb004
Cardio- Cardiac tamponade
AllProb005
Cardio- Cardiogenic shock
AllProb006
Cardio- Cardiomyopathies
AllProb007
Cardio- Decompensated heart failure
AllProb008
Cardio- Dysrhythmias
AllProb009
Cardio- Heart failure
AllProb010
Cardio- Hypertension
AllProb011
Cardio- Hypertensive crisis
AllProb012
Cardio- Peripheral vascular insufficiency
AllProb013
Cardio- Pulmonary edema
AllProb014
Cardio- Structural heart defects & diseases
AllProb015
Pulm- Acute respiratory failure
AllProb016
Pulm- Air-leak syndromes
AllProb017
Pulm- Aspirations
AllProb018
Pulm- Asthma & reactive airway disease
AllProb019
Pulm- Chronic lung disease
AllProb020
Pulm- Congenital & acquired anomalies
AllProb021
Pulm- Exacerbation of chronic lung disease
AllProb022
Pulm- Pulmonary hypertension
AllProb023
Pulm- Pulmonary infections
AllProb024
Pulm- Thoracic surgery
AllProb025
Pulm- Thoracic & pulmonary trauma & injuries
AllProb026
Pulm- Upper airway obstruction
AllProb027
Endo- Adrenal disorders
AllProb028
Endo- Diabetes insipidus
AllProb029
Endo- Hypoglycemia
AllProb030
Endo- SIADH
AllProb031
Musculo- Functional issues
AllProb032
Musculo- Infections
AllProb033
Musculo- Osteoporosis & bone disease
AllProb034
Musculo- Stress fractures
AllProb035
Musculo- Traumatic fractures
AllProb036
Hem-Immuno- Anemia
AllProb037
Hem&Immuno- Autoimmune diseases
AllProb038
Hem&Immuno- Blood group incompatibilities
AllProb039
Hem&Immuno- Coagulopathies
Hem&Immuno- Congenital & acquired
AllProb040
immunosuppression
AllProb041
Hem&Immuno- Hyperbilirubinemia
SEM
.049
.045
.054
.050
.048
.047
.047
.044
.045
.043
.046
.045
.043
.047
.037
.044
.041
.044
.042
.048
.043
.043
.039
.048
.052
.047
.042
.049
.045
.047
.046
.042
.046
.046
.053
.043
.043
.050
.042
% Not
SD Performing
1.33
8.82
1.23
5.34
1.42
16.00
1.37
8.22
1.33
5.97
1.30
5.09
1.30
5.22
1.25
1.48
1.26
3.35
1.19
2.37
1.26
5.11
1.21
9.07
1.19
2.25
1.28
7.89
1.05
1.25
1.23
2.53
1.16
1.25
1.22
2.26
1.17
1.25
1.30
8.65
1.21
2.50
1.19
2.88
1.09
0.88
1.31
6.74
1.39
10.22
1.31
3.27
1.17
4.91
1.35
5.06
1.25
1.28
1.29
3.91
1.28
3.00
1.17
1.64
1.24
10.06
1.19
16.31
1.41
11.84
1.19
1.39
1.18
4.33
1.36
6.49
1.18
2.03
N
734
762
677
737
756
764
763
797
779
784
761
732
782
735
790
771
789
779
791
729
779
777
786
747
720
770
756
751
769
762
775
778
715
667
700
780
751
735
773
Mean
3.48
2.73
3.07
2.97
3.31
3.07
3.56
3.76
3.74
3.68
3.31
3.15
3.56
2.57
4.16
3.38
3.67
3.24
3.43
2.38
3.46
3.15
3.79
3.16
2.94
3.29
2.31
2.83
3.49
2.68
3.52
3.88
2.33
2.09
2.69
3.20
2.60
2.60
3.40
724
2.41
.046 1.24
8.35
645
2.32
.052 1.31
17.94
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 22 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
AllProb042
Hem&Immuno- Leukemia & tumors
AllProb043
Hem&Immuno- Organ & tissue transplantation
AllProb044
Hem&Immuno- Polycythemia
AllProb045
Neuro- Congenital neurological abnormalities
AllProb046
Neuro- Encephalopathy
AllProb047
Neuro- Head and brain trauma & injury
AllProb048
Neuro- Hydrocephalus
AllProb049
Neuro- Increased intracranial pressure
Neuro- Intracranial & intraventricular
AllProb050
hemorrhage
AllProb051
Neuro- Neurologic infectious diseases
AllProb052
Neuro- Neuromuscular disorders
AllProb053
Neuro- Seizure disorders
AllProb054
Neuro- Space-occupying lesions
AllProb055
Neuro- Spinal cord injury
AllProb056
Neuro- Stroke
AllProb057
Neuro- Vascular malformation
AllProb058
Gastro- Abdominal trauma
AllProb059
Gastro- Acute GI hemorrhage
Gastro- Bowel infarction, obstruction,
AllProb060
perforation
AllProb061
Gastro- Gallbladder disease
AllProb062
Gastro- Gastro-esophageal reflux
AllProb063
Gastro- Gastrointestinal infectious diseases
AllProb064
Gastro- GI abnormalities
AllProb065
Gastro- GI motility disorders
AllProb066
Gastro- GI surgeries
AllProb067
Gastro- Hepatic failure & coma
AllProb068
Gastro- Hepatitis
AllProb069
Gastro- Malnutrition
AllProb070
Gastro- Nausea & vomiting
AllProb071
Renal- Acute renal failure
AllProb072
Renal- Chronic renal failure
Renal- Congenital & acquired renal &
AllProb073
genitourinary abnormalities
AllProb074
Renal- Electrolyte imbalances
AllProb075
Renal- Fluid volume imbalances
AllProb076
Renal- Infections
AllProb077
Renal- Renal and genitourinary surgeries
AllProb078
Renal- Renal calculi
AllProb079
Integ- Congenital & acquired abnormalities
AllProb080
Integ- Dermatologic disorders
SEM
.048
.057
.044
.051
.050
.057
.056
.054
% Not
SD Performing
1.25
12.18
1.44
19.11
1.15
11.68
1.28
20.10
1.34
8.02
1.50
10.60
1.40
19.49
1.45
8.50
N
692
639
696
632
723
700
636
721
Mean
2.30
2.58
2.02
2.14
2.91
3.20
2.52
3.43
735
3.51
.052 1.42
7.20
704
724
755
682
672
761
698
665
741
2.72
2.65
3.06
2.63
2.91
3.88
2.61
2.85
3.48
.051
.046
.047
.052
.057
.045
.049
.056
.046
1.34
1.24
1.30
1.36
1.49
1.23
1.30
1.44
1.25
10.43
8.01
4.31
13.12
14.83
3.55
10.97
14.41
3.89
749
3.35
.045 1.22
3.10
695
737
716
688
734
716
718
720
736
744
770
753
2.54
2.80
2.61
2.25
2.56
2.85
3.02
2.68
3.15
3.24
3.99
3.59
.047
.047
.049
.048
.046
.048
.048
.047
.048
.047
.038
.042
1.23
1.26
1.30
1.25
1.25
1.28
1.30
1.27
1.30
1.28
1.05
1.14
10.55
5.03
6.77
11.23
5.41
7.25
7.47
6.86
4.54
3.13
1.16
2.21
677
2.29
.047 1.23
12.42
773
769
745
686
654
604
638
4.20
4.22
3.31
2.52
2.17
1.93
1.87
.034
.034
.048
.048
.047
.049
.044
0.77
0.77
3.62
11.48
14.73
21.96
16.93
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 23 ~
.94
.94
1.30
1.25
1.21
1.20
1.12
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
AllProb081
Integ- Infectious skin disorders
AllProb082
Integ- Pressure ulcers
AllProb083
Integ- Wounds
AllProb084
Multi- Compartment syndrome
AllProb085
Multi- Distributive shock
AllProb086
Multi- End of life issues
AllProb087
Multi- Hypovolemic shock
AllProb088
Multi- Hypoxic ischemic encephalopathy
AllProb089
Multi- Infectious diseases
AllProb090
Multi- Pain
AllProb091
Multi- Palliative care issues
AllProb092
Multi- Patient safety issues
AllProb093
Multi- Sensory impairment
AllProb094
Multi- SIRS, sepsis, septic shock, MODS
AllProb095
Multi- Toxic exposure
AllProb096
Psych- Age-related developmental issues
AllProb097
Psych- Failure to thrive
AllProb098
Psych- Maltreatment
AllProb099
Psych- Medical nonadherence
AllProb100
Psych- Sleep disorders
AllProb101
Psych- Substance abuse
AdultProb01
AdultProb02
AdultProb03
AdultProb04
AdultProb05
AdultProb06
AdultProb07
AdultProb08
AdultProb09
AdultProb10
AdultProb11
AdultProb12
AdultProb13
AdultProb14
AdultProb15
AdultProb16
AdultProb17
AdultProb18
AdultProb19
AdultProb20
Cardio- Cardiac trauma
Cardio- Dyslipidemia
Cardio- Ruptured & dissecting aneurysm
Pulm- Acute pulmonary embolus
Pulm- ALI (ARDS)
Pulm- Obstructive sleep apnea
Endo- Diabetes mellitus
Endo- Diabetes ketoacidosis & HHNK
Endo- Hyperglycemia
Endo- Hormone imbalances & issues
Endo- Thyroid disorders
Musculo- Acute gout
Musculo- Osteoarthritis
Musculo- Spinal disease
Musculo- Sports injuries
Hem&Immuno- AIDS & HIV
Hem&Immuno- HELLP syndrome
Hem&Immuno- Sickle cell disease
Neuro- Migraine headaches
Gastro- Inflammatory bowel disease
N
681
752
755
719
734
766
751
726
756
767
760
768
740
752
667
709
655
713
738
699
746
576
636
621
659
645
646
668
655
662
642
654
552
590
573
467
622
545
575
538
581
Mean
2.27
3.90
3.83
3.05
3.54
4.21
3.92
3.28
3.89
4.43
4.00
4.38
2.74
4.01
2.49
2.99
2.62
2.74
3.19
2.51
3.16
SEM
.048
.045
.042
.050
.049
.037
.044
.050
.042
.031
.040
.034
.048
.044
.051
.052
.053
.051
.047
.046
.046
2.71
3.18
3.29
3.88
3.82
3.16
4.18
3.46
3.95
2.61
2.66
1.97
2.16
2.05
1.99
2.43
2.26
2.17
2.01
2.35
.060
.053
.052
.041
.048
.049
.037
.048
.039
.047
.047
.049
.049
.049
.056
.050
.056
.052
.052
.051
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 24 ~
% Not
SD Performing
1.26
10.86
1.24
2.72
1.16
1.95
1.35
6.62
1.33
4.30
1.04
0.91
1.20
2.21
1.34
5.71
1.15
2.20
.85
0.52
1.12
1.55
.95
0.26
1.31
3.90
1.20
2.72
1.31
12.47
1.38
7.92
1.35
14.15
1.36
6.43
1.28
4.16
1.21
8.63
1.25
2.86
1.44
1.35
1.29
1.06
1.21
1.25
.95
1.23
1.01
1.20
1.19
1.14
1.20
1.18
1.21
1.25
1.31
1.24
1.21
1.23
14.92
5.92
7.73
1.93
3.44
3.73
0.74
2.67
1.19
4.75
2.97
17.37
11.68
13.96
30.19
7.16
18.05
13.92
18.73
10.62
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
AdultProb21
Gastro- Pancreatitis
AdultProb22
Renal- Gynecological problems
AdultProb23
Renal- Incontinence
AdultProb24
Renal- Obstetrical issues
AdultProb25
Renal- Prostate problems
AdultProb26
Renal- Renal trauma
AdultProb27
Integ- Pruritus
AdultProb28
Multi- Burns
Multi- Life-threatening maternal-fetal
AdultProb29
complications
AdultProb30
Multi- Multisystem trauma
AdultProb31
Multi- Near-drowning
AdultProb32
Multi- Toxic ingestions & inhalations
AdultProb33
Psych- Aggression
AdultProb34
Psych- Anxiety disorders
AdultProb35
Psych- ADHD
AdultProb36
Psych- Delirium
AdultProb37
Psych- Dementia
AdultProb38
Psych- Eating disorders
AdultProb39
Psych- Learning disabilities & disorders
AdultProb40
Psych- Mood disorders
AdultProb41
Psych- Personality disorders
AdultProb42
Psych- Risk-taking behaviors
AdultProb43
Psych- Suicidal behavior
509
439
524
625
630
497
649
652
494
523
614
598
589
618
3.12
2.36
2.56
2.82
2.88
1.99
3.85
3.46
1.84
1.93
2.80
2.47
2.75
2.84
.069
.066
.059
.053
.053
.054
.047
.047
.050
.050
.053
.053
.056
.055
% Not
SD Performing
1.21
3.72
1.11
23.63
1.33
11.46
1.15
32.94
1.12
18.09
1.29
19.13
1.13
19.11
1.38
37.57
1.42
44.69
1.56
23.57
1.38
34.48
1.36
21.32
1.31
7.54
1.32
6.25
1.20
26.70
1.19
3.85
1.20
3.55
1.12
27.03
1.15
22.63
1.31
8.90
1.30
10.61
1.37
12.48
1.36
7.62
19
19
19
19
19
18
19
19
19
19
19
4.37
4.42
4.26
4.47
3.68
3.39
4.42
4.00
3.42
4.00
4.11
.175
.159
.227
.160
.297
.304
.159
.216
.279
.254
.228
.76
.69
.99
.70
1.29
1.29
.69
.94
1.22
1.11
.99
NeoProb12
NeoProb13
NeoProb14
Cardio- PDA
Pulm- Apnea of prematurity
Pulm- PPHN
Pulm- Respiratory distress syndrome
Pulm- Transient tachypnea of newborn
Endo- Inborn errors of metabolism
Endo- Infant of diabetic mother
Musculo- Congenital anomalies
Neuro- Periventricular leukomalacia
Multi- Child of addicted mother
Multi- Life-threatening maternal-fetal
complications
Multi- Low birth weight & prematurity
Multi- Transition to extrauterine life
Psych- Behavioral state
19
19
19
4.53 .160
4.21 .196
4.58 .159
.70
.85
.69
0.00
0.00
0.00
0.00
PedsProb01
Cardio- Cardiac trauma
59
2.12 .178
1.37
11.94
NeoProb01
NeoProb02
NeoProb03
NeoProb04
NeoProb05
NeoProb06
NeoProb07
NeoProb08
NeoProb09
NeoProb10
NeoProb11
N Mean
621 3.14
514 1.85
595 2.50
450 1.94
548 2.00
541 2.33
529 1.90
417 2.19
370 2.28
SEM
.049
.049
.055
.054
.048
.056
.049
.068
.074
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 25 ~
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
PedsProb02
Cardio- Dyslipidemia
PedsProb03
Cardio- PDA
PedsProb04
Cardio- Ruptured & dissecting aneurysm
PedsProb05
Pulm- Acute pulmonary embolus
PedsProb06
Pulm- Acute life-threatening events
PedsProb07
Pulm- ALI & ARDS
PedsProb08
Pulm- Obstructive sleep apnea
PedsProb09
Pulm- Pulmonary hemorrhage
PedsProb10
Endo- Diabetes mellitus
PedsProb11
Endo- Diabetic ketoacidosis & HHNK
PedsProb12
Endo- Hormone imbalances & issues
PedsProb13
Endo- Hyperglycemia
PedsProb14
Endo- Inborn errors of metabolism
PedsProb15
Endo- Thyroid disorders
PedsProb16
Musculo- Congenital abnormalities
PedsProb17
Musculo- Osteoarthritis
PedsProb18
Musculo- Spinal disease
PedsProb19
Musculo- Sports injuries
PedsProb20
Hem&Immuno- AIDS & HIV
PedsProb21
Hem&Immuno- Sickle cell disease
PedsProb22
Gastro- Inflammatory bowel disease
PedsProb23
Gastro- Pancreatitis
PedsProb24
Renal- Gynecological problems
PedsProb25
Renal- Incontinence
PedsProb26
Renal- Obstetrical issues
PedsProb27
Renal- Renal trauma
PedsProb28
Integ- Pruritus
PedsProb29
Multi- Burns
PedsProb30
Multi- Child of addicted mother
PedsProb31
Multi- Multisystem trauma
PedsProb32
Multi- Near-drowning
PedsProb33
Multi- Toxic ingestions & inhalations
PedsProb34
Psych- Aggression
PedsProb35
Psych- Anxiety disorders
PedsProb36
Psych- ADHD
PedsProb37
Psych- Autism & autism spectrum disorders
PedsProb38
Psych- Delirium
PedsProb39
Psych- Disorders of elimination
PedsProb40
Psych- Eating disorders
PedsProb41
Psych- Learning disabilities & disorders
PedsProb42
Psych- Mood disorders
PedsProb43
Psych- Personality disorders
N Mean
50 1.56
59 2.80
43 1.81
63 2.35
66 3.95
63 3.81
62 2.35
62 2.53
64 3.72
65 3.74
64 2.52
66 3.42
64 2.89
64 2.22
65 2.97
40 1.75
59 2.69
60 2.48
56 2.34
62 3.16
55 2.64
65 2.60
57 1.56
56 2.05
37 1.24
54 2.39
57 1.91
53 2.40
58 2.22
56 3.96
58 3.66
61 3.49
59 2.31
61 2.25
62 2.47
62 2.58
57 1.98
56 1.96
58 2.10
61 2.21
62 2.26
58 1.90
SEM
.143
.196
.164
.154
.158
.157
.163
.145
.167
.170
.146
.166
.161
.155
.167
.142
.176
.162
.188
.174
.156
.150
.125
.162
.112
.168
.140
.191
.191
.155
.157
.158
.166
.163
.159
.160
.145
.167
.151
.144
.151
.149
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 26 ~
% Not
SD Performing
1.01
23.08
1.51
10.61
1.07
35.82
1.22
4.55
1.28
0.00
1.24
4.55
1.28
6.06
1.14
6.06
1.34
4.48
1.37
2.99
1.17
4.48
1.35
1.49
1.29
4.48
1.24
4.48
1.35
1.52
.90
38.46
1.36
11.94
1.26
10.45
1.40
8.20
1.37
7.46
1.16
8.33
1.21
2.99
.95
14.93
1.21
16.42
.68
43.94
1.23
19.40
1.06
12.31
1.39
20.90
1.45
13.43
1.16
16.42
1.19
13.43
1.23
8.96
1.28
10.61
1.27
8.96
1.25
7.46
1.26
7.46
1.09
14.93
1.25
16.42
1.15
13.43
1.13
8.96
1.19
6.06
1.13
13.43
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
PedsProb44
Psych- Risk-taking behaviors
PedsProb45
Psych- Suicidal behavior
N Mean SEM
61 2.52 .156
63 2.94 .158
% Not
SD Performing
1.22
8.96
1.26
5.97
724
682
696
715
718
621
293
559
239
531
198
326
464
193
1.10
1.32
1.30
1.17
1.13
1.37
1.43
1.45
1.44
1.42
1.30
1.44
1.52
1.46
CardioTask28
CardioTask29
CardioTask30
CardioTask31
CardioTask32
CardioTask33
Interpret ECG rhythms
Interpret 12-lead ECGs
Determine lead selection for ECGs
Interpret hemodynamic values
Interpret non-invasive hemodynamic values
Manage transcutaneous (external) pacemakers
Insert temporary transvenous pacemakers
Manage temporary transvenous pacemakers
Insert permanent transvenous pacemakers
Manage permanent transvenous pacemakers
Insert transesophageal pacemakers
Manage transesophageal pacemakers
Manage epicardial pacemakers
Insert implantable cardioverter defibrillators
(ICDs)
Manage implantable cardioverter defibrillators
(ICDs)
Insert intra-aortic balloon catheter
Remove intra-aortic balloon catheter
Manager cardiac assist devices (e.g., RVAD,
BVAD. LVAD, ECMO)
Perform pericardiocentesis
Direct cardiopulmonary resuscitation
Insert arterial pressure catheters
Insert central venous pressure catheters
Insert pulmonary artery pressure catheters
Adjust pulmonary artery pressure catheters
Perform stress testing
Interpret echocardiograms
Direct extracorporeal compression pressure
(EECP) therapy
Perform elective cardioversion
Perform tilt-table testing
Disconnect pacer wire
Harvest saphenous vein graft
Perform interventional radiology
Interpret stress tests
389
200
349
129
142
215
2.94
2.24
3.23
2.05
2.08
2.38
.073
.096
.077
.121
.113
.097
1.44
1.35
1.43
1.37
1.35
1.42
76.89
47.57
72.97
52.90
82.40
80.84
70.79
PulmTask01
PulmTask02
Order nasal/facial CPAP/BiPAP
Initiate mechanical ventilation
406
364
3.15 .069
3.06 .076
1.40
1.44
45.21
50.41
CardioTask01
CardioTask02
CardioTask03
CardioTask04
CardioTask05
CardioTask06
CardioTask07
CardioTask08
CardioTask09
CardioTask10
CardioTask11
CardioTask12
CardioTask13
CardioTask14
CardioTask15
CardioTask16
CardioTask17
CardioTask18
CardioTask19
CardioTask20
CardioTask21
CardioTask22
CardioTask23
CardioTask24
CardioTask25
CardioTask26
CardioTask27
4.26
3.57
3.68
4.08
4.11
3.50
2.56
3.33
2.46
3.12
2.10
2.40
3.21
2.33
.041
.051
.049
.044
.042
.055
.084
.061
.093
.062
.092
.080
.070
.105
2.95
8.33
6.83
4.28
3.49
16.53
60.46
24.36
67.83
28.53
73.32
55.83
37.04
73.95
508
195
285
364
223
666
274
260
229
371
222
275
171
2.94 .064
2.58 .111
2.86 .085
3.04 .078
2.26
3.92
2.98
2.93
2.64
3.00
2.41
2.40
2.02
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 27 ~
.090
.050
.088
.091
.096
.075
.095
.083
.097
1.44
1.55
1.44
1.49
1.34
1.29
1.46
1.47
1.45
1.45
1.41
1.37
1.27
30.88
73.68
61.49
50.94
69.86
10.12
62.97
64.86
69.05
49.93
70.04
62.79
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
PulmTask03
Manage mechanical ventilation
PulmTask04
Wean mechanical ventilation
PulmTask05
Perform bronchoscopy
PulmTask06
Perform bronchial alveolar lavage
PulmTask07
Perform thoracentesis
PulmTask08
Insert chest tube
PulmTask09
Interpret pulmonary function tests
PulmTask10
Perform intubation
PulmTask11
Perform percutaneous tracheotomy
PulmTask12
Disconnect chest tube
N Mean
528 3.44
520 3.40
168 2.27
191 2.39
184 2.33
205 2.62
332 2.58
247 2.80
164 2.35
461 3.14
EndoTask01
Perform rapid ACTH stimulation test
154
2.10 .099
1.23
63.25
HemTask01
HemTask02
HemTask03
HemTask04
HemTask05
HemTask06
HemTask07
HemTask08
Perform exchange transfusions
Order plasmapheresis
Insert permanent vascular access device
Perform bone marrow aspiration
Perform bone marrow biopsy
Manage chemotherapy
Insert chemotherapy access device
Perform bone marrow transplant
218
173
136
117
112
208
113
93
2.26
2.05
2.18
1.79
1.86
2.53
2.03
1.88
.093
.098
.119
.115
.122
.095
.128
.138
1.37
1.30
1.38
1.24
1.29
1.37
1.36
1.33
70.26
76.33
81.37
84.04
84.59
71.47
84.52
87.17
NeuroTask01
NeuroTask02
NeuroTask03
NeuroTask04
NeuroTask05
NeuroTask06
NeuroTask07
Insert epidural ICP monitoring device
Insert subdural ICP monitoring device
Insert intraventricular ICP monitoring device
Insert cerebral oxygenation monitoring device
Remove epidural ICP monitoring device
Remove subdural ICP monitoring device
Remove intraventricular ICP monitoring device
Remove cerebral oxygenation monitoring
device
Tap ventricular reservoirs/shunts
Perform lumbar puncture
Insert SiO2 catheter
Monitor SiO2 results
Insert epidural catheters
Perform transcranial Doppler
Interpret transcranial Doppler
Interpret EEGs
Insert lumbar drains
Reprogram shunt
98
95
102
92
147
144
147
140
2.08
2.12
2.31
2.18
2.35
2.35
2.41
2.38
.139
.144
.153
.147
.117
.118
.122
.116
1.37
1.41
1.55
1.41
1.42
1.42
1.48
1.37
86.56
86.95
85.93
87.28
79.72
80.14
79.70
NeuroTask08
NeuroTask09
NeuroTask10
NeuroTask11
NeuroTask12
NeuroTask13
NeuroTask14
NeuroTask15
NeuroTask16
NeuroTask17
NeuroTask18
128
143
92
200
99
111
147
208
96
93
SEM
.061
.061
.110
.107
.104
.104
.076
.096
.115
.064
2.16
2.31
1.89
2.78
1.95
1.96
2.29
2.34
2.03
2.06
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 28 ~
.117
.116
.122
.100
.126
.112
.111
.092
.127
.128
% Not
SD Performing
1.40
28.55
1.40
29.25
1.43
77.27
1.47
74.08
1.42
75.07
1.49
72.30
1.39
55.01
1.51
66.49
1.47
77.81
1.38
36.68
1.33
1.39
1.17
1.42
1.26
1.17
1.34
1.32
1.24
1.23
80.77
82.39
80.28
87.31
72.45
86.27
84.63
79.67
71.39
86.76
86.99
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
GastroTask01
Perform endoscopy
GastroTask02
Perform paracentesis
GastroTask03
Perform sigmoidoscopy
GastroTask04
Insert PEG tube
GastroTask05
Insert PEG/JT/drainage catheters
GastroTask06
Remove PEG/JT/drainage catheters
N Mean
102 1.89
121 1.97
90 1.79
126 2.16
107 1.88
213 2.32
RenalTask01
RenalTask02
RenalTask03
RenalTask04
RenalTask05
RenalTask06
Initiate renal replacement therapies
Insert dialysis catheters
Perform pelvic exams
Complete Pap smears
Insert suprapubic catheters
Disconnect and flush renal stent
273
116
145
128
116
148
2.79
2.15
2.31
2.30
2.00
2.18
.089
.130
.118
.126
.114
.108
1.47
1.40
1.43
1.43
1.23
1.31
62.24
83.91
79.94
82.34
83.89
79.39
MusculoTask01
MusculoTask02
MusculoTask03
MusculoTask04
MusculoTask05
MusculoTask06
MusculoTask07
Perform joint aspiration
Perform joint injections
Provide trigger point injections
Perform casting/splinting
Apply treatment device
Relocate dislocated bones
Administer pain block/cortisone shot
85
87
82
148
220
91
98
1.93
2.03
1.95
2.25
2.30
2.02
2.19
.135
.138
.141
.107
.086
.134
.136
1.24
1.29
1.28
1.30
1.27
1.28
1.34
88.24
87.97
88.60
79.44
69.53
87.36
86.33
IntegTask01
IntegTask02
IntegTask03
IntegTask04
IntegTask05
IntegTask06
Suture wounds
Provide wound care
Incise and drain abscesses
Perform skin biopsies
Perform KOH preparations
Excise lesions
214
610
206
128
104
114
2.53
3.59
2.76
2.44
2.50
2.47
.101
.054
.101
.124
.140
.138
1.48
1.32
1.44
1.41
1.43
1.47
70.36
15.40
71.27
82.17
85.43
84.01
MultiTask01
MultiTask02
MultiTask03
106
295
69
540
2.23
2.73
1.93
3.53
.137
.076
.139
.055
1.41
1.31
1.15
1.27
85.32
59.03
90.24
MultiTask05
MultiTask06
Perform as a surgical first assist
Interpret diagnostic imaging
Perform RetCam
Provide nonpharmacological interventions for
pain
Prescribe pharmaceutical interventions
Prescribe durable medical equipment
266
307
3.36 .089
3.21 .084
1.45
1.48
25.00
62.90
57.12
PsychTask01
Perform ECT therapy
51
1.73 .132
.94
92.47
ClinJudComp01
Conduct comprehensive, holistic
wellness/illness assessments
.054 1.356
9.86
MultiTask04
640
3.61
SEM
.129
.114
.126
.120
.117
.092
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 29 ~
% Not
SD Performing
1.30
85.95
1.25
83.29
1.19
87.57
1.35
82.55
1.21
85.16
1.35
70.17
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Obtain data necessary to formulate differential
ClinJudComp02
diagnoses/plans of care, and evaluate
outcomes
Use evidence-based guidelines to guide clinical
ClinJudComp03
practice
Synthesize data/advanced
ClinJudComp04
knowledge/experience using critical thinking to
formulate differential diagnoses
Determine diagnoses considering:
ClinJudComp05
physiologic/pathophysiologic changes
Determine diagnoses considering:
ClinJudComp06
morbidities/co-morbidities
Determine diagnoses considering: events
ClinJudComp07
across life span
Determine diagnoses considering: pts
ClinJudComp08
pharmacologic history w/ particular attention to
issues of polypharmacy
Use reliable and valid age-appropriate
assessment instruments is assess acute and
ClinJudComp09
chronic health concerns, including but not
limited to mental status, delirium, dementia, and
pain
Assess for manifestation of health
disorders/disruptions, e.g., infection, adverse
ClinJudComp10
drug effect, dehydration, ischemia, and geriatric
syndromes
Evaluate for mental health disorders such as
ClinJudComp11
depression, dementia, anxiety, or substancerelated disorders
Conduct pharmacologic assessment including
polypharmacy, drug interactions, over-theClinJudComp12
counter and herbal product use and the ability
to safely and correctly store and self-administer
medications
Interpret values/results of lab/diagnostic tests
ClinJudComp13
with consideration of age, ethnicity and health
status
Assess pt/caregiver/family ability to implement
ClinJudComp14
complex plans of care
Assess pt/caregiver/family preferences in
ClinJudComp15
relation to cultural/spiritual/quality of life/lifestyle
choices
ClinJudComp16
Prioritize differential diagnoses
Design strategies to meet multifaceted needs of
ClinJudComp17
complex pts/ groups of pts
ClinJudComp18
Prescribe: pharmacologic interventions
ClinJudComp19
Prescribe: non-pharmacologic interventions
N
Mean SEM
SD
% Not
Performing
678
3.98
.046 1.201
4.37
704
4.62
.028 .732
0.28
690
4.36
.037 .982
2.68
682
4.22
.040 1.032
4.08
682
4.16
.041 1.062
4.08
676
3.89
.046 1.203
4.52
671
3.94
.047 1.209
5.36
683
3.87
.045 1.166
3.67
676
3.93
.044 1.144
4.25
642
3.39
.054 1.372
9.45
646
3.46
.055 1.386
8.89
689
4.06
.043 1.117
2.96
693
4.01
.043 1.145
2.12
690
3.92
.045 1.179
2.40
669
3.88
.047 1.218
5.77
689
4.12
.042 1.106
2.55
304
506
3.44
3.77
.085 1.483
.053 1.191
56.94
28.33
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 30 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
ClinJudComp20
Prescribe: diagnostic measures
ClinJudComp21
Prescribe: equipment
ClinJudComp22
Prescribe: procedures
ClinJudComp23
Prescribe: treatments
ClinJudComp24
Recommend: pharmacologic interventions
ClinJudComp25
Recommend: non-pharmacologic interventions
ClinJudComp26
Recommend: diagnostic measures
ClinJudComp27
Recommend: equipment
ClinJudComp28
Recommend: procedures
ClinJudComp29
Recommend: treatments
Provide direct care to selected pts based on
ClinJudComp30
needs of pt and CNSs specialty knowledge and
skills
Evaluate nursing practice that considers safety,
ClinJudComp31
timeliness, effectiveness, efficiency, efficacy
and pt/family centered care
Determine when evidence-based
ClinJudComp32
guidelines/policies/procedures/plans of care
need to be tailored to individual
Manage or refer pt with signs/symptoms of
ClinJudComp33
physical/mental health disorders across the
adult lifespan, including geriatric syndromes
ClinJudComp34
Intervene to prevent/minimize iatrogenesis
Differentiate between outcomes that require
ClinJudComp35
care process modification @ the pt vs. system
level
Lead development of evidence-based plans for
ClinJudComp36
meeting individual, family, community, and
population needs
Provide leadership for collaborative, evidenceClinJudComp37
based plans for meeting individual, family,
community, and population needs
Provide consultation to interdisciplinary
ClinJudComp38
colleagues
Provide consultation to the interdisciplinary
team re: the pts mental status, home
ClinJudComp39
environment, mobility, functional status, selfcare, and caregivers abilities
Coordinate care w/ other healthcare providers &
community resources, with special attention to
ClinJudComp40
the needs of the non-verbal, developmentally,
and cognitively impaired patient and frail older
adult
Initiate consultation to obtain resources to
ClinJudComp41
facilitate progress toward achieving identified
outcomes
SEM
.074
.065
.074
.067
.047
.041
.048
.045
.049
.046
% Not
SD Performing
1.408
48.80
1.321
41.87
1.409
48.44
1.343
42.08
1.214
5.52
1.089
2.40
1.234
6.36
1.166
3.96
1.255
5.94
1.178
4.15
N
362
411
363
406
667
691
662
679
665
669
Mean
3.42
3.44
3.28
3.41
3.77
3.98
3.71
3.79
3.65
3.78
682
3.82
.048 1.252
2.85
702
4.39
.032 .843
0.14
702
4.46
.032 .836
0.14
650
3.68
.052 1.317
7.54
665
3.97
.046 1.175
5.14
691
4.07
.041 1.070
1.71
693
4.13
.040 1.053
1.28
693
4.26
.037 .971
1.14
694
4.20
.038 .991
1.00
680
3.85
.046 1.207
3.00
664
3.67
.051 1.323
5.14
676
3.86
.046 1.202
3.43
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 31 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Design a comprehensive, individualized, ageClinJudComp42
and disease-appropriate plan for health
promotion
Develop age-specific, individualized treatment
plans and interventions with consideration of
ClinJudComp43
cognitive status, sensory function, perception,
and the environment
AdvoComp01
AdvoComp02
AdvoComp03
AdvoComp04
AdvoComp05
AdvoComp06
AdvoComp07
AdvoComp08
AdvoComp09
AdvoComp10
AdvoComp11
AdvoComp12
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 health care
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 pt/family understanding of
risks/benefits/outcomes of proposed healthcare
regimens to promote informed decision making
Facilitate decision-making regarding treatment
options with the
patient/family/caregivers/healthcare proxy
Advocate for equitable pt care by: participating
in organizational, local, state, national, or
international level of policy-making activities for
issues related to their expertise
Advocate for equitable pt care by: ii. evaluating
the impact of legislative and regulatory policies
as they apply to nursing practice and patient or
population outcomes
Facilitate resolution of ethical conflicts by:
identifying ethical implications of complex care
situations
N
Mean SEM
SD
% Not
Performing
671
3.64
.050 1.296
3.87
674
3.69
.048 1.259
3.58
680
3.54
.049 1.274
2.44
687
4.03
.041 1.081
1.15
693
4.40
.033 .875
0.29
697
4.36
.034 .885
0.00
683
4.11
.040 1.058
1.16
673
3.57
.051 1.314
3.30
670
3.60
.052 1.355
3.46
675
3.89
.045 1.174
3.16
666
3.86
.046 1.181
3.20
655
3.09
.054 1.378
5.21
654
3.09
.052 1.331
3.82
686
3.88
.042 1.108
1.15
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 32 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Facilitate resolution of ethical conflicts by:
considering the impact of scientific
AdvoComp13
advances/cost/clinical effectiveness/ pt & family
values & preferences/other external influence
Facilitate resolution of ethical conflicts by:
AdvoComp14
applying ethical principles to resolve concerns
Advocate for access to hospice and palliative
AdvoComp15
care services for patients across the adult age
spectrum
CaringComp01
CaringComp02
CaringComp03
CaringComp04
CaringComp05
CaringComp06
CaringComp07
CaringComp08
CaringComp09
CaringComp10
CaringComp11
CollabComp01
CollabComp02
Use advanced communication skills to improve
patient outcomes
Assess the effects of interactions among the
individual/family/community/social systems
Identify potential risks to pt safety/autonomy,
quality of care based on assessments across all
sphere of influence
Determine nursing practice and system
interventions that promote pt/family/community
safety
Select interventions that may include, but are
not limited to: application of advanced nursing
therapies
Select interventions that may include, but are
not limited to: initiation of interdisciplinary team
meetings/consults/other communications to
benefit pt care
Select interventions that may include, but are
not limited to: management of pain meds/clinical
procedures/other interventions
Select interventions that may include, but are
not limited to: psychosocial support including pt
counseling & spiritual interventions
Create therapeutic health-promoting, agingfriendly environments
Provide leadership to address threats to
healthcare safety/quality in the adult-older adult
population
Use behavioral, communication, and
environmental-modification strategies with
individuals who have cognitive/psychiatric
impairments
Communicate consultation findings as
appropriate
Facilitate the provision of clinically competent
care through education, role modeling,
teambuilding, and quality monitoring
N
Mean SEM
SD
% Not
Performing
681
3.76
.044 1.136
1.30
678
3.96
.042 1.100
1.17
651
3.86
.047 1.205
4.55
689
4.30
.035 .922
0.14
684
3.89
.044 1.144
0.87
686
4.17
.038 1.006
0.44
683
4.13
.040 1.058
0.58
671
3.82
.044 1.130
2.33
677
4.03
.041 1.077
1.02
654
3.68
.048 1.239
4.94
659
3.49
.050 1.283
3.65
655
3.51
.050 1.268
5.07
633
3.73
.049 1.238
8.26
640
3.25
.055 1.396
6.57
680
4.11
.039 1.027
1.02
684
4.38
.034 .899
0.29
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 33 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Provide leadership in promoting interdisciplinary
CollabComp03
collaboration to implement outcome-focused
patient care programs
Use leadership, team building, negotiation, and
conflict resolution skills to build partnerships
CollabComp04
within and across systems, including
communities
Establish collaborative relationships within and
across departments that promote patient safety,
CollabComp05
culturally competent care, and clinical
excellence
Provide leadership for establishing, improving,
CollabComp06
and sustaining collaborative relationships
Practice collegially with members of the
CollabComp07
healthcare team
Facilitate intra-agency and inter-agency
CollabComp08
communication
Foster an interdisciplinary approach to quality
improvement, evidence-based practice,
CollabComp09
research, and translation of research into
practice
SysThinkComp01
SysThinkComp02
SysThinkComp03
SysThinkComp04
SysThinkComp05
SysThinkComp06
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to:
population variables (age distribution, health
status, income distribution, culture)
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to:
environment (schools, community support
services, housing availability, employment
opportunities)
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to: system of
health care delivery
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to:
regulatory requirements
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to: internal
and external political influences/stability
Perform system level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to: health
care financing
N
Mean SEM
SD
% Not
Performing
680
4.24
.037 .968
0.29
681
4.06
.042 1.084
0.44
681
4.32
.035 .905
0.29
684
4.24
.037 .959
0.29
682
4.52
.029 .749
0.15
675
3.81
.045 1.170
1.32
677
4.31
.037 .956
0.29
640
3.29
.052 1.310
5.47
607
2.82
.057 1.395
9.94
649
3.35
.051 1.291
3.99
653
3.57
.049 1.262
2.39
646
3.15
.052 1.330
4.30
634
2.98
.053 1.329
6.35
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 34 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Perform system level assessments to identify
variables that influence nursing practice and
SysThinkComp07 outcomes, including but not limited to: recurring
practices that enhance or compromise pt or
system outcomes
Use effective strategies for changing clinician
and team behavior to encourage adoption of
SysThinkComp08
evidence-based practices and innovations in
care delivery
Provide leadership in maintaining a supportive
SysThinkComp09
and healthy work environment
Evaluate use of products and services for
SysThinkComp10 appropriateness and cost/benefit in meeting
care needs
Conduct cost/benefit analysis of new clinical
SysThinkComp11
technologies
Evaluate impact of introduction or withdrawal of
SysThinkComp12
products, services and technologies
Assess the impact of environmental/system
SysThinkComp13
factors on care
Coordinate the care of pts with use of system &
community resources to assure successful
SysThinkComp14 health/illness/wellness transition, enhance
delivery of care and achieve optimal pt
outcomes
Manage pts transitions of care in collaboration
with individual/family/
SysThinkComp15 caregivers/interdisciplinary team members
including: analyzing the readiness of the pt and
family to transition
Manage pts transitions of care in collaboration
with individual/family/
SysThinkComp16 caregivers/interdisciplinary team members
including: determining the appropriate level
and/or setting of care
Manage pts transitions of care in collaboration
with individual/family/
SysThinkComp17 caregivers/interdisciplinary team members
including: coordinating implementation of
transition
Provide leadership in conflict
SysThinkComp18 management/negotiation to address problems
in the healthcare system
Lead system change to improve health
outcomes through evidence-based practice by:
SysThinkComp19
specifying expected clinical and system level
outcomes
N
Mean SEM
SD
% Not
Performing
657
3.65
.048 1.240
2.38
671
4.12
.041 1.068
0.89
672
4.15
.039 1.018
0.74
666
3.83
.043 1.118
1.19
654
3.59
.049 1.247
3.25
659
3.62
.048 1.244
2.37
661
3.63
.047 1.220
1.93
656
3.48
.051 1.305
2.24
651
3.44
.049 1.263
3.98
642
3.47
.049 1.243
4.18
637
3.25
.051 1.297
5.35
655
3.52
.050 1.270
1.95
669
3.73
.047 1.219
1.76
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 35 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Lead system change to improve health
outcomes through evidence-based practice by:
SysThinkComp20
designing programs to improve clinical and
system level processes and outcomes
Lead system change to improve health
SysThinkComp21 outcomes through evidence-based practice by:
facilitating the adoption of practice change
Evaluate impact of CNS and other nursing
SysThinkComp22 practice on systems of care using nursesensitive outcomes
Disseminate outcomes of system-level change
SysThinkComp23
internally and externally
Assess system barriers and facilitators to
SysThinkComp24
adoption of evidence-based practices
Promote healthcare policy and system changes
that facilitate access to care and address biases
SysThinkComp25
(e.g., socioeconomic, ethnic, ageism, sexism,
cultural, mental health stigma)
Integrate information technology into systems of
SysThinkComp26 care to enhance safety and monitor health
outcomes
DiversityComp01
DiversityComp02
DiversityComp03
ClinInqComp01
ClinInqComp02
ClinInqComp03
ClinInqComp04
ClinInqComp05
Develop age-specific clinical standards,
policies, and procedures
Promote system-wide policies and protocols
that address cultural, ethnic, spiritual, and
intergenerational/age differences among pts,
healthcare providers, and caregivers
Design educational programs that enhance the
knowledge of older adults, families, and
caregivers regarding normal changes of aging,
myths, and stereotypes of aging, and health
promotion and prevention activities for older
adults
Assess the quality and effectiveness of
interdisciplinary, intra-agency, and inter-agency
communication and collaboration
Contribute to the advancement of the profession
by disseminating outcomes of CNS practice
Analyze research findings and other evidence
for potential application to clinical practice
Integrate evidence into the health, illness, and
wellness management of patients, families
communities and groups
Apply principles of evidence-based practice and
quality improvement to all patient care
N
Mean SEM
SD
% Not
Performing
666
3.78
.047 1.218
1.91
674
4.04
.043 1.119
1.17
666
3.84
.046 1.193
1.91
663
3.76
.046 1.191
2.36
668
3.97
.043 1.103
1.76
649
3.38
.053 1.353
4.14
661
3.73
.047 1.196
2.36
663
3.54
.049 1.269
2.36
668
3.52
.049 1.279
1.76
610
3.35
.056 1.395
9.36
657
3.36
.049 1.245
2.81
664
3.61
.049 1.262
1.19
667
4.01
.040 1.041
1.04
667
3.76
.045 1.160
1.33
671
4.29
.035 .913
0.30
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 36 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Designs programs for effective implementation
ClinInqComp06
of research findings and other evidence in
clinical practice
Develop evidence-based clinical interventions to
ClinInqComp07
achieve defined pt and system outcomes
Assist staff in the development of innovative,
ClinInqComp08
cost-effective programs or protocols of care
Cultivate a climate of clinical inquiry across
spheres of influence by: evaluating the need for
ClinInqComp09
improvement or redesign of care delivery
processes to improve safety, efficiency,
reliability, and quality
Cultivate a climate of clinical inquiry across
ClinInqComp10
spheres of influence by: disseminating expert
knowledge
Participate in establishing quality improvement
ClinInqComp11
agenda for unit, department, program, system,
or population
Provide leadership in planning data collection
ClinInqComp12
and quality monitoring
Use data to assess the quality and
ClinInqComp13
effectiveness of clinical programs in meeting
outcomes
Develop quality improvement initiatives based
ClinInqComp14
on assessments
Provide leadership in the design, integration,
ClinInqComp15
and evaluation of process improvement
initiatives
Provide leadership in the system-wide
ClinInqComp16
integration of quality improvement and
innovation
Engage in a formal self-evaluation process,
seeking feedback regarding own practice, from
ClinInqComp17
patients, peers, professional colleagues and
others
Analyze data from consultations to implement
ClinInqComp18
practice improvements
Participate in conduct/implementation of
ClinInqComp19
research by: identifying questions for clinical
inquiry
Participate in conduct/implementation of
ClinInqComp20
research by: critiquing literature during literature
reviews
Participate in conduct/implementation of
ClinInqComp21
research by: synthesizing literature during
literature reviews
N
Mean SEM
SD
% Not
Performing
663
3.82
.044 1.145
1.92
664
3.99
.042 1.071
1.19
665
3.94
.042 1.086
0.89
661
3.87
.043 1.114
1.05
656
4.15
.040 1.018
0.46
667
3.93
.043 1.108
0.89
665
3.81
.045 1.163
1.19
664
3.97
.042 1.084
1.04
662
3.96
.043 1.096
1.63
659
3.89
.045 1.153
1.79
660
3.77
.047 1.207
1.93
668
4.00
.042 1.088
0.74
657
3.83
.044 1.116
1.35
664
3.73
.045 1.152
1.34
660
3.84
.044 1.120
1.35
663
3.78
.045 1.158
1.04
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 37 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Participate in conduct/implementation of
ClinInqComp22
research by: designing and implementing
studies
Participate in conduct/implementation of
ClinInqComp23
research by: collecting data
Participate in conduct/implementation of
ClinInqComp24
research by: analyzing data
Participate in conduct/implementation of
ClinInqComp25
research by: disseminating findings
Apply ethical principles in safeguarding the
confidentiality dignity, and safety of all adultClinInqComp26
older adult research participants including the
vulnerable and those with impaired decisionmaking capacity
FacLearnComp01
FacLearnComp02
FacLearnComp03
FacLearnComp04
FacLearnComp05
FacLearnComp06
FacLearnComp07
FacLearnComp08
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
Provide education to individuals, families,
groups and communities to promote knowledge,
understanding and optimal functioning across
the wellness-illness continuum
Mentor staff nurses, graduate students, and
others to acquire new knowledge and skills, and
develop their careers
Mentor health professionals in applying the
principles of evidence-based care
Coordinate formal and informal education for
healthcare providers to improve adult-older
adult healthcare outcomes
Advise pts/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
Participate in pre-professional, graduate, and
continuing education of nurses and other
healthcare providers by: completing a needs
assessment as appropriate to guide
interventions with staff
Participate in pre-professional, graduate, and
continuing education of nurses and other
healthcare providers by: promoting professional
development of staff nurses and continuing
education activities
N
Mean SEM
SD
% Not
Performing
632
3.07
.055 1.381
5.81
648
3.40
.051 1.306
3.28
654
3.43
.050 1.291
2.68
650
3.69
.049 1.250
2.11
614
4.08
.046 1.128
5.54
657
3.41
.049 1.266
2.09
649
3.50
.049 1.260
2.99
664
4.16
.039 .994
0.75
662
4.12
.039 1.011
0.75
621
3.78
.048 1.186
6.76
615
3.13
.055 1.357
7.80
649
3.72
.046 1.175
2.84
660
4.02
.041 1.041
1.05
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 38 ~
Patient Problems, Skills and Procedures, and Competencies
Presented in Survey Order
Participate in pre-professional, graduate, and
continuing education of nurses and other
FacLearnComp09
healthcare providers by: implementing staff
development and continuing education activities
Participate in pre-professional, graduate, and
continuing education of nurses and other
FacLearnComp10
healthcare providers by: mentoring others to
use research findings in practice
Modify health information, pt education
programs, and interventions for pts with
FacLearnComp11
sensory, perceptual, cognitive, and physical and
mental illness limitations
N
Mean SEM
SD
% Not
Performing
654
3.91
.045 1.142
1.51
650
4.01
.041 1.034
1.66
612
3.10
.054 1.341
5.70
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 39 ~
THIS PAGE INTENTIONALLY LEFT BLANK
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 40 ~
Appendix B
Significance Ratings in Descending Mean Order
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 41 ~
AllProb090
AllProb092
AllProb075
AllProb086
AllProb074
AllProb015
AllProb094
AllProb091
AllProb071
AllProb087
AllProb082
AllProb089
AllProb032
AllProb056
AllProb083
AllProb023
AllProb008
AllProb009
AllProb010
AllProb017
AllProb072
AllProb013
AllProb007
AllProb085
AllProb031
AllProb050
AllProb029
AllProb001
AllProb059
AllProb021
AllProb019
AllProb049
AllProb039
AllProb016
AllProb060
AllProb005
AllProb076
AllProb011
AllProb026
AllProb088
AllProb070
AllProb018
AllProb047
AllProb036
AllProb099
AllProb101
Patient Care Problems Presented
in Descending Mean Order
Multi- Pain
Multi- Patient safety issues
Renal- Fluid volume imbalances
Multi- End of life issues
Renal- Electrolyte imbalances
Pulm- Acute respiratory failure
Multi- SIRS, sepsis, septic shock, MODS
Multi- Palliative care issues
Renal- Acute renal failure
Multi- Hypovolemic shock
Integ- Pressure ulcers
Multi- Infectious diseases
Musculo- Infections
Neuro- Stroke
Integ- Wounds
Pulm- Pulmonary infections
Cardio- Dysrhythmias
Cardio- Heart failure
Cardio- Hypertension
Pulm- Aspirations
Renal- Chronic renal failure
Cardio- Pulmonary edema
Cardio- Decompensated heart failure
Multi- Distributive shock
Musculo- Functional issues
Neuro- Intracranial & intraventricular hemorrhage
Endo- Hypoglycemia
Cardio- Acute coronary syndromes
Gastro- Acute GI hemorrhage
Pulm- Exacerbation of chronic lung disease
Pulm- Chronic lung disease
Neuro- Increased intracranial pressure
Hem&Immuno- Coagulopathies
Pulm- Air-leak syndromes
Gastro- Bowel infarction, obstruction, perforation
Cardio- Cardiogenic shock
Renal- Infections
Cardio- Hypertensive crisis
Pulm- Upper airway obstruction
Multi- Hypoxic ischemic encephalopathy
Gastro- Nausea & vomiting
Pulm- Asthma & reactive airway disease
Neuro- Head and brain trauma & injury
Hem-Immuno- Anemia
Psych- Medical nonadherence
Psych- Substance abuse
N
767
768
769
766
773
790
752
760
770
751
752
756
778
761
755
786
797
779
784
789
753
782
763
734
775
735
769
734
741
779
791
721
773
771
749
756
745
761
770
726
744
779
700
780
738
746
Mean
4.43
4.38
4.22
4.21
4.20
4.16
4.01
4.00
3.99
3.92
3.90
3.89
3.88
3.88
3.83
3.79
3.76
3.74
3.68
3.67
3.59
3.56
3.56
3.54
3.52
3.51
3.49
3.48
3.48
3.46
3.43
3.43
3.40
3.38
3.35
3.31
3.31
3.31
3.29
3.28
3.24
3.24
3.20
3.20
3.19
3.16
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 42 ~
SEM
.031
.034
.034
.037
.034
.037
.044
.040
.038
.044
.045
.042
.042
.045
.042
.039
.044
.045
.043
.041
.042
.043
.047
.049
.046
.052
.045
.049
.046
.043
.042
.054
.042
.044
.045
.048
.048
.046
.047
.050
.047
.044
.057
.043
.047
.046
% Not
SD Performing
.85
0.52
.95
0.26
.94
0.77
1.04
0.91
.94
0.77
1.05
1.25
1.20
2.72
1.12
1.55
1.05
1.16
1.20
2.21
1.24
2.72
1.15
2.20
1.17
1.64
1.23
3.55
1.16
1.95
1.09
0.88
1.25
1.48
1.26
3.35
1.19
2.37
1.16
1.25
1.14
2.21
1.19
2.25
1.30
5.22
1.33
4.30
1.28
3.00
1.42
7.20
1.25
1.28
1.33
8.82
1.25
3.89
1.21
2.50
1.17
1.25
1.45
8.50
1.18
2.03
1.23
2.53
1.22
3.10
1.33
5.97
1.30
3.62
1.26
5.11
1.31
3.27
1.34
5.71
1.28
3.13
1.22
2.26
1.50
10.60
1.19
1.39
1.28
4.16
1.25
2.86
AllProb024
AllProb069
AllProb012
AllProb022
AllProb003
AllProb006
AllProb053
AllProb084
AllProb067
AllProb096
AllProb004
AllProb025
AllProb046
AllProb055
AllProb066
AllProb058
AllProb028
AllProb062
AllProb098
AllProb093
AllProb002
AllProb051
AllProb035
AllProb030
AllProb068
AllProb052
AllProb054
AllProb097
AllProb057
AllProb063
AllProb038
AllProb037
AllProb043
AllProb014
AllProb065
AllProb061
AllProb048
AllProb077
AllProb100
AllProb095
AllProb040
AllProb020
AllProb033
AllProb041
AllProb027
Patient Care Problems Presented
in Descending Mean Order
Pulm- Thoracic surgery
Gastro- Malnutrition
Cardio- Peripheral vascular insufficiency
Pulm- Pulmonary hypertension
Cardio- Cardiac surgery
Cardio- Cardiomyopathies
Neuro- Seizure disorders
Multi- Compartment syndrome
Gastro- Hepatic failure & coma
Psych- Age-related developmental issues
Cardio- Cardiac tamponade
Pulm- Thoracic & pulmonary trauma & injuries
Neuro- Encephalopathy
Neuro- Spinal cord injury
Gastro- GI surgeries
Gastro- Abdominal trauma
Endo- Diabetes insipidus
Gastro- Gastro-esophageal reflux
Psych- Maltreatment
Multi- Sensory impairment
Cardio- Acute inflammatory disease
Neuro- Neurologic infectious diseases
Musculo- Traumatic fractures
Endo- SIADH
Gastro- Hepatitis
Neuro- Neuromuscular disorders
Neuro- Space-occupying lesions
Psych- Failure to thrive
Neuro- Vascular malformation
Gastro- Gastrointestinal infectious diseases
Hem&Immuno- Blood group incompatibilities
Hem&Immuno- Autoimmune diseases
Hem&Immuno- Organ & tissue transplantation
Cardio- Structural heart defects & diseases
Gastro- GI motility disorders
Gastro- Gallbladder disease
Neuro- Hydrocephalus
Renal- Renal and genitourinary surgeries
Psych- Sleep disorders
Multi- Toxic exposure
Hem&Immuno- Congenital & acquired
immunosuppression
Pulm- Congenital & acquired anomalies
Musculo- Osteoporosis & bone disease
Hem&Immuno- Hyperbilirubinemia
Endo- Adrenal disorders
N
747
736
732
777
677
764
755
719
718
709
737
720
723
672
716
665
751
737
713
740
762
704
700
762
720
724
682
655
698
716
735
751
639
735
734
695
636
686
699
667
Mean
3.16
3.15
3.15
3.15
3.07
3.07
3.06
3.05
3.02
2.99
2.97
2.94
2.91
2.91
2.85
2.85
2.83
2.80
2.74
2.74
2.73
2.72
2.69
2.68
2.68
2.65
2.63
2.62
2.61
2.61
2.60
2.60
2.58
2.57
2.56
2.54
2.52
2.52
2.51
2.49
SEM
.048
.048
.045
.043
.054
.047
.047
.050
.048
.052
.050
.052
.050
.057
.048
.056
.049
.047
.051
.048
.045
.051
.053
.047
.047
.046
.052
.053
.049
.049
.050
.043
.057
.047
.046
.047
.056
.048
.046
.051
% Not
SD Performing
1.31
6.74
1.30
4.54
1.21
9.07
1.19
2.88
1.42
16.00
1.30
5.09
1.30
4.31
1.35
6.62
1.30
7.47
1.38
7.92
1.37
8.22
1.39
10.22
1.34
8.02
1.49
14.83
1.28
7.25
1.44
14.41
1.35
5.06
1.26
5.03
1.36
6.43
1.31
3.90
1.23
5.34
1.34
10.43
1.41
11.84
1.29
3.91
1.27
6.86
1.24
8.01
1.36
13.12
1.35
14.15
1.30
10.97
1.30
6.77
1.36
6.49
1.18
4.33
1.44
19.11
1.28
7.89
1.25
5.41
1.23
10.55
1.40
19.49
1.25
11.48
1.21
8.63
1.31
12.47
724
2.41
.046
1.24
8.35
729
715
645
756
2.38
2.33
2.32
2.31
.048
.046
.052
.042
1.30
1.24
1.31
1.17
8.65
10.06
17.94
4.91
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 43 ~
AllProb042
AllProb073
AllProb081
AllProb064
AllProb078
AllProb045
AllProb034
AllProb044
AllProb079
AllProb080
AdultProb07
AdultProb09
AdultProb04
AdultProb36
AdultProb05
AdultProb08
AdultProb37
AdultProb03
AdultProb02
AdultProb06
AdultProb21
AdultProb30
AdultProb34
AdultProb43
AdultProb33
AdultProb40
AdultProb42
AdultProb01
AdultProb11
AdultProb10
AdultProb32
AdultProb23
AdultProb41
AdultProb16
AdultProb31
AdultProb20
AdultProb26
AdultProb29
AdultProb17
AdultProb28
AdultProb18
AdultProb13
AdultProb14
AdultProb19
Patient Care Problems Presented
in Descending Mean Order
Hem&Immuno- Leukemia & tumors
Renal- Congenital & acquired renal &
genitourinary abnormalities
Integ- Infectious skin disorders
Gastro- GI abnormalities
Renal- Renal calculi
Neuro- Congenital neurological abnormalities
Musculo- Stress fractures
Hem&Immuno- Polycythemia
Integ- Congenital & acquired abnormalities
Integ- Dermatologic disorders
Endo- Diabetes mellitus
Endo- Hyperglycemia
Pulm- Acute pulmonary embolus
Psych- Delirium
Pulm- ALI (ARDS)
Endo- Diabetes ketoacidosis & HHNK
Psych- Dementia
Cardio- Ruptured & dissecting aneurysm
Cardio- Dyslipidemia
Pulm- Obstructive sleep apnea
Gastro- Pancreatitis
Multi- Multisystem trauma
Psych- Anxiety disorders
Psych- Suicidal behavior
Psych- Aggression
Psych- Mood disorders
Psych- Risk-taking behaviors
Cardio- Cardiac trauma
Endo- Thyroid disorders
Endo- Hormone imbalances & issues
Multi- Toxic ingestions & inhalations
Renal- Incontinence
Psych- Personality disorders
Hem&Immuno- AIDS & HIV
Multi- Near-drowning
Gastro- Inflammatory bowel disease
Renal- Renal trauma
Multi- Life-threatening maternal-fetal complications
Hem&Immuno- HELLP syndrome
Multi- Burns
Hem&Immuno- Sickle cell disease
Musculo- Osteoarthritis
Musculo- Spinal disease
Neuro- Migraine headaches
N
692
Mean
2.30
SEM
.048
% Not
SD Performing
1.25
12.18
677
2.29
.047
1.23
12.42
681
688
654
632
667
696
604
638
2.27
2.25
2.17
2.14
2.09
2.02
1.93
1.87
.048
.048
.047
.051
.046
.044
.049
.044
1.26
1.25
1.21
1.28
1.19
1.15
1.20
1.12
10.86
11.23
14.73
20.10
16.31
11.68
21.96
16.93
668
662
659
649
645
655
652
621
636
646
621
509
630
618
625
614
589
576
654
642
524
595
598
622
439
581
541
370
545
417
575
590
573
538
4.18
3.95
3.88
3.85
3.82
3.46
3.46
3.29
3.18
3.16
3.14
3.12
2.88
2.84
2.82
2.80
2.75
2.71
2.66
2.61
2.56
2.50
2.47
2.43
2.36
2.35
2.33
2.28
2.26
2.19
2.17
2.16
2.05
2.01
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 44 ~
.037
.039
.041
.047
.048
.048
.047
.052
.053
.049
.049
.069
.053
.055
.053
.053
.056
.060
.047
.047
.059
.055
.053
.050
.066
.051
.056
.074
.056
.068
.052
.049
.049
.052
.95
1.01
1.06
1.19
1.21
1.23
1.20
1.29
1.35
1.25
1.21
1.56
1.32
1.36
1.31
1.31
1.37
1.44
1.19
1.20
1.36
1.33
1.30
1.25
1.38
1.23
1.29
1.42
1.31
1.38
1.24
1.20
1.18
1.21
0.74
1.19
1.93
3.85
3.44
2.67
3.55
7.73
5.92
3.73
3.72
23.57
6.25
7.62
7.54
8.90
12.48
14.92
2.97
4.75
21.32
11.46
10.61
7.16
34.48
10.62
19.13
44.69
18.05
37.57
13.92
11.68
13.96
18.73
AdultProb25
AdultProb35
AdultProb15
AdultProb12
AdultProb24
AdultProb39
AdultProb27
AdultProb22
AdultProb38
Patient Care Problems Presented
in Descending Mean Order
Renal- Prostate problems
Psych- ADHD
Musculo- Sports injuries
Musculo- Acute gout
Renal- Obstetrical issues
Psych- Learning disabilities & disorders
Integ- Pruritus
Renal- Gynecological problems
Psych- Eating disorders
N
Mean SEM
548
2.00 .048
497
1.99 .054
467
1.99 .056
552
1.97 .049
450
1.94 .054
523
1.93 .050
529
1.90 .049
514
1.85 .049
494
1.84 .050
% Not
SD Performing
1.12
18.09
1.20
26.70
1.21
30.19
1.14
17.37
1.15
32.94
1.15
22.63
1.13
19.11
1.11
23.63
1.12
27.03
NeoProb14
NeoProb12
NeoProb04
NeoProb02
NeoProb07
NeoProb01
NeoProb03
NeoProb13
NeoProb11
NeoProb08
NeoProb10
NeoProb05
NeoProb09
NeoProb06
Psych- Behavioral state
Multi- Low birth weight & prematurity
Pulm- Respiratory distress syndrome
Pulm- Apnea of prematurity
Endo- Infant of diabetic mother
Cardio- PDA
Pulm- PPHN
Multi- Transition to extrauterine life
Multi- Life-threatening maternal-fetal complications
Musculo- Congenital anomalies
Multi- Child of addicted mother
Pulm- Transient tachypnea of newborn
Neuro- Periventricular leukomalacia
Endo- Inborn errors of metabolism
19
19
19
19
19
19
19
19
19
19
19
19
19
18
4.58
4.53
4.47
4.42
4.42
4.37
4.26
4.21
4.11
4.00
4.00
3.68
3.42
3.39
.159
.160
.160
.159
.159
.175
.227
.196
.228
.216
.254
.297
.279
.304
.69
.70
.70
.69
.69
.76
.99
.85
.99
.94
1.11
1.29
1.22
1.29
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PedsProb31
PedsProb06
PedsProb07
PedsProb11
PedsProb10
PedsProb32
PedsProb33
PedsProb13
PedsProb21
PedsProb16
PedsProb45
PedsProb14
PedsProb03
PedsProb18
PedsProb22
PedsProb23
PedsProb37
PedsProb09
PedsProb44
PedsProb12
PedsProb19
Multi- Multisystem trauma
Pulm- Acute life-threatening events
Pulm- ALI & ARDS
Endo- Diabetic ketoacidosis & HHNK
Endo- Diabetes mellitus
Multi- Near-drowning
Multi- Toxic ingestions & inhalations
Endo- Hyperglycemia
Hem&Immuno- Sickle cell disease
Musculo- Congenital abnormalities
Psych- Suicidal behavior
Endo- Inborn errors of metabolism
Cardio- PDA
Musculo- Spinal disease
Gastro- Inflammatory bowel disease
Gastro- Pancreatitis
Psych- Autism & autism spectrum disorders
Pulm- Pulmonary hemorrhage
Psych- Risk-taking behaviors
Endo- Hormone imbalances & issues
Musculo- Sports injuries
56
66
63
65
64
58
61
66
62
65
63
64
59
59
55
65
62
62
61
64
60
3.96
3.95
3.81
3.74
3.72
3.66
3.49
3.42
3.16
2.97
2.94
2.89
2.80
2.69
2.64
2.60
2.58
2.53
2.52
2.52
2.48
.155
.158
.157
.170
.167
.157
.158
.166
.174
.167
.158
.161
.196
.176
.156
.150
.160
.145
.156
.146
.162
1.16
1.28
1.24
1.37
1.34
1.19
1.23
1.35
1.37
1.35
1.26
1.29
1.51
1.36
1.16
1.21
1.26
1.14
1.22
1.17
1.26
16.42
0.00
4.55
2.99
4.48
13.43
8.96
1.49
7.46
1.52
5.97
4.48
10.61
11.94
8.33
2.99
7.46
6.06
8.96
4.48
10.45
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 45 ~
PedsProb36
PedsProb29
PedsProb27
PedsProb08
PedsProb05
PedsProb20
PedsProb34
PedsProb42
PedsProb35
PedsProb30
PedsProb15
PedsProb41
PedsProb01
PedsProb40
PedsProb25
PedsProb38
PedsProb39
PedsProb28
PedsProb43
PedsProb04
PedsProb17
PedsProb24
PedsProb02
PedsProb26
Patient Care Problems Presented
in Descending Mean Order
Psych- ADHD
Multi- Burns
Renal- Renal trauma
Pulm- Obstructive sleep apnea
Pulm- Acute pulmonary embolus
Hem&Immuno- AIDS & HIV
Psych- Aggression
Psych- Mood disorders
Psych- Anxiety disorders
Multi- Child of addicted mother
Endo- Thyroid disorders
Psych- Learning disabilities & disorders
Cardio- Cardiac trauma
Psych- Eating disorders
Renal- Incontinence
Psych- Delirium
Psych- Disorders of elimination
Integ- Pruritus
Psych- Personality disorders
Cardio- Ruptured & dissecting aneurysm
Musculo- Osteoarthritis
Renal- Gynecological problems
Cardio- Dyslipidemia
Renal- Obstetrical issues
N
Mean SEM
62
2.47 .159
53
2.40 .191
54
2.39 .168
62
2.35 .163
63
2.35 .154
56
2.34 .188
59
2.31 .166
62
2.26 .151
61
2.25 .163
58
2.22 .191
64
2.22 .155
61
2.21 .144
59
2.12 .178
58
2.10 .151
56
2.05 .162
57
1.98 .145
56
1.96 .167
57
1.91 .140
58
1.90 .149
43
1.81 .164
40
1.75 .142
57
1.56 .125
50
1.56 .143
37
1.24 .112
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 46 ~
% Not
SD Performing
1.25
7.46
1.39
20.90
1.23
19.40
1.28
6.06
1.22
4.55
1.40
8.20
1.28
10.61
1.19
6.06
1.27
8.96
1.45
13.43
1.24
4.48
1.13
8.96
1.37
11.94
1.15
13.43
1.21
16.42
1.09
14.93
1.25
16.42
1.06
12.31
1.13
13.43
1.07
35.82
.90
38.46
.95
14.93
1.01
23.08
.68
43.94
CardioTask01
CardioTask05
CardioTask04
CardioTask20
CardioTask03
IntegTask02
CardioTask02
MultiTask04
CardioTask06
PulmTask03
PulmTask04
MultiTask05
CardioTask08
CardioTask30
CardioTask13
MultiTask06
PulmTask01
PulmTask12
CardioTask10
PulmTask02
CardioTask18
CardioTask24
CardioTask21
CardioTask28
CardioTask15
CardioTask22
CardioTask17
PulmTask10
RenalTask01
NeuroTask12
IntegTask03
MultiTask02
CardioTask23
PulmTask08
CardioTask16
PulmTask09
CardioTask07
IntegTask01
HemTask06
IntegTask05
IntegTask06
CardioTask09
IntegTask04
CardioTask25
NeuroTask07
CardioTask26
Skills and Procedures Presented
in Descending Mean Order
Interpret ECG rhythms
Interpret non-invasive hemodynamic values
Interpret hemodynamic values
Direct cardiopulmonary resuscitation
Determine lead selection for ECGs
Provide wound care
Interpret 12-lead ECGs
Provide nonpharmacological interventions for
pain
Manage transcutaneous (external) pacemakers
Manage mechanical ventilation
Wean mechanical ventilation
Prescribe pharmaceutical interventions
Manage temporary transvenous pacemakers
Disconnect pacer wire
Manage epicardial pacemakers
Prescribe durable medical equipment
Order nasal/facial CPAP/BiPAP
Disconnect chest tube
Manage permanent transvenous pacemakers
Initiate mechanical ventilation
Manager cardiac assist devices (e.g., RVAD,
BVAD. LVAD, ECMO)
Adjust pulmonary artery pressure catheters
Insert arterial pressure catheters
Perform elective cardioversion
Manage implantable cardioverter defibrillators
(ICDs)
Insert central venous pressure catheters
Remove intra-aortic balloon catheter
Perform intubation
Initiate renal replacement therapies
Monitor SiO2 results
Incise and drain abscesses
Interpret diagnostic imaging
Insert pulmonary artery pressure catheters
Insert chest tube
Insert intra-aortic balloon catheter
Interpret pulmonary function tests
Insert temporary transvenous pacemakers
Suture wounds
Manage chemotherapy
Perform KOH preparations
Excise lesions
Insert permanent transvenous pacemakers
Perform skin biopsies
Perform stress testing
Remove intraventricular ICP monitoring
device
Interpret echocardiograms
N
724
718
715
666
696
610
682
Mean SEM
4.26 .041
4.11 .042
4.08 .044
3.92 .050
3.68 .049
3.59 .054
3.57 .051
% Not
SD Performing
1.10
2.95
1.13
3.49
1.17
4.28
1.29
10.12
1.30
6.83
1.32
15.40
1.32
8.33
540
3.53
.055
1.27
25.00
621
528
520
266
559
349
464
307
406
461
531
364
3.50
3.44
3.40
3.36
3.33
3.23
3.21
3.21
3.15
3.14
3.12
3.06
.055
.061
.061
.089
.061
.077
.070
.084
.069
.064
.062
.076
1.37
1.40
1.40
1.45
1.45
1.43
1.52
1.48
1.40
1.38
1.42
1.44
16.53
28.55
29.25
62.90
24.36
52.90
37.04
57.12
45.21
36.68
28.53
50.41
364
3.04
.078
1.49
50.94
371
274
389
3.00
2.98
2.94
.075
.088
.073
1.45
1.46
1.44
49.93
62.97
47.57
508
2.94
.064
1.44
30.88
260
285
247
273
200
206
295
229
205
195
332
293
214
208
104
114
239
128
222
2.93
2.86
2.80
2.79
2.78
2.76
2.73
2.64
2.62
2.58
2.58
2.56
2.53
2.53
2.50
2.47
2.46
2.44
2.41
.091
.085
.096
.089
.100
.101
.076
.096
.104
.111
.076
.084
.101
.095
.140
.138
.093
.124
.095
1.47
1.44
1.51
1.47
1.42
1.44
1.31
1.45
1.49
1.55
1.39
1.43
1.48
1.37
1.43
1.47
1.44
1.41
1.41
64.86
61.49
66.49
62.24
72.45
71.27
59.03
69.05
72.30
73.68
55.01
60.46
70.36
71.47
85.43
84.01
67.83
82.17
70.04
147
2.41
.122
1.48
79.70
275
2.40
.083
1.37
62.79
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 47 ~
Skills and Procedures Presented
in Descending Mean Order
N
Mean SEM
SD
% Not
Performing
CardioTask12
PulmTask06
NeuroTask08
CardioTask33
NeuroTask06
PulmTask11
NeuroTask05
NeuroTask16
CardioTask14
PulmTask07
GastroTask06
NeuroTask10
NeuroTask03
RenalTask03
RenalTask04
MusculoTask05
NeuroTask15
PulmTask05
CardioTask19
HemTask01
MusculoTask04
CardioTask29
MultiTask01
MusculoTask07
NeuroTask04
HemTask03
RenalTask06
NeuroTask09
GastroTask04
RenalTask02
NeuroTask02
EndoTask01
CardioTask11
CardioTask32
NeuroTask01
NeuroTask18
CardioTask31
HemTask02
MusculoTask02
NeuroTask17
HemTask07
MusculoTask06
CardioTask27
RenalTask05
GastroTask02
NeuroTask14
Perform bronchial alveolar lavage
Remove cerebral oxygenation monitoring
device
Interpret stress tests
Remove subdural ICP monitoring device
Perform percutaneous tracheotomy
Remove epidural ICP monitoring device
Interpret EEGs
Insert implantable cardioverter defribrillators
(ICDs)
Perform thoracentesis
Remove PEG/JT/drainage catheters
Perform lumbar puncture
Insert intraventricular ICP monitoring device
Perform pelvic exams
Complete Pap smears
Apply treatment device
Interpret transcranial Doppler
Perform bronchoscopy
Perform pericardiocentesis
Perform exchange transfusions
Perform casting/splinting
Perform tilt-table testing
Perform as a surgical first assist
Administer pain block/cortisone shot
Insert cerebral oxygenation monitoring device
Insert permanent vascular access device
Disconnect and flush renal stent
Tap ventricular reservoirs/shunts
Insert PEG tube
Insert dialysis catheters
Insert subdural ICP monitoring device
Perform rapid ACTH stimulation test
Insert transesophageal pacemakers
Perform interventional radiology
Insert epidural ICP monitoring device
Reprogram shunt
Harvest saphenous vein graft
Order plasmapheresis
Perform joint injections
Insert lumbar drains
Insert chemotherapy access device
Relocate dislocated bones
Direct extracorporeal compression pressure
(EECP) therapy
Insert suprapubic catheters
Perform paracentesis
Perform transcranial Doppler
191
2.39
.107
1.47
74.08
140
2.38
.116
1.37
80.77
215
144
164
147
208
2.38
2.35
2.35
2.35
2.34
.097
.118
.115
.117
.092
1.42
1.42
1.47
1.42
1.32
70.79
80.14
77.81
79.72
71.39
193
2.33
.105
1.46
73.95
184
213
143
102
145
128
220
147
168
223
218
148
200
106
98
92
136
148
128
126
116
95
154
198
142
98
93
129
173
87
96
113
91
2.33
2.32
2.31
2.31
2.31
2.30
2.30
2.29
2.27
2.26
2.26
2.25
2.24
2.23
2.19
2.18
2.18
2.18
2.16
2.16
2.15
2.12
2.10
2.10
2.08
2.08
2.06
2.05
2.05
2.03
2.03
2.03
2.02
.104
.092
.116
.153
.118
.126
.086
.111
.110
.090
.093
.107
.096
.137
.136
.147
.119
.108
.117
.120
.130
.144
.099
.092
.113
.139
.128
.121
.098
.138
.127
.128
.134
1.42
1.35
1.39
1.55
1.43
1.43
1.27
1.34
1.43
1.34
1.37
1.30
1.35
1.41
1.34
1.41
1.38
1.31
1.33
1.35
1.40
1.41
1.23
1.30
1.35
1.37
1.23
1.37
1.30
1.29
1.24
1.36
1.28
75.07
70.17
80.28
85.93
79.94
82.34
69.53
79.67
77.27
69.86
70.26
79.44
72.97
85.32
86.33
87.28
81.37
79.39
82.39
82.55
83.91
86.95
63.25
73.32
80.84
86.56
86.99
82.40
76.33
87.97
86.76
84.52
87.36
171
2.02
.097
1.27
76.89
116
121
111
2.00
1.97
1.96
.114
.114
.112
1.23
1.25
1.17
83.89
83.29
84.63
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 48 ~
Skills and Procedures Presented
in Descending Mean Order
MusculoTask03
Provide trigger point injections
NeuroTask13
Insert epidural catheters
MusculoTask01
Perform joint aspiration
MultiTask03
Perform RetCam
GastroTask01
Perform endoscopy
NeuroTask11
Insert SiO2 catheter
HemTask08
Perform bone marrow transplant
GastroTask05
Insert PEG/JT/drainage catheters
HemTask05
Perform bone marrow biopsy
HemTask04
Perform bone marrow aspiration
GastroTask03
Perform sigmoidoscopy
PsychTask01
Perform ECT therapy
N
82
99
85
69
102
92
93
107
112
117
90
51
Mean SEM
1.95 .141
1.95 .126
1.93 .135
1.93 .139
1.89 .129
1.89 .122
1.88 .138
1.88 .117
1.86 .122
1.79 .115
1.79 .126
1.73 .132
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 49 ~
% Not
SD Performing
1.28
88.60
1.26
86.27
1.24
88.24
1.15
90.24
1.30
85.95
1.17
87.31
1.33
87.17
1.21
85.16
1.29
84.59
1.24
84.04
1.19
87.57
.94
92.47
ClinJudComp03
CollabComp07
ClinJudComp32
AdvoComp03
ClinJudComp31
CollabComp02
AdvoComp04
ClinJudComp04
CollabComp05
CollabComp09
CaringComp01
ClinInqComp05
ClinJudComp37
CollabComp06
CollabComp03
ClinJudComp05
ClinJudComp38
CaringComp03
FacLearnComp03
Competencies Presented
in Descending Mean Order
Use evidence-based guidelines to guide
clinical practice
Practice collegially with members of the
healthcare team
Determine when evidence-based
guidelines/policies/procedures/plans of care
need to be tailored to individual
Foster professional accountability in self and
others
Evaluate nursing practice that considers
safety, timeliness, effectiveness, efficiency,
efficacy and pt/family centered care
Facilitate the provision of clinically competent
care through education, role modeling,
teambuilding, and quality monitoring
Promote a practice climate conducive to
providing ethical care
Synthesize data/advanced
knowledge/experience using critical thinking
to formulate differential diagnoses
Establish collaborative relationships within
and across departments that promote patient
safety, culturally competent care, and clinical
excellence
Foster an interdisciplinary approach to quality
improvement, evidence-based practice,
research, and translation of research into
practice
Use advanced communication skills to
improve patient outcomes
Apply principles of evidence-based practice
and quality improvement to all patient care
Provide leadership for collaborative,
evidence-based plans for meeting individual,
family, community, and population needs
Provide leadership for establishing, improving,
and sustaining collaborative relationships
Provide leadership in promoting
interdisciplinary collaboration to implement
outcome-focused patient care programs
Determine diagnoses considering:
physiologic/pathophysiologic changes
Provide consultation to interdisciplinary
colleagues
Identify potential risks to pt safety/autonomy,
quality of care based on assessments across
all sphere of influence
Mentor staff nurses, graduate students, and
others to acquire new knowledge and skills,
and develop their careers
N
Mean
SEM
SD
% Not
Performing
704
4.62
.028
.732
0.28
682
4.52
.029
.749
0.15
702
4.46
.032
.836
0.14
693
4.40
.033
.875
0.29
702
4.39
.032
.843
0.14
684
4.38
.034
.899
0.29
697
4.36
.034
.885
0.00
690
4.36
.037
.982
2.68
681
4.32
.035
.905
0.29
677
4.31
.037
.956
0.29
689
4.30
.035
.922
0.14
671
4.29
.035
.913
0.30
693
4.26
.037
.971
1.14
684
4.24
.037
.959
0.29
680
4.24
.037
.968
0.29
682
4.22
.040 1.032
4.08
694
4.20
.038
.991
1.00
686
4.17
.038 1.006
0.44
664
4.16
.039
0.75
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 50 ~
.994
ClinJudComp06
SysThinkComp09
ClinInqComp10
ClinJudComp36
CaringComp04
ClinJudComp17
SysThinkComp08
FacLearnComp04
CollabComp01
AdvoComp05
ClinInqComp26
ClinJudComp35
ClinJudComp13
CollabComp04
SysThinkComp21
AdvoComp02
CaringComp06
Competencies Presented
in Descending Mean Order
Determine diagnoses considering:
morbidities/co-morbidities
Provide leadership in maintaining a supportive
and healthy work environment
Cultivate a climate of clinical inquiry across
spheres of influence by: disseminating expert
knowledge
Lead development of evidence-based plans
for meeting individual, family, community, and
population needs
Determine nursing practice and system
interventions that promote
pt/family/community safety
Design strategies to meet multifaceted needs
of complex pts/ groups of pts
Use effective strategies for changing clinician
and team behavior to encourage adoption of
evidence-based practices and innovations in
care delivery
Mentor health professionals in applying the
principles of evidence-based care
Communicate consultation findings as
appropriate
Facilitate interdisciplinary teams to address
ethical concerns, risks or considerations,
benefits and outcomes of patient care
Apply ethical principles in safeguarding the
confidentiality dignity, and safety of all adultolder adult research participants including the
vulnerable and those with impaired decisionmaking capacity
Differentiate between outcomes that require
care process modification at the pt vs. system
level
Interpret values/results of lab/diagnostic tests
with consideration of age, ethnicity and health
status
Use leadership, team building, negotiation,
and conflict resolution skills to build
partnerships within and across systems,
including communities
Lead system change to improve health
outcomes through evidence-based practice
by: facilitating the adoption of practice
change
Use coaching and advanced communication
skills to facilitate the development of effective
clinical teams
Select interventions that may include, but are
not limited to: initiation of interdisciplinary
team meetings/consults/other
communications to benefit pt care
Mean
682
4.16
.041 1.062
4.08
672
4.15
.039 1.018
0.74
656
4.15
.040 1.018
0.46
693
4.13
.040 1.053
1.28
683
4.13
.040 1.058
0.58
689
4.12
.042 1.106
2.55
671
4.12
.041 1.068
0.89
662
4.12
.039 1.011
0.75
680
4.11
.039 1.027
1.02
683
4.11
.040 1.058
1.16
614
4.08
.046 1.128
5.54
691
4.07
.041 1.070
1.71
689
4.06
.043 1.117
2.96
681
4.06
.042 1.084
0.44
674
4.04
.043 1.119
1.17
687
4.03
.041 1.081
1.15
677
4.03
.041 1.077
1.02
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 51 ~
SEM
SD
% Not
Performing
N
FacLearnComp08
ClinJudComp14
FacLearnComp10
ClinInqComp03
ClinInqComp17
ClinInqComp07
ClinJudComp02
ClinJudComp25
SysThinkComp24
ClinJudComp34
ClinInqComp13
ClinInqComp14
AdvoComp14
ClinInqComp08
ClinJudComp08
ClinInqComp11
ClinJudComp10
ClinJudComp15
Competencies Presented
in Descending Mean Order
Participate in pre-professional, graduate, and
continuing education of nurses and other
healthcare providers by: promoting
professional development of staff nurses and
continuing education activities
Assess pt/caregiver/family ability to implement
complex plans of care
Participate in pre-professional, graduate, and
continuing education of nurses and other
healthcare providers by: mentoring others to
use research findings in practice
Analyze research findings and other evidence
for potential application to clinical practice
Engage in a formal self-evaluation process,
seeking feedback regarding own practice,
from patients, peers, professional colleagues
and others
Develop evidence-based clinical interventions
to achieve defined pt and system outcomes
Obtain data necessary to formulate differential
diagnoses/plans of care, and evaluate
outcomes
Recommend: non-pharmacologic
interventions
Assess system barriers and facilitators to
adoption of evidence-based practices
Intervene to prevent/minimize iatrogenesis
Use data to assess the quality and
effectiveness of clinical programs in meeting
outcomes
Develop quality improvement initiatives based
on assessments
Facilitate resolution of ethical conflicts by:
applying ethical principles to resolve concerns
Assist staff in the development of innovative,
cost-effective programs or protocols of care
Determine diagnoses considering: pts
pharmacologic history w/ particular attention
to issues of polypharmacy
Participate in establishing quality
improvement agenda for unit, department,
program, system, or population
Assess for manifestation of health
disorders/disruptions, e.g., infection, adverse
drug effect, dehydration, ischemia, and
geriatric syndromes
Assess pt/caregiver/family preferences in
relation to cultural/spiritual/quality of
life/lifestyle choices
Mean
660
4.02
.041 1.041
1.05
693
4.01
.043 1.145
2.12
650
4.01
.041 1.034
1.66
667
4.01
.040 1.041
1.04
668
4.00
.042 1.088
0.74
664
3.99
.042 1.071
1.19
678
3.98
.046 1.201
4.37
691
3.98
.041 1.089
2.40
668
3.97
.043 1.103
1.76
665
3.97
.046 1.175
5.14
664
3.97
.042 1.084
1.04
662
3.96
.043 1.096
1.63
678
3.96
.042 1.100
1.17
665
3.94
.042 1.086
0.89
671
3.94
.047 1.209
5.36
667
3.93
.043 1.108
0.89
676
3.93
.044 1.144
4.25
690
3.92
.045 1.179
2.40
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 52 ~
SEM
SD
% Not
Performing
N
FacLearnComp09
ClinInqComp15
ClinJudComp07
AdvoComp08
CaringComp02
ClinJudComp16
AdvoComp12
ClinInqComp09
ClinJudComp09
ClinJudComp41
AdvoComp09
AdvoComp15
ClinJudComp39
ClinInqComp20
SysThinkComp22
ClinInqComp18
Competencies Presented
in Descending Mean Order
Participate in pre-professional, graduate, and
continuing education of nurses and other
healthcare providers by: implementing staff
development and continuing education
activities
Provide leadership in the design, integration,
and evaluation of process improvement
initiatives
Determine diagnoses considering: events
across life span
Facilitate pt/family understanding of
risks/benefits/outcomes of proposed
healthcare regimens to promote informed
decision making
Assess the effects of interactions among the
individual/family/community/social systems
Prioritize differential diagnoses
Facilitate resolution of ethical conflicts by:
identifying ethical implications of complex
care situations
Cultivate a climate of clinical inquiry across
spheres of influence by: evaluating the need
for improvement or redesign of care delivery
processes to improve safety, efficiency,
reliability, and quality
Use reliable and valid age-appropriate
assessment instruments is assess acute and
chronic health concerns, including but not
limited to mental status, delirium, dementia,
and pain
Initiate consultation to obtain resources to
facilitate progress toward achieving identified
outcomes
Facilitate decision-making regarding
treatment options with the
patient/family/caregivers/healthcare proxy
Advocate for access to hospice and palliative
care services for patients across the adult age
spectrum
Provide consultation to the interdisciplinary
team re: the pts mental status, home
environment, mobility, functional status, selfcare, and caregivers abilities
Participate in conduct/implementation of
research by: critiquing literature during
literature reviews
Evaluate impact of CNS and other nursing
practice on systems of care using nursesensitive outcomes
Analyze data from consultations to implement
practice improvements
Mean
654
3.91
.045 1.142
1.51
659
3.89
.045 1.153
1.79
676
3.89
.046 1.203
4.52
675
3.89
.045 1.174
3.16
684
3.89
.044 1.144
0.87
669
3.88
.047 1.218
5.77
686
3.88
.042 1.108
1.15
661
3.87
.043 1.114
1.05
683
3.87
.045 1.166
3.67
676
3.86
.046 1.202
3.43
666
3.86
.046 1.181
3.20
651
3.86
.047 1.205
4.55
680
3.85
.046 1.207
3.00
660
3.84
.044 1.120
1.35
666
3.84
.046 1.193
1.91
657
3.83
.044 1.116
1.35
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 53 ~
SEM
SD
% Not
Performing
N
SysThinkComp10
CaringComp05
ClinInqComp06
ClinJudComp30
ClinInqComp12
CollabComp08
ClinJudComp27
ClinJudComp29
FacLearnComp05
ClinInqComp21
SysThinkComp20
ClinInqComp16
ClinJudComp24
ClinJudComp19
SysThinkComp23
AdvoComp13
Competencies Presented
in Descending Mean Order
Evaluate use of products and services for
appropriateness and cost/benefit in meeting
care needs
Select interventions that may include, but are
not limited to: application of advanced nursing
therapies
Designs programs for effective
implementation of research findings and other
evidence in clinical practice
Provide direct care to selected pts based on
needs of pt and CNSs specialty knowledge
and skills
Provide leadership in planning data collection
and quality monitoring
Facilitate intra-agency and inter-agency
communication
Recommend: equipment
Recommend: treatments
Coordinate formal and informal education for
healthcare providers to improve adult-older
adult healthcare outcomes
Participate in conduct/implementation of
research by: synthesizing literature during
literature reviews
Lead system change to improve health
outcomes through evidence-based practice
by: designing programs to improve clinical
and system level processes and outcomes
Provide leadership in the system-wide
integration of quality improvement and
innovation
Recommend: pharmacologic interventions
Prescribe: non-pharmacologic interventions
Disseminate outcomes of system-level
change internally and externally
Facilitate resolution of ethical conflicts by:
considering the impact of scientific
advances/cost/clinical effectiveness/ pt &
family values & preferences/other external
influence
Mean
666
3.83
.043 1.118
1.19
671
3.82
.044 1.130
2.33
663
3.82
.044 1.145
1.92
682
3.82
.048 1.252
2.85
665
3.81
.045 1.163
1.19
675
3.81
.045 1.170
1.32
679
669
3.79
3.78
.045 1.166
.046 1.178
3.96
4.15
621
3.78
.048 1.186
6.76
663
3.78
.045 1.158
1.04
666
3.78
.047 1.218
1.91
660
3.77
.047 1.207
1.93
667
506
3.77
3.77
.047 1.214
.053 1.191
5.52
28.33
663
3.76
.046 1.191
2.36
681
3.76
.044 1.136
1.30
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 54 ~
SEM
SD
% Not
Performing
N
Appendix C
ACCNS-P Test Plan
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 55 ~
pediatric clinical nurse specialist test plan
i. CliniCal judgment (61%)
a. Cardiovascular (9%)
1. Acute inflammatory disease
(e.g., myocarditis, endocarditis, pericarditis)
3. Diabetic ketoacidosis/hyperglycemic
hyperosmolar nonketotic coma (HHNK)
4. Hyperglycemia
5. Hypoglycemia
2. Cardiac surgery
6. Inborn errors of metabolism
3. Cardiac tamponade
7. Syndrome of inappropriate secretion of
antidiuretic hormone (SIADH)
4. Cardiogenic shock
5. Cardiomyopathies (e.g., hypertrophic, dilated,
restrictive, idiopathic)
6. Decompensated heart failure
d. musculoskeletal (3%)
1. Congenital abnormalities
7. Dysrhythmias
2. Functional issues (e.g., immobility, gait
disorders)
8. Heart failure
3. Infections
9. Hypertension
4. Spinal disease (e.g., scoliosis, kyphosis, disc
disease)
10. Hypertensive crisis
11. Pulmonary edema
12. Structural heart defects and diseases
(acquired and congenital)
5. Sports injuries
6. Traumatic fractures
e. Hematology/immunology/Oncology (5%)
1. Anemia
B. Pulmonary (10%)
1. Acute life-threatening events (ALTE)
2. Autoimmune diseases
2. Acute respiratory failure
3. Coagulopathies (e.g., thrombocytopenia)
3. Air-leak syndromes (e.g., pneumothorax,
pulmonary interstitial emphysema [PIE],
pneumopericardium)
4. Congenital and acquired immunosuppression
4. Acute respiratory distress syndrome (ARDS,
to include acute lung injury or ALI)
5. Leukemia and tumors
6. Sickle cell disease
F. neurology (7%)
5. Aspirations
1. Encephalopathy
6. Asthma and reactive airway disease
2. Head and brain trauma
7. Chronic lung disease
3. Hydrocephalus
8. Exacerbation of chronic lung disease
4. Increased intracranial pressure
9. Pulmonary hypertension
5. Intracranial and intraventricular hemorrhage
10. Pulmonary infections
6. Neurologic infectious diseases
11. Thoracic surgery (e.g., fractured ribs,
hemothorax, lobectomy, tracheal surgery)
7. Neuromuscular disorders
12. Thoracic and pulmonary trauma
9. Space-occupying lesions
13. Upper airway obstruction
8. Seizure disorders
10. Spinal cord injury
11. Stroke
C. endocrine (3%)
1. Diabetes insipidus
12. Vascular malformation
2. Diabetes mellitus
© 2011 AMP and AACN Certification Corporation. All rights reserved.
~ 56 ~
pediatric clinical nurse specialist test plan
g. gastrointestinal (6%)
9. Near-drowning
1. Abdominal trauma
10. Pain (e.g., pharmacologic/therapeutic
interventions)
2. Acute GI hemorrhage
11. Palliative care issues (e.g., symptom
management)
3. Bowel infarction, obstruction, perforation
4. Gastroesophageal reflux
12. Patient safety issues (physiologic)
5. Gastrointestinal infectious diseases
13. Sensory impairment (e.g., hearing loss)
6. GI motility disorders
8. Hepatic failure and coma
14. Systemic inflammatory response syndrome
(SIRS)/sepsis/septic shock/multiple
organ dysfunction syndrome (MODS)
9. Hepatitis
15. Toxic ingestions and inhalations
7. GI surgeries
10. Malnutrition
K. Psychosocial/Behavioral/Cognitive Health (5%)
11. Nausea and vomiting
1. Age-related developmental issues
2. Anxiety disorders (e.g., PTSD, OCD, fears)
H. Renal/genitourinary (3%)
1. Acute renal failure
3. Attention deficit hyperactivity disorder (ADHD)
2. Chronic renal failure
4. Failure to thrive
3. Electrolyte imbalances
5. Maltreatment (abuse/neglect)
4. Fluid volume imbalances
6. Medical nonadherence
5. Infections (e.g., UTI, PID, STDs)
7. Mood disorders (e.g., depression)
8. Substance abuse
i. integumentary (2%)
1. Pressure ulcers
2. Wounds (surgical and non-surgical)
j. multisystem (8%)
1. Burns (e.g., management of superficial, pretransport of partial/full thickness)
2. Compartment syndrome
3. Distributive shock (e.g., anaphylaxis,
neurogenic)
i.
9. Suicidal behavior
10.
ii. PROFessiOnal CaRing and etHiCal PRaCtiCe
a. advocacy/moral agency (5%)
B. Caring Practices (7%)
C. Collaboration (5%)
d. systems thinking (7%)
e. Response to diversity (3%)
4. End-of-life issues
F. Clinical inquiry (7%)
5. Hypovolemic shock
g. Facilitation of learning (6%)
6. Hypoxic ischemic encephalopathy
7. Infectious diseases (e.g., viral, bacterial,
hospital-acquired)
The sum of these percentages is not 100 due to rounding.
8. Multisystem trauma
Order of content does not necessarily reflect importance.
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
skills and procedures
In addition to classifying exam items according to the specified patient care problems and identifying related underlying
competencies on the following pages, items may require an understanding of skills and procedures pertinent to the Pediatric
CNS. If applicable to assessment of knowledge of the patient care problem, the following skills and procedures may be
incorporated within items.
Cardiovascular
Pulmonary
• Interpret ECG rhythms
• Order nasal/facial CPAP/BiPAP
• Interpret 12-lead ECGs
• Initiate mechanical ventilation
• Determine lead selection for ECGs
• Manage mechanical ventilation
• Interpret hemodynamic values
• Wean mechanical ventilation
• Interpret noninvasive hemodynamic values
• Interpret pulmonary function tests
• Manage transcutaneous (external) pacemakers
• Disconnect chest tube
• 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
gastrointestinal
• Remove PEG/JT/drainage catheters
Renal/genitourinary
• Initiate renal replacement therapies
integumentary
• Provide wound care
multisystem
• Insert pulmonary artery pressure catheters
• Interpret diagnostic imaging
• Adjust pulmonary artery pressure catheters
• Provide nonpharmacologic interventions for pain
• Perform elective cardioversion
• Manage (i.e., recommend/prescribe)
pharmaceutical interventions
• Disconnect pacer wire
• Prescribe durable medical equipment
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
Validated competencies
In addition to classifying exam items according to the prior specifications, items are written to reflect one of the following competencies.
Clinical judgment
• Conduct comprehensive, holistic wellness/illness
assessments
• Obtain data necessary to formulate differential
diagnoses/plans of care and evaluate outcomes
• Use evidence base to guide clinical practice
• Synthesize data/advanced knowledge/
experience using critical thinking to formulate
differential diagnoses
• Determine diagnoses considering:
o
physiologic/pathophysiologic changes
o
morbidities/co-morbidities
o
events across the life span
o
patient’s pharmacologic history with
particular attention to issues of
polypharmacy
• Assess patient/caregiver/family preferences in
relation to cultural/spiritual/quality of
life/lifestyle choices
• Prioritize differential diagnoses
• Design strategies to meet multifaceted needs of
complex patients/groups of patients
• According to legal restrictions in the state,
recommend/prescribe:
o
pharmacologic interventions
o
non-pharmacologic interventions
o
diagnostic measures
o
equipment
o
procedures
o
treatments
• Provide direct care to selected patients based on
needs of patient and CNS’s specialty knowledge
and skills
• Use reliable and valid age-appropriate
assessment instruments to assess acute and
chronic health concerns, including but not limited
to mental status, delirium, dementia and pain
• Evaluate nursing practice that considers safety,
timeliness, effectiveness, efficiency, efficacy and
patient/family centered care
• Assess for manifestation of health disorders/
disruptions, such as infection, adverse drug
effect, dehydration and ischemia
• Determine when evidence-based guidelines/
policies/procedures/plans of care need to be
tailored to individual
• Evaluate for mental health disorders, such as
depression, dementia, anxiety or substancerelated disorders
• Manage or refer patient with signs/symptoms of
physical/mental health disorders across the
life span
• Conduct pharmacologic assessment, including
polypharmacy, drug interactions, over-the-counter
and herbal product use, and the ability to safely
and correctly store and self-administer
medications
• Intervene to prevent/minimize iatrogenesis
• Interpret values/results of lab/diagnostic tests
with consideration of age, ethnicity and health
status
• Assess patient/caregiver/family ability to
implement complex plans of care
• Differentiate between outcomes that require care
process modification at the patient vs. systemlevel
• Lead development of evidence-based plans for
meeting individual, family, community and
population needs
• Provide leadership for collaborative, evidencebased plans for meeting individual, family,
community and population needs
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
Validated competencies
Clinical judgment (cont’d)
• Provide consultation to interdisciplinary
colleagues
• Provide consultation to the interdisciplinary team
regarding the patient’s mental status, home
environment, mobility, functional status, self-care
and caregiver’s abilities
• Coordinate care with other healthcare providers
and community resources, with special attention
to the needs of the non-verbal, developmentally
and cognitively impaired patient
• Initiate consultation to obtain resources to
facilitate progress toward achieving identified
outcomes
• Design a comprehensive, individualized, age- and
disease-appropriate plan for health promotion
• Develop age-specific, individualized treatment
plans and interventions with consideration of
cognitive status, sensory function, perception
and the environment
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
CNS practice through the use of the media,
advanced technologies and community networks
• Facilitate patient/family understanding of risks/
benefits/outcomes of proposed healthcare
regimens to promote informed decision making
• Facilitate decision making regarding treatment
options with the patient/family/caregivers/
healthcare proxy
• Advocate for equitable patient care by:
o
participating in organizational, local, state,
national or international level of policymaking activities for issues related to CNS’s
expertise
o
evaluating the impact of legislative and
regulatory policies as they apply to nursing
practice and patient or population
outcomes
• Facilitate resolution of ethical conflicts by:
o
identifying ethical implications of complex
care situations
o
considering the impact of scientific
advances/cost/clinical effectiveness/
patient and family values and
preferences/other external influences
o
applying ethical principles to resolve
concerns
• Advocate for access to hospice and palliative
care services for patients across the age
spectrum
Caring Practices
• Promote a practice climate conducive to
providing ethical care
• Use advanced communication skills to improve
patient outcomes
• Facilitate interdisciplinary teams to address
ethical concerns, risks or considerations,
benefits and outcomes of patient care
• Assess the effects of interactions among
individual/family/community/social systems
• 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
• Identify potential risks to patient safety/
autonomy and quality of care based on
assessments across all spheres of influence
• Determine nursing practice and system
interventions that promote patient/family/
community safety
2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
Validated competencies
Caring Practices (cont’d)
• Select interventions that may include, but are not
limited to:
o
application of advanced nursing therapies
o
initiation of interdisciplinary team meetings/
consults/other communications to benefit
patient care
o
management of pain medications/clinical
procedures/other interventions
o
psychosocial support, including patient
counseling and spiritual interventions
• Create therapeutic health-promoting, agingfriendly environments
• Provide leadership to address threats to healthcare safety/quality
• Use behavioral, communication and
environmental-modification strategies with
individuals who have cognitive/psychiatric
impairments
Collaboration
• Communicate consultation findings as
appropriate
• Facilitate the provision of clinically competent
care through education, role modeling, team
building and quality monitoring
• Provide leadership in promoting interdisciplinary
collaboration to implement outcome-focused
patient care programs
• Use leadership, team building, negotiation and
conflict resolution skills to build partnerships
within and across systems, including
communities
• Establish collaborative relationships within and
across departments that promote patient safety,
culturally competent care and clinical excellence
• Provide leadership for establishing, improving
and sustaining collaborative relationships
• Practice collegially with members of the healthcare team
• Facilitate intra-agency and interagency
communication
• Foster an interdisciplinary approach to quality
improvement, evidence-based practice, research
and translation of research into practice
systems thinking
• Perform system-level assessments to identify
variables that influence nursing practice and
outcomes, including but not limited to:
o
population variables (age distribution,
health status, income distribution, culture)
o
environment (schools, community support
services, housing availability, employment
opportunities)
o
system of healthcare delivery
o
regulatory requirements
o
internal and external political influences/
stability
o
healthcare financing
o
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
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
Validated competencies
systems thinking (cont’d)
Response to diversity
• Assess the impact of environmental/system
factors on care
• Develop age-specific clinical standards, policies
and procedures
• Coordinate the care of patients with use of
system and community resources to ensure
successful health/illness/wellness transition,
enhance delivery of care and achieve optimal
patient outcomes
• Promote system-wide policies and protocols that
address cultural, ethnic, spiritual and
intergenerational/age differences among
patients, healthcare providers and caregivers
• Manage patient’s transition of care in
collaboration with individual/family/caregivers/
interdisciplinary team members, including:
o
analyzing the readiness of the patient
and family to transition
o
determining the appropriate level and/or
setting of care
o
coordinating implementation of transition
• Provide leadership in conflict management/
negotiation to address problems in the
healthcare system
• Lead system change to improve health outcomes
through evidence-based practice by:
o
specifying expected clinical and system-level
outcomes
o
designing programs to improve clinical and
system-level processes and outcomes
o
facilitating the adoption of practice change
• Evaluate impact of CNS and other nursing
practice on systems of care using nurse-sensitive
outcomes
• Assess system barriers and facilitators to
adoption of evidence-based practices
• Promote healthcare policy and system changes
that facilitate access to care and address biases
(e.g., socioeconomic, ethnic, ageism, sexism,
cultural, mental health stigma)
• Disseminate outcomes of system-level change
internally and externally
• Integrate information technology into systems of
care to enhance safety and monitor health
outcomes
• Design educational programs that enhance the
knowledge of families and caregivers regarding
normal developmental changes
Clinical inquiry
• Assess the quality and effectiveness of
interdisciplinary, intra-agency and interagency
communication and collaboration
• Contribute to the advancement of the profession
by disseminating outcomes of CNS practice
• Analyze research findings and other evidence for
potential application to clinical practice
• Integrate evidence into the health, illness and
wellness management of patients, families,
communities and groups
• Apply principles of evidence-based practice and
quality improvement to all patient care
• Design programs for effective implementation of
research findings and other evidence in clinical
practice
• Develop evidence-based clinical interventions to
achieve defined patient and system outcomes
• Assist staff in the development of innovative,
cost-effective programs or protocols of care
• Cultivate a climate of clinical inquiry across
spheres of influence by:
o
evaluating the need for improvement or
redesign of care delivery processes to
improve safety, efficiency, reliability and
quality
o
disseminating expert knowledge
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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pediatric clinical nurse specialist test plan
Validated competencies
Clinical inquiry (cont’d)
Facilitation of learning
• Participate in establishing quality improvement
agenda for unit, department, program, system or
population
• Provide leadership in planning data collection
and quality monitoring
• Use data to assess the quality and effectiveness
of clinical programs in meeting outcomes
• Develop quality improvement initiatives based on
assessments
• Provide leadership in the design, integration and
evaluation of process improvement initiatives
• Provide leadership in the system-wide integration
of quality improvement and innovation
• Engage in a formal self-evaluation process,
seeking feedback regarding own practice from
patients, peers, professional colleagues and
others
• Analyze data from consultations to implement
practice improvements
• Participate in conduct/implementation of
research by:
o
identifying questions for clinical inquiry
o
critiquing literature during literature reviews
o
synthesizing literature during literature
reviews
o
designing and implementing studies
o
collecting data
o
analyzing data
o
disseminating findings
• Apply ethical principles in safeguarding the
confidentiality, dignity and safety of all research
participants including the vulnerable and those
with impaired decision making capacity
• 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
• Provide education to individuals, families, groups
and communities to promote knowledge,
understanding and optimal functioning across
the wellness-illness continuum
• Mentor staff nurses, graduate students and
others to acquire new knowledge and skills, and
develop their careers
• Mentor health professionals in applying the
principles of evidence-based care
• Coordinate formal and informal education for
healthcare providers to improve healthcare
outcomes
• 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
• Participate in pre-professional, graduate and
continuing education of nurses and other
healthcare providers by:
o
completing a needs assessment, as
appropriate, to guide interventions with staff
o
promoting professional development of staff
nurses and continuing education activities
o
implementing staff development and
continuing education activities
o
mentoring others to use research findings in
practice
• Modify health information, patient education
programs and interventions for patients with
sensory, perceptual, cognitive, and physical and
mental illness limitations
© 2011 AMP and AACN Certification Corporation. All rights reserved.
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