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Our affiliated professional association, the Academy of Medical-Surgical Nurses, offers the Medical-Surgical Nursing Certification Review Course. It is a 2-day course designed for nurses preparing to take the Certified Medical-Surgical Registered Nurse (CMSRNŽ) Certification Exam.

In order to meet the varied needs of nurses and facilities, AMSN offers the course in a number of live and independent study formats, including bringing it to your facility or accessing it through the AMSN Online Library.

An alternative to nurses preparing for the CMSRN test is the Focused CE Series, a collaboration between AMSN and nurse.com. The Focused CE Series is a blended learning model that combines weekly online CE course readings, weekly live webinar presentations, and an online forum for information exchange and networking with peers.

1. Helping Role
- Maintain an environment in which patient confidentiality is assured.
- Assess patient's level of comfort/pain.
- Act as an advocate to help patient meet needs/goals.
- Acknowledge, respect, and support emotional state of patient and/or family as they experience and/or express their emotions.
- Assist patients to achieve optimal level of comfort, using an interdisciplinary approach.
- Modify plan of care to achieve patient's optimal level of comfort, i.e., pharmacological interventions, heat, cold, massage, positioning, touch, etc.
- Provide a therapeutic environment, considering privacy, noise, light, visitors'/providers' interaction with patients.
- Provide culturally competent patient care, including education.
- Support family involvement in accordance with patient's wishes regarding caregiving and decision making.
- Assess for potential for self-harm.
- Identify need of patient/family for support systems/resources and make appropriate referrals.
- Work on behalf of patient/family to help resolve ethical and clinical concerns.
- Coordinate care across multiple settings.
- Identify, acknowledge, support, and facilitate patient/family decisions regarding end-of-life care.
- Identify signs of domestic or intimate partner violence.
- Assess and provide for spiritual needs of patients and families.
- Identify ethical issues in clinical practice and facilitate a resolution with patient, family, and staff.

2. Teaching/Coaching Function
- Assess the patient's and family's readiness and ability to learn.
- Identify barriers to learning.
- Prepare/educate patient for transition in care, e.g., discharge to home or other facility.
- Provide information and rationales related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.
- Utilize opportunities for spontaneous education.
- Encourage patient's and family's participation in establishing educational goals.
- Develop and implement an individualized teaching plan for patient and/or family.
- Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.
- Assist staff in identifying educational needs of patients and their families.
- Assist staff in selecting/developing educational materials appropriate for intended learner(s).
- Teach patient and family about available community resources.

3. Diagnostic and Patient Monitoring
- Conduct and document a comprehensive baseline assessment.
- Anticipate patient's response to treatment and monitor for potential problems.
- Reassess patient based on established standards of care at appropriate intervals.
- Interpret results of laboratory and diagnostic studies and take appropriate action.
- Use invasive and non-invasive methods to collect data.
- Analyze all patient data in formulating a plan of care.
- Participate in medication reconciliation at transitions of care.
- Anticipate the patient's response and needs related to physiological, psychosocial sexual, spiritual, and cultural aspects of his/her illness.
- Prioritize identified problems and modify the plan of care to achieve the best possible outcomes.
- Develop an individualized plan of care congruent with patient goals.
- Identify purpose and appropriateness of diagnostic studies.

4. Administering and Monitoring Nursing Interventions
- Administer medications accurately and safely.
- Identify subtle changes in patient's assessment to prevent deterioration of patient status.
- Assess patient's level of consciousness.
- Monitor patients for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.
- Implement measures to ensure adequate oxygenation and gas exchange.
- Monitor and implement measures to prevent alterations in skin integrity.
- Initiate, maintain, and monitor intravenous therapy.
- Identify, document, and report deviations from expected findings.
- Monitor for signs and symptoms of complications of disease processes.
- Implement measures to address threats to patient safety, e.g., falls, seizures.
- Maintain patent airway.
- Maintain integrity and prevent infection of invasive drainage systems, e.g., catheters, percutaneous drains.
- Implement measures to maintain adequate hydration and electrolyte balance.
- Provide care to patients on continuous cardiac monitoring.
- Use adaptive/assistive devices for mobility, immobility, positioning, and comfort.
- Interpret cardiac rhythm strips.
- Monitor for complications of musculoskeletal trauma and surgical procedures.
- Perform a neurovascular assessment, e.g., extremities, flaps, grafts.
- Provide optimum nutrition during hospitalization, allowing for cultural and individual preferences.
- Identify and implement transmission-based precautions based on patient's history and symptoms.
- Monitor effectiveness of nutritional interventions.
- Develop and implement a wound management strategy.
- Care for patient receiving IV patient-controlled analgesia
- Perform central line dressing change.
- Administer heparin drip
- Apply and/or monitor devices used to immobilize affected area, e.g., cast, splint, collar, etc.
- Care for patient receiving epidural analgesia
- Provide care for patients who have chest drainage systems.

5. Effective Management of Rapidly Changing Situations
- Recognize signs that a patients condition is deteriorating and take appropriate action.
- Obtain appropriate orders to address a change in the patients condition,
- Determine priorities in rapidly changing situations.
- Use existing guidelines/protocols/policies to respond to changing patient situations, e.g., hypoglycemia, wound dehiscence.
- Use existing guidelines/protocols/policies to respond to urgent and emergent situations, e.g., acute chest pain, stroke.
- Initiate basic life support.

6. Monitoring/Ensuring Quality Health Care Practices
- Communicate effectively to the healthcare team.
- Question/clarify orders as appropriate.
- Incorporate evidence-based practice into the patient's plan of care.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
- Report system failures, e.g., chain of command, equipment, safety, medication administration, computer systems.
- Assist nursing staff in incorporating evidence-based practice and quality improvement into practice.
- Participate in quality improvement activities.
- Identify clinical problems for further investigation.

7. Organizational and Work-Role Competencies
- Practice in accordance with the rules and regulations of the state board of nursing in state(s) of licensure.
- Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.
- Utilize electronic/computer resources to optimize patient care.
- Set priorities based on assignment, unit, and institutional needs.
- Act as a professional role model.
- Participate as an active member of the interdisciplinary healthcare team.
- Delegate patient care assignments based on competency levels and scope of practice of healthcare team members.
- Act as a resource for other nurses on the unit.
- Provide collaborative, interdisciplinary, coordinated care.
- Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
- Evaluate own practice based on established standards of care.
- Evaluate nursing care based on outcome criteria.
- Recognize unsafe work practices (nurse/patient ratio, ergonomics, standard precautions, etc.) and intervene appropriately.
- Identify, develop, and implement strategies to reduce readmissions.
- Use the chain of command appropriately.
- Serve as consultant to nursing staff and other disciplines.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
- Identify, develop, and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.
- Provide expert support to unit educators, preceptors, and nurse managers.
- Follow institutional policies and procedures in response to an internal or external crisis or event.
- Serve as preceptor/mentor for students and staff.
- Assist with data collection (e.g., patient outcomes, nurse-sensitive indicators).



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Committee reviews

The national affiliation of scientific Nurse consultants sponsors and hosts an annual summit which provides a discussion board for the CNS neighborhood to talk about present considerations affecting scientific Nurse experts. Summit members are made from associations with massive numbers of CNS contributors and CNS certifying bodies. during the last yr, NACNS has been asked in numerous knowledgeable boards to exhibit national consensus on the CNS apply expertise described within the NACNS remark on CNS practice and training. To that conclusion, this year's center of attention on the July 21-22, 2005 CNS summit convened at Sigma Theta Tau Headquarters in Indianapolis, Indiana become on CNS observe competencies. Fifteen companies participated: ANA, ANCC, APNA, WOCN, WOCN Certification Board, BCEN, AORN, ONCC, ONS, Federal Nursing functions Council, AWHONN, AACN (crucial care), AACN Certification business enterprise, MSNCB, and NGNA. The national Council of State Boards of Nursing (NCSBN) and the NCSBN APRN Advisory Panel representatives had been invited as special visitors as a result of the summit focal point and growth with the core CNS exam. a total of 29 individuals attended.

NACNS supplied an overview of the preliminary information compiled about each and every state's law and rules referring to CNSs. They dispensed the draft certification White Paper that covered an in depth description of the processes used for construction of the 1998 observation and also for validation of the content material of each the 1998 and 2004 Statements. They also dispensed the White Paper clarifying NACNS's place on CNS education and practice regarding pharmacology. The White Paper will soon be posted as an NACNS place paper.

The essential outcome turned into standard affirmation that the NACNS core potential reflect CNS observe. "The uniqueness businesses on the Summit demonstrated that their core practice expertise follow across specialties, which is awfully crucial assistance for their colleagues in education, regulation and certification," brought up NACNS President Kathleen Baldwin, PhD, RN, CNS, ANP, GNP. NACNS will continue to are seeking for formal endorsement of the CNS capabilities. it will be stated that old to the summit, voluntary endorsement of the observation and the CNS apply abilities turned into offered by the American firm of Nurse Executives and the countrywide League for Nursing NLN-AC.

on the request of the NACNS Board of administrators, the Legislative/Regulatory Committee has embarked on a thorough assessment of each state's legislation and legislation of CNS practice. This evaluation covers APN awareness, title protection, scope of observe, regulatory requirements for focus, certification necessities, waiver alternate options, prescriptive authority and collaborative agreement requirements, continuing education necessities, present state apply act undertaking related to CNS follow, CNS representation on State Boards of Nursing, and Psychiatric mental health CNS attention. The preliminary evaluation has been accomplished and now the information will bear a validation system with each and every particular person state board of nursing. The ultimate outcomes will be posted within the clinical Nurse expert: The Journal for superior Nursing practice. dwell tuned for this comprehensive update! Jo Ellen Rust, MSN, RN, Co-Chair.


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