CNL Question Bank

A. Horizontal Leadership

• Apply leadership change and complexity theories
• Guide the healthcare team to use clinical judgement when providing patient care
• Facilitate delegation of patient care coordination activities
• Provide coaching and mentoring to the healthcare team
• Act as a role model for the healthcare team
• Coordinate the evaluating and updating plans of care with the healthcare team
• Facilitate coordination of applicable healthcare team members and stakeholders to meet care objectives
• Manage the healthcare team to provide timely and efficient care
• Develop effective working relationships across the healthcare system
• Advocate for the CNL role

B. Interprofessional Communication and Collaboration Skills

• Analyze communication structures and chain of command that impact care within the healthcare team and across settings
• Demonstrate effective written, spoken, and non-verbal communication skills
• Utilize communication skills that effectively navigate high-stakes or difficult conversations within the healthcare team
• Employ strategies to build relationships within the healthcare team, including both clinical and administrative members
• Employ strategies that promote diversity, equity, and inclusion to bridge barriers across the healthcare system
• Integrate emotional intelligence in communication and collaboration with patients, families, and the healthcare team
• Leverage the roles and responsibilities of the interprofessional team to influence care delivery
• Utilize effective communication strategies to adapt information to the target audience

C. Healthcare Advocacy

• Identify health disparities across populations
• Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs
• Protect patient rights by being an advocate in the healthcare system
• Ensure that patients, families, and communities are well informed in creating a patient-centered plan of care
• Advocate for necessary healthcare delivery changes and advancements to key stakeholders
• Identify and propose microsystem resources to meet the needs of target populations
• Determine shared understanding among the healthcare team before decisions are made
• Advocate for patients, particularly the most vulnerable

D. Implementation of the CNL Role

• Demonstrate professional identity and practice in developing the CNL role
• Explain the capacity of CNL practice to improve healthcare processes and outcomes
• Exhibit qualities of a microsystem leader within and across interprofessional teams
• Apply current and new CNL evidence and competencies into practice
• Disseminate CNL practice outcomes at system, regional, national, or international level
• Collaborate with a network of CNL professionals at the system, regional, national, or international level

E. Lateral Integration of Care Services

• Coordinate the healthcare of patients across the care continuum
• Integrate an interprofessional approach to identify and acquire resources for patient populations
• Coordinate patient care within and across specific episodes of illness and throughout the care continuum
• Apply systems and organization theory in the design, delivery, and evaluation of healthcare delivery across the care continuum

F. Patient Assessment

• Perform an advanced comprehensive assessment of the patient across the lifespan (e.g. culture, socioeconomic status, health literacy, vulnerabilities)
• Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs

G. Ethics

• Apply patient-centered ethical decision-making framework to clinical situations
• Apply legal and ethical guidelines to advocate for patient well-being and preferences
• Identify ethical dilemmas and the impact on patient care and outcomes
• Analyze how ethical decision making from both a personal and organizational perspective may create conflicts of interest
• Collaborate with ethics committees or resources and recognize their role in health care delivery
• Demonstrate knowledge of professional and ethical boundaries (e.g. power dynamics, dual relationships)

A. Illness/Disease Management

• Coordinate the provision and management of care at the microsystem level and across the care continuum
• Evaluate care for patients with emphasis on health promotion and risk reduction
• Evaluate readiness, needs, and interventions for safe transition of care
• Evaluate patient care based on analysis of outcomes, evidence-based knowledge, and patient's goals
• Analyze microsystems of care and outcome datasets to anticipate patient risk and improve quality of care delivery
• Apply theories of chronic illness care and population health management to patient and families
• Coordinate community resources, social networks, and decision support mechanisms into care management
• Recognize differences in responses to illness and therapies based on patient's risk factors and preferences
• Apply advanced pathophysiology, assessment, and pharmacology to anticipate illness progression, response to therapy, and to guide, teach, and engage patients and families regarding care
• Use knowledge of cost and affordability issues in managing patient illness/disease across the care continuum
• Synthesize literature and research findings as the foundation for the design of interventions for illness and disease management
• Coordinate and implement education programs for patients and health professionals
• Identify epidemiological patterns in order to manage illness and disease

B. Health Promotion, Disease Prevention & Risk Reduction

• Collaborate with the healthcare team to promote health and/or prevent disease
• Employ strategies to engage patients in therapeutic partnerships with the healthcare team
• Apply interventions based on evidence to meet specific patient needs
• Design and implement interventions to modify risk factors and promote engagement in healthy lifestyles for diverse populations
• Assess risk, predictive, and genetic factors that influence the health of patients
• Coordinate clinical and health promotion programs for patient populations to reduce risk, prevent disease, and prevent disease sequelae (e.g. heart failure, Enhanced Recovery After Surgery (ERAS), diabetes)
• Incorporate principles of diversity, equity, and inclusion into health promotion and disease prevention strategies
• Incorporate theories and research in creating patient engagement strategies to promote and preserve health
• Develop community partnerships to establish risk reduction strategies to address identified needs of the microsystem population

C. Healthcare Policy

• Recognize the effect of healthcare policy on health promotion, risk reduction, and disease and injury prevention
• Recognize the interactive effect of socioeconomics on national/global health policy related to health outcomes
• Analyze the effect of local, state, and/or national healthcare policy as they apply to the standards of care and scope of practice in the microsystem
• Identify the influence of regulatory guidelines and quality controls within the healthcare delivery system

A. Knowledge Management

• Collect data that documents the characteristics, conditions, and outcomes for various patient groups
• Apply knowledge of technology, equipment, treatment regimens, and medication therapies for various patient groups
• Compare and evaluate trends of institutional and unit data to national benchmarks
• Analyze variations in clinical outcomes to determine where nurses have the greatest impact at the microsystem level
• Synthesize data, information, and knowledge to evaluate and achieve optimal clinical outcomes
• Integrate assessment data into information management systems to support shared decision making
• Disseminate microsystem data that impacts health outcomes
• Employ strategies to engage the healthcare team to impact clinical outcomes

B. Healthcare Systems/Organizations

• Apply knowledge of change theory to manage group dynamics and promote information dissemination across healthcare systems
• Appraise existing organizational policies and procedures based on current evidence
• Implement system-based strategies that decrease healthcare disparities
• Apply systems thinking theories to address problems and develop solutions
• Evaluate how health care delivery systems are organized and their effect on patient care within microsystems
• Evaluate the economic, legal, and political factors that influence health care delivery

C. Team Coordination

• Employ strategies to ensure skilled nursing procedures are incorporated to promote safety
• Evaluate the microsystem culture/climate that influence healthcare team dynamics
• Establish strategies to maintain effective team structures to ensure shared decision making
• Employ conflict mitigation and resolutions strategies
• Promote a positive and healthy work environment and a culture of retention

D. Quality Improvement & Safety

• Employ quality improvement methods in evaluating individual and aggregate patient care processes
• Evaluate healthcare outcomes through the acquisition of data and the questioning of inconsistencies
• Redesign patient care utilizing quality improvement tools (e.g. Failure Modes Effect Analysis (FMEA), Root Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles)
• Employ strategies to guide the healthcare team in quality improvement activities
• Identify variability and/or gaps in care practices and processes
• Employ standardized work practices to address and improve gaps in processes

E. Evidence-Based Practice

• Create framework within the microsystem to integrate patient and family preferences, interprofessional clinical expertise, and best evidence into clinical decisions
• Develop advanced assessment for clinical decisions by applying evidence-based practice
• Synthesize quantitative or qualitative evidence to promote critical thinking
• Select relevant sources of evidence to meet specific needs of patients, microsystems, or communities when planning care
• Identify relevant measurement strategies that will improve patient outcomes and promote cost-effective care
• Demonstrate expertise in the evidence appraisal process

F. Healthcare Finance & Economics

• Propose cost-effective strategies to the healthcare team that improve efficiency and patient care outcomes
• Employ financial stewardship for the environmental, human, and material resources while coordinating patient care
• Identify high-cost/high-volume activities to benchmark costs nationally and across care settings
• Identify the impact of financial policies on healthcare delivery and patient outcomes
• Interpret the impact of both public and private reimbursement policies that may affect patient care decisions
• Evaluate the effect of healthcare financing on access to care and patient outcomes
• Demonstrate knowledge of healthcare economic concepts (e.g. Return on Investment (ROI), Value-Based Purchasing (VBP), bundled payments)

G. Healthcare Informatics

• Analyze information, health technology sources
• Evaluate care utilizing informatics and patient care technology
• Apply multiple sources of systems data in designing processes for care delivery
• Evaluate clinical information systems to provide feedback related to efficient and accurate documentation
• Evaluate the impact of new technologies on patients, families, and healthcare delivery
• Assess the relationships between information systems, accurate communication, error reduction, and healthcare system operation
• Utilize technology for health promotion and disease prevention
• Collaborate with quality improvement and information technology teams to design and implement processes for improving patient outcomes
• Evaluate innovative technologies for inclusion in processes to anticipate patient risk
• Demonstrate efficient and appropriate use of healthcare technologies to maximize healthcare outcomes