Clinical Nurse Leader (CNL) Test Specifications [2023]

I. Nursing Leadership (31%)

A. Horizontal Leadership
1. Apply leadership change and complexity theories
2. Guide the healthcare team to use clinical judgement when providing patient care
3. Facilitate delegation of patient care coordination activities
4. Provide coaching and mentoring to the healthcare team
5. Act as a role model for the healthcare team
6. Coordinate the evaluating and updating plans of care with the healthcare team
7. Facilitate coordination of applicable healthcare team members and stakeholders to meet care objectives
8. Manage the healthcare team to provide timely and efficient care
9. Develop effective working relationships across the healthcare system
10. Advocate for the CNL role
B. Interprofessional Communication and Collaboration Skills
1. Analyze communication structures and chain of command that impact care within the healthcare team and across settings
2. Demonstrate effective written spoken and non-verbal communication skills
3. Utilize communication skills that effectively navigate high-stakes or difficult conversations within the healthcare team
4. Employ strategies to build relationships within healthcare team including both clinical and administrative members
5. Employ strategies that promote diversity equity and inclusion to bridge barriers across the healthcare system
6. Integrate emotional intelligence in communication and collaboration with patients families and the healthcare team
7. Leverage the roles and responsibilities of the interprofessional team to influence care delivery
8. Utilize effective communication strategies to adapt information to the target audience
C. Healthcare Advocacy
1. Identify health disparities across populations
2. Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs
3. Protect patient rights by being an advocate in the healthcare system
4. Ensure that patients families and communities are well informed in creating a patient-centered plan of care
5. Advocate for necessary healthcare delivery changes and advancements to key stakeholders
6. Identify and propose microsystem resources to meet the needs of target populations
7. Determine shared understanding among the healthcare team before decisions are made
8. Advocate for patients particularly the most vulnerable
D. Implementation of the CNL Role
1. Demonstrate professional identity and practice in developing the CNL role
2. Explain the capacity of CNL practice to improve healthcare processes and outcomes
3. Exhibit qualities of a microsystem leader within and across interprofessional teams
4. Apply current and new CNL evidence and competencies into practice
5. Disseminate CNL practice outcomes at system regional national or international level
6. Collaborate with a network of CNL professionals at the system regional national or international level
E. Lateral Integration of Care Services
1. Coordinate the healthcare of patients across the care continuum
2. Integrate an interprofessional approach to identify and acquire resources for patient populations
3. Coordinate patient care within and across specific episodes of illness and throughout the care continuum
4. Apply systems and organization theory in the design delivery and evaluation of healthcare delivery across the care continuum
F. Patient Assessment
1. Perform an advanced comprehensive assessment of the patient across the lifespan (e.g., culture, socioeconomic status, health literacy, vulnerabilities)
2. Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs
G. Ethics
1. Apply patient-centered ethical decision-making framework to clinical situations
2. Apply legal and ethical guidelines to advocate for patient well-being and preferences
3. Identify ethical dilemmas and the impact on patient care and outcomes
4. Analyze how ethical decision making from both a personal and organizational perspectives may create conflicts of interest
5. Collaborate with ethics committees or resources and recognize their role in health care delivery
6. Demonstrate knowledge of professional and ethical boundaries (e.g., power dynamics dual relationships)
II. Clinical Outcomes Management (37%)
A. Illness/Disease Management
1. Coordinate the provision and management of care at the microsystem level and across the care continuum
2. Evaluate care for patients with emphasis on health promotion and risk reduction
3. Evaluate readiness needs and interventions for safe transition of care
4. Evaluate patient care based on analysis of outcomes evidence-based knowledge and patient's goals
5. Analyze microsystems of care and outcome datasets to anticipate patient risk and improve quality of care delivery
6. Apply theories of chronic illness care and population health management to patient and families
7. Coordinate community resources social networks and decision support mechanisms into care management
8. Recognize differences in responses to illness and therapies based on patient's risk factors and preferences
9. Apply advanced pathophysiology assessment and pharmacology to anticipate illness progression response to therapy and to guide teach and engage patients and families regarding care
10. Use knowledge of cost and affordability issues in managing patient illness/disease across the care continuum
11. Synthesize literature and research findings as the foundation for the design of interventions for illness and disease management
12. Coordinate and implement education programs for patients and health professionals
13. Identify epidemiological patterns in order to manage illness and disease
B. Health Promotion, Disease, and Risk Reduction
1. Collaborate with the healthcare team to promote health and/or prevent disease
2. Employ strategies to engage patients in therapeutic partnerships with the healthcare team
3. Apply interventions based on evidence to meet specific patient needs
4. Design and implement interventions to modify risk factors and promote engagement in healthy lifestyles for diverse populations
5. Assess risk predictive and genetic factors that influence the health of patients
6. 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)
7. Incorporate principles of diversity, equity, and inclusion into health promotion and disease prevention strategies
8. Incorporate theories and research in creating patient engagement strategies to promote and preserve health
9. Develop community partnerships to establish risk reduction strategies to address identified needs of the microsystem population
C. Healthcare Policy
1. Recognize the effect of healthcare policy on health promotion, risk reduction, and disease and injury prevention
2. Recognize the interactive effect of socioeconomics on national/global health policy related to health outcomes
3. 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
4. Identify the influence of regulatory guidelines and quality controls within the healthcare delivery system
III. Care Environment Management (32%)
A. Knowledge Management
 1. Collect data that documents the characteristics conditions and outcomes for various patient groups
2. Apply knowledge of technology equipment treatment regimens and medication therapies for various patient groups
3. Compare and evaluate trends of institutional and unit data to national benchmarks
4. Analyze variations in clinical outcomes to determine where nurses have the greatest impact at the microsystem level
5. Synthesize data information and knowledge to evaluate and achieve optimal clinical outcomes
6. Integrate assessment data into information management systems to support shared decision making
7. Disseminate microsystem data that impacts health outcomes
8. Employ strategies to engage the healthcare team to impact clinical outcomes
B. Healthcare Systems/Organizations
1. Apply knowledge of change theory to manage group dynamics and promote information dissemination across healthcare systems
2. Appraise existing organizational policies and procedures based on current evidence
3. Implement system-based strategies that decrease healthcare disparities
4. Apply systems thinking theories to address problems and develop solutions
5. Evaluate how health care delivery systems are organized and their effect on patient care within microsystems
6. Evaluate the economic legal and political factors that influence health care delivery
C. Team Coordination
1. Employ strategies to ensure skilled nursing procedures are incorporated to promote safety
2. Evaluate the microsystem culture/climate that influence healthcare team dynamics
3. Establish strategies to maintain effective team structures to ensure shared decision making
4. Employ conflict mitigation and resolutions strategies
5. Promote a positive and healthy work environment and a culture of retention
D. Quality Improvement and Safety
1. Employ quality improvement methods in evaluating individual and aggregate patient care processes
2. Evaluate healthcare outcomes through the acquisition of data and the questioning of inconsistencies
3. Redesign patient care utilizing quality improvement tools (e.g., Failure Modes Effect Analysis (FMEA), Root Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles)
4. Employ strategies to guide the healthcare team in quality improvement activities
5. Identify variability and/or gaps in care practices and processes
6. Employ standardized work practices to address and improve gaps in processes
E. Evidence-Based Practice
1. Create framework within the microsystem to integrate patient and family preferences, interprofessional clinical expertise, and best evidence into clinical decisions
2. Develop advanced assessment for clinical decisions by applying evidence-based practice
3. Synthesize quantitative or qualitative evidence to promote critical thinking
4. Select relevant sources of evidence to meet specific needs of patients microsystems or communities when planning care
5. Identify relevant measurement strategies that will improve patient outcomes and promote cost effective care
6. Demonstrate expertise in the evidence appraisal process
F. Healthcare Finance and Economics
1. Propose cost effective strategies to the healthcare team that improve efficiency and patient care outcomes
2. Employ financial stewardship for the environmental human and material resources while coordinating patient care
3. Identify high cost / high volume activities to benchmark costs nationally and across care settings
4. Identify the impact of financial policies on healthcare delivery and patient outcomes
5. Interpret the impact of both public and private reimbursement policies that may affect patient care decisions
6. Evaluate the effect of healthcare financing on access to care and patient outcomes
7. Demonstrate knowledge of healthcare economic concepts (e.g. ,Return on Investment (ROI), Value-Based Purchasing (VBP), bundled payments)
G. Healthcare Informatics
1. Analyze information health technology sources
2. Evaluate care utilizing informatics and patient care technology
3. Apply multiple sources of systems data in designing processes for care delivery
4. Evaluate clinical information systems to provide feedback related to efficient and accurate documentation
5. Evaluate the impact of new technologies on patients, families, and healthcare delivery
6. Assess the relationships between information systems, accurate communication error reduction, and healthcare system operation
7. Utilize technology for health promotion and disease prevention
8. Collaborate with quality improvement and information technology teams to design and implement processes for improving patient outcomes
9. Evaluate innovative technologies for inclusion in processes to anticipate patient risk
10. Demonstrate efficient and appropriate use of healthcare technologies to maximize healthcare outcomes