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Exam Code: CNL
Exam Name: AACN Clinical Nurse Leader (CNL)
Total Questions: 140 multiple-choice questions (some are unscored pretest questions)
Time Allotted: 3 hours
Passing Marks: Minimum scaled score of 350 out of 500

- Nursing Leadership (~36%)
- Clinical Outcomes Management (~34%)
- Care Environment Management (~30%)

- Nursing Leadership
- 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

- 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 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

- Healthcare Advocacy
- Identify health disparities across populations
- Perform an advanced exam 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

- 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

- 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
- Patient Assessment
- Perform an advanced comprehensive exam of the patient across the lifespan (e.g. culture socioeconomic status health literacy vulnerabilities)
- Perform an advanced exam of microsystems across the care continuum to determine patient population care needs

- 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 perspectives 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)

- Clinical Outcomes Management
- 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 exam 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

- 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

- 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

- Care Environment Management
- 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 exam 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

- 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

- 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

- 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

- 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 exam 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

- 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)

- 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