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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 (CMSRN®) 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 exam 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 exam.


- 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 exam 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 exam- 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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