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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 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 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 test 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).