CNS outcomes are achieved through a set of core competencies (NACNS, 2010), employed across three spheres of influence (patient/family, nurses/nursing practice, and systems/organizations), including: Direct Care: Direct interaction with patients, families, and groups of patients to promote health or well-being and improve quality of life. Special knowledge and skills are required for the role, including clinical expertise, advanced understanding of evidence-based practice, and proficiency in communication, collaboration, consultation, evaluation, education, mentorship, and change management strategies.