Consultation/collaboration: shares information with other members of the health care team, makes appropriate patient referrals, uses interdisciplinary resources to enhance own clinical decision making, provides continuity among home, office, inpatient setting and community, uses appropriate systems, automated or manual, to obtain patient information or schedule appointments. In addition, this role provides comprehensive assessments to establish and evaluate a plan of care and address changes in a patient's condition, delegates nursing tasks when appropriate and provides supervision and monitoring of function or activity, creates and implements dynamic teaching plans based upon identified patient need and acts as a resource for other staff.