Chapter 6 of 620% of exam

Professional Caring and Ethical Practice

One fifth of the exam is built on the nurse characteristics of the AACN Synergy Model: advocacy/moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity and systems thinking. Questions describe a situation and ask which action, or which characteristic, fits best.

The Synergy Model framework

The model matches patient characteristics such as resiliency, vulnerability, stability and complexity with nurse characteristics. Synergy results when the nurse's competencies meet the patient's needs. Knowing each definition lets you classify an action quickly.

Patient characteristics

Resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision-making, predictability.

CCRN Exam Handbook (July 2026), Synergy Model

Tested nurse characteristics

Advocacy/moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity, systems thinking.

Adult CCRN Test Plan, Part II

Clinical judgment

The eighth characteristic, clinical judgment, is the organizing idea behind the clinical part of the exam.

CCRN Exam Handbook (July 2026)

Advocacy, moral agency and ethics

Advocacy means representing the patient's and family's concerns and helping resolve ethical conflicts. Capable adults can refuse treatment, and surrogates decide as the patient would. Moral distress is recognized and addressed rather than endured alone.

Autonomy

A patient with decision-making capacity may accept or refuse treatment; confirm the refusal is informed and document it.

Varkey, Principles of Clinical Ethics, 2021

Health care agent

Acts only when the patient cannot and follows the patient's known wishes, not personal preferences.

MedlinePlus (NLM), Health care agents

DNR scope

A DNR order applies to CPR; other treatments such as antibiotics and pain relief continue unless separately declined.

MedlinePlus (NLM), Do-not-resuscitate order

Moral distress

The inability to do the right thing because of institutional constraints; seek ethics and peer support.

AACN Position Statement on Moral Distress (2025)

Collaboration and facilitation of learning

Structured communication tools reduce errors between team members and with families. Teaching is effective only when understanding is confirmed.

SBAR

Situation, Background, Assessment (what you think is wrong), Recommendation or Request.

AHRQ TeamSTEPPS, SBAR

Check-back

The receiver repeats the order back and the sender confirms, closing the loop.

AHRQ TeamSTEPPS, Check-Back

CUS

Concerned, Uncomfortable, Safety issue; escalate to a supervisor if safety is not acknowledged.

AHRQ TeamSTEPPS, CUS

Teach-back and show-me

Ask patients to explain in their own words and to demonstrate new skills; teach in chunks and check each one.

AHRQ Health Literacy Toolkit, Tool 5

Caring practices, diversity, inquiry and systems

Caring practices focus on comfort and preventing suffering. Response to diversity means incorporating each patient's values, language and beliefs. Clinical inquiry and systems thinking extend the nurse's influence beyond one bedside.

Language access

Use qualified interpreters; do not rely on minor children or accompanying adults except in narrow emergency situations.

45 CFR 92.201 (Section 1557)

Family presence

A staff member can act as family support person during a witnessed resuscitation.

J Clin Nurs 2023 family support person study

Clinical inquiry

Question routine practice and bring current evidence to the unit's decision process.

CCRN Exam Handbook, Synergy Model

Systems thinking in transitions

Pharmacist-led medication reconciliation and structured post-discharge support for sepsis survivors.

Surviving Sepsis Campaign 2026

Scarce resources

Institutions should use consistent, equitable allocation policies and interdisciplinary triage committees.

AACN Position Statement on Moral Distress (2025)

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