Develops and provides individualized patient education based on assessed needs. Develops and implements individualized care plan. Assists with the coordination of patient care across the continuum by collaborating with the inter-professional team and community partners. Works with the clinical team and may manage the disease registries by identifying and following up with patients not meeting clinical and evidenced-based goals as well as Sanford approved clinical guidelines. Provides services that focus on health and wellness. Provides healthcare leadership, coordination of services, and the implementation of evidence-based practice to support the overall goals of the designated setting and/or program. Applies population health care management strategies to panels of patients.

Demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. Functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Sanford Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct.