This is the second in a series of two courses designed to enhance the ongoing development of knowledge for the advanced practice role of the Critical Care Clinical Nurse Specialist. The American Association of Critical-Care Nurses (AACN) Synergy Model serves as the theoretical foundation of the course. Nurse competencies of the Synergy Model include in-depth systems thinking, advocacy and moral agency, caring practices, and response to diversity. Professional development and expanded opportunities for the CNS are explored. Advanced strategies for care of patients and families with critical alterations of the neurological, gastrointestinal, and renal systems are explored at an advanced level. Various multisystem alterations are addressed.