THE ESSENTIALS:

CORE COMPETENCIES FOR

PROFESSIONAL NURSING EDUCATION
 THE ESSENTIALS:

CORE COMPETENCIES FOR

PROFESSIONAL NURSING EDUCATION

APPROVED BY THE AACN MEMBERSHIP ON APRIL 6 , 2021

COPYRIGHT © 2021 AMERICAN ASSOCIATION OF COLLEGES OF NURSING.

ALL RIGHTS RESERVED. NO PART OF THIS PUBLICATION MAY BE REPRODUCED
IN PRINT, BY PHOTOSTATIC MEANS, OR IN ANY OTHER MANNER, WITHOUT THE
EXPRESSED WRITTEN PERMISSION OF THE ASSOCIATION.
 The Essentials: Core Competencies for Professional Nursing Education

TABLE OF CONTENTS

Introduction................................................................................................................................... 1
Foundational Elements......................................................................................................... 2
Nursing Education for the 21st Century................................................................................ 5
Domains and Concepts................................................................................................................ 10
Domains for Nursing........................................................................................................... 10
Concepts for Nursing Practice............................................................................................ 11
Competencies and Sub-Competencies........................................................................................ 15
A New Model for Nursing Education........................................................................................... 16
Implementing the Essentials: Considerations for Curriculum..................................................... 18
Entry-Level Professional Nursing Education....................................................................... 19
Advanced-Level Nursing Education.................................................................................... 21
Domains, Competencies, and Sub-Competencies for Entry-level Professional Nursing
Education and Advanced-level Nursing Education...................................................................... 27
1. Knowledge for Nursing Practice................................................................................... 27
2. Person-Centered Care.................................................................................................. 29
3. Population Health......................................................................................................... 33
4. Scholarship for the Nursing Discipline.......................................................................... 37
5. Quality and Safety........................................................................................................ 39
6. Interprofessional Partnerships..................................................................................... 42
7. Systems-Based Practice................................................................................................ 44
8. Informatics and Healthcare Technologies..................................................................... 46
9. Professionalism............................................................................................................. 49
10. Personal, Professional, and Leadership Development.................................................. 53
Glossary....................................................................................................................................... 55
Reference List.............................................................................................................................. 67
Essentials Task Force................................................................................................................... 75

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION iii

 The Essentials: Core Competencies for
Professional Nursing Education

Introduction
Since 1986, the American Association of Colleges of Nursing (AACN) has published the
Essentials series that provides the educational framework for the preparation of nurses at
four-year colleges and universities. In the past, three versions of Essentials were published:
The Essentials of Baccalaureate Education for Professional Nursing Practice, last published in
2008; The Essentials of Master’s Education in Nursing, last published in 2011; and The Essentials
of Doctoral Education for Advanced Nursing Practice, last published in 2006. Each of these
documents has provided specific guidance for the development and revision of nursing curricula
at a specific degree level. Given changes in higher education, learner expectations, and the
rapidly evolving healthcare system outlined in AACN’s Vision for Academic Nursing (2019), new
thinking and new approaches to nursing education are needed to prepare the nursing workforce
of the future.
The Essentials: Core Competencies for Professional Nursing Education provides a framework for
preparing individuals as members of the discipline of nursing, reflecting expectations across
the trajectory of nursing education and applied experience. In this document competencies
for professional nursing practice are made explicit. These Essentials introduce 10 domains that
represent the essence of professional nursing practice and the expected competencies for each
domain (see page 26). The domains and competencies exemplify the uniqueness of nursing
as a profession and reflect the diversity of practice settings yet share common language that
is understandable across healthcare professions and by employers, learners, faculty, and the
public. The competencies accompanying each domain are designed to be applicable across four
spheres of care (disease prevention/promotion of health and wellbeing, chronic disease care,
regenerative or restorative care, and hospice/palliative/supportive care), across the lifespan,
and with diverse patient populations. While the domains and competencies are identical for
both entry and advanced levels of education, the sub-competencies build from entry into
professional nursing practice to advanced levels of knowledge and practice. The intent is that
any curricular model should lead to the ability of the learner to achieve the competencies. The
Essentials also feature eight concepts that are central to professional nursing practice and are
integrated within and across the domains and competencies.
Because this document has been shared with practice partners and with other nursing
colleagues, the Essentials serve to bridge the gap between education and practice. The core
competencies are informed by the expanse of higher education, nursing education, nursing
as a discipline, and a breadth of knowledge. The core competencies also are informed by the
lived experiences of those deeply entrenched in various areas where nurses practice and the
synthesis of knowledge and action intersect. The collective understanding allows all nurses
to have a shared vision; promotes open discourse and exchange about nursing practice; and
expresses a unified voice that represents the nursing profession.
This introduction provides an overview of the evolution of nursing as a discipline, critical
aspects of the profession that serve as a framework, and sufficient depth to inform nursing
education across the educational trajectory (entry into practice through advanced education).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 1

Specific citations throughout provide immediate access to pertinent references that
substantiate relevancy.

Foundational Elements
The Essentials: Core Competencies for Professional Nursing Education has been built on the
strong foundation of nursing as a discipline, the foundation of a liberal education, and principles
of competency-based education.

Nursing as a Discipline
The Essentials, as the framework for preparing nursing’s future workforce, intentionally reflect
and integrate nursing as a discipline. The emergence of nursing as a discipline had its earliest
roots in Florence Nightingale’s thoughts about the nature of nursing. Believing nursing to be
both a science and an art, she conceptualized the whole patient (mind, body, and spirit) as
the center of nursing’s focus. The influence of the environment on an individual’s health and
recovery was of utmost importance. The concepts of health, healing, well-being, and the
interconnectedness with the multidimensional environment also were noted in her work.
Although Nightingale did not use the word “caring” explicitly, the concept of care and a
commitment to others were evident through her actions (Dunphy, 2015). In the same era of
Florence Nightingale, nurse pioneer Mary Seacole was devoted to healing the wounded during
the Crimean war.
Following Nightingale, the nursing profession underwent a period of disorganization and
confusion as it began to define itself as a distinct scientific discipline. Early nursing leaders
(including Mary Eliza Mahoney, Effie Taylor, Annie Goodrich, Agatha Hodgins, Esther
Lucille Brown, and Loretta Ford) sought to define the functions of the nurse (Gunn, 1991;
Keeling, Hehman, & Kirchgessner, 2017). Other leaders devoted their efforts to addressing
discrimination, advancing policies, and creating a collective voice for the profession. It would
be difficult to gain an understanding of this period of the profession’s development without
considering the work of Lavinia Dock, Estelle Osborne, Mary Elizabeth Carnegie, Ildaura Murillo-
Rohde, and many other fearless champions.
Contemporary nursing as it is practiced today began to take shape as a discipline in the
1970s and 1980s. Leaders of this era shared the belief that the discipline of nursing was the
study of the well-being patterning of human behavior and the constant interaction with
the environment, including relationships with others, health, and the nurse (Rogers, 1970;
Donaldson & Crowley, 1978; Fawcett, 1984; Chinn & Kramer 1983, 2018; Chinn, 2019; Roy &
Jones, 2007). The concept of caring also was described as the defining attribute of the nursing
discipline (Leininger, 1978; Watson, 1985). Newman (1991) spoke to the need to sharpen the
focus of the discipline of nursing to better define its social relevance and the nature of its
service. Newman, Smith, Pharris, and Jones (2008) affirmed caring as the focus of the discipline,
suggesting that relationships were the unifying construct. Smith and Parker (2010) later posited
that relationships were built on partnership, presence, and shared meaning.
In a historical analysis of literature on the discipline of nursing, five concepts emerged as
defining the discipline: human wholeness; health; healing and well-being; environment-health
relationship; and caring. When practicing from a holistic perspective, nurses understand the

2 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

dynamic, ongoing body-brain-mind-spirit interactions of the person, between and among
individuals, groups, communities, and the environment (Smith, 2019, pp. 9-12). Smith purports
that if nursing is to retain its status as a discipline, the explicit disciplinary knowledge must be an
integral part of all levels of nursing. Nursing has its own science, and this body of knowledge is
foundational for the next generation (Smith, 2019, p.13).
Why consider the past in a document that strives to shape the future? The historical roots of
the profession help its members understand how the past has answered complex questions
and shapes vital discipline concepts, traditions, policies, and even relationships. D’Antonio, et.
al (2010) also emphasize the disciplinary insights gained by considering the different histories
that challenge the dominant and accepted historical narrative. Undoubtedly, many experts have
contributed to the development of the discipline as it exists today. While the work of early and
current theorists is extensive, Green (2018) notes that none have been accepted as completely
defining the nature of nursing as a discipline. No doubt, nursing as a discipline will continue to
evolve as society and health care evolves.

Advancing the Discipline of Nursing

The continued development of nursing as a unique discipline requires an intentional approach.
Jairath et. al (2018) stated that any further development of the discipline should have the
capacity to directly transform the patient’s health experience. A new social order may be
necessary in which scientists, theorists, and practitioners work together to address questions
related to the interplay of big data and nursing theory. Nursing graduates, particularly at
the advanced nursing practice level, must be well-prepared to think ethically, conceptually,
and theoretically to better inform nursing care. Students must not only be introduced to the
knowledge and values of the discipline, but they must be guided to practice from a disciplinary
perspective – by seeing patients through the lens of wholeness and interconnectedness with
family and community; appreciating how the social, political, and economic environment
influences health; attending to what is most important to well-being; developing a caring-
healing relationship; and honoring personal dignity, choice, and meaning. Smith and McCarthy
(2010) spoke to the need to provide a foundation for practitioners in the knowledge of the
discipline. Without this knowledge, the persistent challenge of differentiating nursing and the
professional levels of practice will continue.
Knowledge of the discipline grows in graduate education, as students apply and generate
nursing knowledge in their advanced nursing roles or develop and test theories as researchers.
Nursing practice should be guided by a nursing perspective while functioning within an
interdisciplinary arena. To appropriately educate the next generation of nurses, disciplinary
knowledge must be leveled to reflect the competencies or roles expected at each level.

The Value of a Liberal Education

In higher education, every academic discipline is grounded in a unique body of knowledge that
distinguishes that discipline. Through the study of the humanities, social sciences, and natural
sciences, students develop the capacity to engage in socially valued work and civic leadership in
society. Liberal education exposes students to a broad worldview, multiple disciplines, and ways
of knowing through specific coursework; however, the richness of perspective and knowledge
is woven throughout the nursing curriculum as these are integral to the full scope of nursing

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 3

practice (Hermann, 2004). Successful integration of liberal and nursing education provides
graduates with knowledge of human cultures, including spiritual beliefs, as well as the physical
and natural worlds supporting an approach to practice. The study of history, critical race
theories, critical theories of nursing, critical digital studies, planetary health and climate science,
politics, public policies, policy formation, fine arts, literature, languages, and the behavioral,
biological, and natural sciences are key to the understanding of one’s self and others, civil
readiness, and engagement and forms the basis for clinical reasoning and subsequent
clinical judgments.
A liberal education creates the foundation for intellectual and practical abilities within the
context of nursing practice as well as for engagement with the larger community, locally
and globally. A hallmark of liberal education is the development of a personal value system
that includes the ability to act ethically regardless of the situation and where students are
encouraged to define meaningful personal and professional goals with a commitment to
integrity, equity, and social justice. Liberally educated graduates are well prepared to integrate
knowledge, skills, and values from the arts, sciences, and humanities to provide safe, quality
care; advocate for patients, families, communities, and populations; and promote health equity
and social justice. Equally important, nursing education needs to ensure an understanding of
the intersection of bias, structural racism, and social determinants with healthcare inequities
and promote a call to action.

Competency-Based Education
Competency-based education is a process whereby students are held accountable to the
mastery of competencies deemed critical for an area of study. Competency-based education
is inherently anchored to the outputs of an educational experience versus the inputs of the
educational environment and system. Students are the center of the learning experience,
and performance expectations are clearly delineated along all pathways of education and
practice. Across the health professions, curriculum, course work, and practice experiences
are designed to promote responsible learning and assure the development of competencies
that are reliably demonstrated and transferable across settings. By consistently assessing
their own performance, students develop the ability to reflect on their own progress towards
the achievement of learning goals and the ongoing attainment of competencies required
for practice.
Advances in learning approaches and technologies, understanding of evolving student learning
styles and preferences, and the move to outcome-driven education and assessment all point
to a transition to competency-based education. This learning approach is linked to explicitly
defined performance expectations, based on observable behavior, and requires frequent
assessment using diverse methodologies and formats. Designed in this fashion, competency-
based education produces learning and behavior that endures, since it encourages conscious
connections between knowledge and action. Learners who put knowledge into action grasp
the interrelatedness of their learning with both theoretical perspectives and the world of their
professional work. Achieving a specific competency gives meaning to the theoretical and assists
in understanding and taking on a professional identity.
Further, today’s students increasingly are taking responsibility for their own learning and, varied
as they are in age and experience, respond to active learning strategies. Active learning involves

4 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

making an action out of knowledge—using knowledge to reflect, analyze, judge, resolve,
discover, interact, and create. Active learning requires clear information regarding what is to
be learned, including guided practice in using that information to achieve a competency. It
also requires regular assessment of progress towards mastery of the competency and frequent
feedback on successes and areas needing development. Additionally, students must learn
how to assess their own performances to develop the skill of continual self-reflection in their
own practice.
Stakeholders (employers, students, and the public) expect all nursing graduates to exit their
education programs with defined and observable skills and knowledge. Employers desire
assurance that graduates have expected competencies—the ability “to know” and also “to do”
based on current knowledge. Moving to a competency-based model fosters intentionality of
learning by defining domains, associated competencies, and performance indicators for those
competencies. Currently, there is wide variability in graduate capabilities. Therefore, there is a
need for consistency enabled by a competency-based approach to nursing education.
A standard set of definitions frame competency-based education in the health professions and
was adopted for these Essentials. Adoption of common definitions allows multiple stakeholders
involved in health education and practice to share much of the same language. These
definitions are included in the glossary (p. 59).

Nursing Education for the 21st Century

In addition to the foundational elements on which the Essentials has been developed, other
factors have served as design influencers. What does the nursing workforce need to look like
for the future and how do nursing education programs prepare graduates to be “work ready”?
Nursing education for the 21st century ought to reflect a number of contemporary trends and
values and address several issues to shape the future workforce, including diversity, equity, and
inclusion; four spheres of care (including an enhanced focus on primary care); systems-based
practice; informatics and technology; academic-practice partnerships; and career-long learning.

Diversity, Equity, and Inclusion

Shifting U.S. population demographics, health workforce shortages, and persistent health
inequities necessitate the preparation of nurses able to address systemic racism and pervasive
inequities in health care. The existing inequitable distribution of the nursing workforce
across the United States, particularly in underserved urban and rural areas, impacts access
to healthcare services across the continuum from health promotion and disease prevention,
to chronic disease management, to restorative and supportive care. Diversity, equity, and
inclusion—as a value— supports nursing workforce development to prepare graduates who
contribute to the improvement of access and care quality for underrepresented and medically
underserved populations (AACN, 2019). Diversity, equity, and inclusion require intentionality,
an institutional structure of social justice, and individually concerted efforts. The integration
of diversity, equity, and inclusion in this Essentials document moves away from an isolated
focus on these critical concepts. Instead, these concepts, defined in competencies, are
fully represented and deeply integrated throughout the domains and expected in learning
experiences across curricula.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 5

Making nursing education equitable and inclusive requires actively combating structural
racism, discrimination, systemic inequity, exclusion, and bias. Holistic admission reviews are
recommended to enhance the admission of a more diverse student population to the profession
(AACN, 2020). Additionally, an equitable and inclusive learning environment will support the
recruitment, retention, and graduation of nursing students from disadvantaged and diverse
backgrounds. Diverse and inclusive environments allow examination of any implicit or explicit
biases, which can undermine efforts to enhance diversity, equity, and inclusion. When diversity
is integrated within inclusive educational environments with equitable systems in place, biases
are examined, assumptions are challenged, critical conversations are engaged, perspectives
are broadened, civil readiness and engagement are enhanced, and socialization occurs. These
environments recognize the value of and need for diversity, equity, and inclusion to achieve
excellence in teaching, learning, research, scholarship, service, and practice.
Academic nursing must address structural racism, systemic inequity, and discrimination in
how nurses are prepared. Nurse educators are called to critically evaluate policies, processes,
curricula, and structures for homogeneity, classism, color-blindness, and non-inclusive
environments. Evidence-based, institution-wide approaches focused on equity in student
learning and catalyzing culture shifts in the academy are fundamental to eliminating structural
racism in higher education (Barber et al., 2020). Only through deconstructive processes
can academic nursing prepare graduates who provide high quality, equitable, and culturally
competent health care.
Finally, nurses should learn to engage in ongoing personal development towards understanding
their own conscious and unconscious biases. Then, acting as stewards of the profession, they
can fulfill their responsibility to influence both nursing and societal attitudes and behaviors
toward eradicating structural/systemic racism and discrimination and promoting social justice.

Four Spheres of Care

Historically, nursing education has emphasized clinical education in acute care. Looking at
current and future needs, it is becoming increasingly evident that the future of healthcare
delivery will occur within four spheres of care: 1) disease prevention/promotion of health and
well-being, which includes the promotion of physical and mental health in all patients as well
as management of minor acute and intermittent care needs of generally healthy patients;
2) chronic disease care, which includes management of chronic diseases and prevention of
negative sequelae; 3) regenerative or restorative care, which includes critical/trauma care,
complex acute care, acute exacerbations of chronic conditions, and treatment of physiologically
unstable patients that generally requires care in a mega-acute care institution; and 4) hospice/
palliative/supportive care, which includes end-of-life care as well as palliative and supportive
care for individuals requiring extended care, those with complex, chronic disease states, or
those requiring rehabilitative care (Lipstein et al., 2016; AACN, 2019).
Entry-level professional nursing education ensures that graduates demonstrate competencies
through practice experiences with individuals, families, communities, and populations across
the lifespan and within each of these four spheres of care. The workforce of the future needs
to attract and retain registered nurses who choose to practice in diverse settings, including
community settings to sustain the nation’s health. Expanding primary care into communities
will enable our healthcare delivery systems to achieve the Quadruple Aim of improving patient

6 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

experiences (quality and satisfaction), improving the health of populations, decreasing per
capita costs of health care, and improving care team well-being (Bowles et al., 2018). It is time
for nursing education to refocus and move beyond some long-held beliefs such as: primary care
content is not important because it is not on the national licensing exam for registered nurses;
students only value those skills required in acute care settings; and faculty preceptors only have
limited community-based experiences. Recommendations from the Josiah Macy Foundation
Conference (2016) on expanding the use of registered nursing in primary care provides a call
to education and practice to place more value on primary care as a career choice, effectively
changing the culture of nursing and health care. A collaborative effort between academic and
practice leaders is needed to ensure this culture change and educate primary care practitioners
about the value of the registered nurse role.

Systems-Based Practice
Integrated healthcare systems that require coordination across settings as well as across the
lifespan of diverse individuals and populations are emerging. Healthcare systems are revising
strategic goals and reorganizing services to move more care from the most expensive venues
– inpatient facilities and emergency departments – to primary care and community settings.
Consequently, nurse employment settings also are shifting, creating a change in workforce
distribution and the requisite knowledge and skills necessary to provide care in those settings.
Knowledge differentiating equity and equality in healthcare systems and systems-based practice
is essential. Nurses in the future are needed to lead initiatives to address structural racism,
systemic inequity, and discrimination. Equitable healthcare better serves the needs of all
individuals, populations, and communities.
Importantly, an understanding of how local, national, and global structures, systems, politics,
and rules and regulations contribute to the health outcomes of individual patients, populations,
and communities will support students in developing agility and advocacy skills. Factors such as
structural racism, cost containment, resource allocation, and interdisciplinary collaboration are
considered and implemented to ensure the delivery of high quality, equitable, and safe patient
care (Plack et al., 2018).

Informatics and Technology

Informatics increasingly has been a focus in nursing education, correlating with the
advancement in sophistication and reach of information technologies, the use of technology to
support healthcare processes and clinical thinking, and the ability of informatics and technology
to positively impact patient outcomes. Health information technology is required for person-
centered service across the continuum and requires consistency in user input, proper process,
and quality management. While different specialty roles in nursing may require varying depth
and breadth of informatics competency, basic informatics competencies are foundational to all
nursing practice. Much work will be required to achieve full integration of core information and
communication technologies competencies into nursing curricula.

Engagement and Experience

The future consumers of health care are changing. They are transitioning from passive
participants in medically focused acute care environments to engaged participants of healthcare
services. They actively participate in managing not only their chronic illnesses but also acute

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 7

care exacerbations with an increasing focus on prevention and wellness. Thus, nurses need
an understanding of consumer engagement and experience across all settings as an essential
component of person-centered, quality care.
In today’s society, many people seek information and use technology to help make informed
decisions about their health. Nurses seek to help patients determine what information to use
and how to use it. Individuals want to know about their options when it comes to healthcare
services, which extends to using websites to provide information on provider quality and
performance, comparing prices for common procedures, and reviewing the effectiveness of
treatments and care approaches (Adler-Milstein & Sinaiko, 2019). Gaffney (2015) stated that
as consumers shoulder more of the financial responsibility for their health care, they became
more educated about available options. Studies have shown that patients who are engaged in
decision-making regarding their care have better outcomes and lower costs (Gaffney, 2015).
Meaningful practice experiences in health care start with the individual who is actively engaged
in the journey throughout the continuum of care. Each interaction between the recipient of
care and the nurse or healthcare provider creates an experience. Practice experience is defined
as “the sum of all interactions, shaped by an organization’s culture that influence patient
perceptions across the continuum of care.” (Wolf, Niederhauser, Marshburn, & LaVela, 2014,
p. 8). Within that interactive experience, the attitudes and the behaviors of the nurse matter a
great deal. Nurses are identified as one of the most trusted professionals in the United States.
Mutual trust is foundational to an interactive and ongoing relationship that will enhance a
positive experience of care. Those with positive experiences of care often have better outcomes.
Individual engagement has been described as “the blockbuster drug of the 21st century”
(Dentzer, 2013). Who better to engage individuals in their care than nurses? Nursing practice
has focused consistently on individual care and ongoing communication with family members
and care providers. Sherman points to the fact that effective individual/family involvement
leads to safer and higher quality care. In addition, individual/patient engagement can be directly
correlated with increased reimbursement to hospitals based on achieving health outcomes.
Nurses in all settings and across the continuum of care contribute to creating a culture that
supports full engagement of individuals in their care and in the development of policies, which
will provide guidance to the improvement of individual engagement (Sherman, 2014).

Academic-Practice Partnerships
Partnerships and collaborative team-based care are the cornerstones of safe, effective care
whether it be for individuals, families, communities, or populations. Academic-practice
partnerships serve to recruit and retain nurses and to support the practice and academic
enterprise in relation to mutual research, leadership development, and a shared commitment
to redesign practice environments. Such partnerships also have the potential to facilitate the
ability of nurses to achieve educational and career advancement, prepare nurses of the future
to practice and lead, provide mechanisms for career-long learning, and provide a structure for
transition to practice programs. Successful academic-practice partnerships are predicated on
respect, relationship, reciprocity, and co-design.
The 2016 report Advancing Healthcare Transformation: A New Era for Academic Nursing
identified a path for achieving enhanced partnerships between nursing schools and academic

8 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

health centers with the goals of achieving improved healthcare outcomes, fostering new models
for innovation, and advancing integrated systems of health care. While focused primarily on
academic health centers, the recommendations apply to partnerships between non-academic
health centers and schools of nursing as well. The recommendations include enhancing the
clinical practice of academic nursing; partnering in the preparation of the nurses of the future;
collaborating to develop workforce plans in partnership with the health system; integrating
academic nursing into population health initiatives; partnering in the implementation
of Accountable Care; and partnering for optimal patient care and healthcare delivery
(AACN, 2016).

Career-Long Learning
Current trends in higher education focus on supplemental methods of awarding credit and
recognition for additional learning which has implications for career-long learning. Emerging
educational methods should be considered as possible additions in the development of
curriculum pathways in contemporary nursing education. For example, the use of e-portfolios,
which may be used to record competency achievement and educational milestones and
continued throughout one’s career, can be used to document personal development plans,
badges, certifications, employment appraisals, and reflections on clinical events to establish
meaning from various encounters.
Awarding of micro-credentials or badges by academic institutions also is becoming popular.
Badges recognize incremental learning in visible ways and can support career development
(Educause, 2018). Stackable credentials can be accumulated over time and facilitate one’s
professional development along a career trajectory (Department of Labor, 2015). Open access
courses represent another way to learn a variety of skills or subject matter. All of these are
important considerations in basic and advanced nursing education.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 9

 Domains and Concepts
Domains for Nursing
Domains are broad distinguishable areas of competence that, when considered in the aggregate,
constitute a descriptive framework for the practice of nursing. These Essentials include 10 domains that
were adapted from the interprofessional work initiated by Englander (2013) and tailored to reflect
the discipline of nursing.

This document delineates the domains that are essential to nursing practice, including how these are
defined, what competencies should be expected for each domain at each level of nursing, and how those
domains and competencies both distinguish nursing and relate toother health professions. Each
domain has a descriptor (or working definition) and a contextual statement. The contextual statement
(presented in the Domain, Competency, Sub-Competency Table found beginning on page 26) provides a
framing for what the domain represents in the
context of nursing practice – thus providing an explanation for how the competencies within the domain
should be interpreted. The domain designations, descriptors, and contextual statements may evolve over
time to reflect future changes in healthcare and nursing practice. Although the domains are presented as
discrete entities, the expert practice of nursing requires integration
of most of the domains in every practice situation or patient encounter, thus they provide arobust
framework for competency-based education. The domains and descriptors used in the Essentials are
listed below.

• Domain 1: Knowledge for Nursing Practice

Descriptor: Integration, translation, and application of established and evolving disciplinary
nursing knowledge and ways of knowing, as well as knowledge from otherdisciplines,
including a foundation in liberal arts and natural and social sciences. This distinguishes the
practice of professional nursing and forms the basis for clinical judgment and innovation in
nursing practice.
• Domain 2: Person-Centered Care
Descriptor: Person-centered care focuses on the individual within multiple complicated
contexts, including family and/or important others. Person-centered care is holistic,
individualized, just, respectful, compassionate, coordinated, evidence-based, and
developmentally appropriate. Person-centered care builds on a scientific body of knowledge that
guides nursing practice regardless of specialty or functional area.
• Domain 3: Population Health
Descriptor: Population health spans the healthcare delivery continuum from public health
prevention to disease management of populations and describes collaborative activities with
both traditional and non-traditional partnerships from affected communities, public health,
industry, academia, health care, local government entities,and others for the improvement of
equitable population health outcomes.
• Domain 4: Scholarship for Nursing Discipline
Descriptor: The generation, synthesis, translation, application, and dissemination ofnursing
knowledge to improve health and transform health care.

10 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 • Domain 5: Quality and Safety
Descriptor: Employment of established and emerging principles of safety and
improvement science. Quality and safety, as core values of nursing practice, enhance
quality and minimize risk of harm to patients and providers through both system
effectiveness and individual performance.
• Domain 6: Interprofessional Partnerships
Descriptor: Intentional collaboration across professions and with care team members,
patients, families, communities, and other stakeholders to optimize care, enhance the
healthcare experience, and strengthen outcomes.
• Domain 7: Systems-Based Practice
Descriptor: Responding to and leading within complex systems of health care. Nurses
effectively and proactively coordinate resources to provide safe, quality, equitable
care to diverse populations.

• Domain 8: Informatics and Healthcare Technologies

Descriptor: Information and communication technologies and informatics processes
are used to provide care, gather data, form information to drive decision making, and
support professionals as they expand knowledge and wisdom for practice. Informatics
processes and technologies are used to manage and improve the delivery of safe,
high-quality, and efficient healthcare services in accordance with best practice and
professional and regulatory standards.
• Domain 9: Professionalism
Descriptor: Formation and cultivation of a sustainable professional nursing identity,
accountability, perspective, collaborative disposition, and comportment that reflects
nursing’s characteristics and values.
• Domain 10: Personal, Professional, and Leadership Development
Descriptor: Participation in activities and self-reflection that foster personal health,
resilience, and well-being, lifelong learning, and support the acquisition of nursing
expertise and assertion of leadership.

Concepts for Nursing Practice

In addition to domains, there are featured concepts associated with professional nursing
practice that are integrated within the Essentials. A concept is an organizing idea or a mental
abstraction that represents important areas of knowledge. A common understanding of each
concept is achieved through characteristics and attributes. Many disciplines, like nursing, have
numerous concepts. The featured concepts are well-represented in the nursing literature
and thus also are found throughout the Essentials and verified through a crosswalk analysis.
Specifically, the featured concepts are found in the introduction, across the domains (within
domain descriptors and contextual statements), and within the competencies and sub-
competencies. Although not every concept is found within every domain, each concept is
represented in most domains – and all domains have multiple concepts represented.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 11

The featured concepts found within the Essentials are not of ‘lesser importance’ than a domain.
Each of these concepts serves as a core component of knowledge, facts, and skills across
multiple situations and contexts within nursing practice. Each concept functions as a hub for
transferable knowledge, thus enhancing learning when learners make cognitive links to other
information through mental constructs. The integration of concepts within the competencies
and sub-competencies is essential for the application throughout the educational experience. As
an example, can you imagine delivering person-centered care without also considering diversity,
equity, and inclusion? Can you imagine having a conversation about population health without
considering ethics and health policy? These concepts truly are interrelated and interwoven
within the domains and competencies, serving as a foundation to students’ learning. The
featured concepts are:
• Clinical Judgment
As one of the key attributes of professional nursing, clinical judgment refers to the
process by which nurses make decisions based on nursing knowledge (evidence,
theories, ways/patterns of knowing), other disciplinary knowledge, critical thinking,
and clinical reasoning (Manetti, 2019). This process is used to understand and interpret
information in the delivery of care. Clinical decision making based on clinical judgment,
is directly related to care outcomes.
• Communication
Communication, informed by nursing and other theories, is a central component in all
areas of nursing practice. Communication is defined as an exchange of information,
thoughts, and feelings through a variety of mechanisms. The definition encompasses
the various ways people interact with each other, including verbal, written, behavioral,
body language, touch, and emotion. Communication also includes intentionality,
mutuality, partnerships, trust, and presence. Effective communication between nurses
and individuals and between nurses and other health professionals is necessary for
the delivery of high quality, individualized nursing care. With increasing frequency
communication is delivered through technological modalities. Communication also is a
core component of team-based, interprofessional care and closely interrelated with the
concept Social Determinants of Health (described below).
• Compassionate Care
As an essential principle of person-centered care, compassionate care refers to the
way nurses relate to others as human beings and involves “noticing another person’s
vulnerability, experiencing an emotional reaction to this, and acting in some way with
them in a way that is meaningful for people” (Murray & Tuqiri, 2020). Compassionate
care is interrelated with other concepts such as caring, empathy, and respect and is
also closely associated with patient satisfaction.
• Diversity, Equity, and Inclusion
Collectively, diversity, equity, and inclusion (DEI) refers to a broad range of individual,
population, and social constructs and is adapted in the Essentials as one of the most
visible concepts. Although these are collectively considered a concept, differentiation
of each conceptual element leads to enhanced understanding.

12 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 Diversity references a broad range of individual, population, and social characteristics,
including but not limited to age; sex; race; ethnicity; sexual orientation; gender identity;
family structures; geographic locations; national origin; immigrants and refugees;
language; any impairment that substantially limits a major life activity; religious beliefs;
and socioeconomic status. Inclusion represents environmental and organizational
cultures in which faculty, students, staff, and administrators with diverse characteristics
thrive. Inclusive environments require intentionality and embrace differences, not
merely tolerate them (AACN, 2017; Bloomberg, 2019). Everyone works to ensure the
perspectives and experiences of others are invited, welcomed, acknowledged, and
respected in inclusive environments. Equity is the ability to recognize the differences in
the resources or knowledge needed to allow individuals to fully participate in society,
including access to higher education, with the goal of overcoming obstacles to ensure
fairness (Kranich, 2001). To have equitable systems, all people should be treated fairly,
unhampered by artificial barriers, stereotypes, or prejudices (Cooper, 2016). Two
related concepts that fit within DEI include structural racism and social justice. (See the
glossary for definitions of structural racism and social justice.)
• Ethics
Core to professional nursing practice, ethics refers to principles that guide a
person’s behavior. Ethics is closely tied to moral philosophy involving the study of or
examination of morality through a variety of different approaches (Tubbs, 2009). There
are commonly accepted principles in bioethics that include autonomy, beneficence,
non-maleficence, and justice (ANA 2015; ACNM, 2015; AANA, 2018; ICN, 2012). The
study of ethics as it relates to nursing practice has led to the exploration of other
relevant concepts, including moral distress, moral hazard, moral community, and moral
or critical resilience.
• Evidence-Based Practice
The delivery of optimal health care requires the integration of current evidence and
clinical expertise with individual and family preferences. Evidence-based practice is a
problem-solving approach to the delivery of health care that integrates best evidence
from studies and patient care data with clinician expertise and patient preferences
and values (Melnyk, Fineout-Overhold, Stillwell, & Williamson, 2010). In addition
there is a need to consider those scientific studies that ask: whose perspectives are
solicited, who creates the evidence, how is that evidence created, what questions
remain unanswered, and what harm may be created? Answers to these questions
are paramount to incorporating meaningful, culturally safe, evidence-based practice
(Nursing Mutual Aid, 2020).
• Health Policy
Health policy involves goal directed decision-making about health that is the result
of an authorized public decision-making process (Keller & Ridenour, 2021). Nurses
play critical roles in advocating for policy that impacts patients and the profession,
especially when speaking with a united voice on issues that affect nursing practice and
health outcomes. Nurses can have a profound influence on health policy by becoming
engaged in the policy process on many levels, which includes interpreting, evaluating,
and leading policy change.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 13

 • Social Determinants of Health
Determinants of health, a broader term, include personal, social, economic, and
environmental factors that impact health. Social determinants of health, a primary
component of determinants of health “are the conditions in the environment where
people are born, live, learn, work, play, worship, and age that affect a wide range of
health, functioning, and quality of life outcomes and risks.”

The social determinants of health contribute to wide health disparities and inequities
in areas such as economic stability, education quality and access, healthcare quality
and access, neighborhood and built environment, and social and community context
(Healthy People, 2030). Nursing practices such as assessment, health promotion, access
to care, and patient teaching support improvements in health outcomes. The social
determinants of health are closely interrelated with the concepts of diversity, equity,
and inclusion, health policy, and communication.

14 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 Competencies and Sub-Competencies
The competencies identified in this Essentials document provide a bridge between the current
and future needs of practice and the requisite education to prepare a competent practitioner.
Competence develops over time, is progressive, and reflects the impact of internal and
external factors and experiences of the student. Internal factors include education, experience,
knowledge, and professional orientation, among others. External forces include the complexity
of the learning experience and professional autonomy. While knowledge is essential to the
development of competence, it does not in and of itself validate competence (Currier, 2019).
Rather, learners progress to successive levels of competence by demonstrating achievement of
expectations across the span of their education and practice experience. Students are successful
when they meet and sustain measurable competence at each level of performance expectation
and are able to transfer their competence across different practice experiences and settings
(Josiah Macy Foundation, 2017).

All competencies, organized within the 10 domains, are broad in scope and cross all levels
and areas of nursing practice. The competency is intentionally written as a short statement;
therefore, it is necessary to be familiar with the contextual statement within the parent
domain to fully understand the competency. In other words, the competency is interpreted
as a component within the domain. It also should be noted that there is intentional overlap
of competencies in several domains to account for differences in the competency or sub-
competency context in different domains.
Each competency statement has multiple sub-competencies written at two levels to reflect
learner expectations for entry-level and advanced nursing education. These sub-competencies
are designed to ‘paint a picture’ of how the competency is achieved at each level. The sub-
competencies are designed to be understandable, observable, and measurable by learner,
faculty, and future employers. Competencies mature over time and become more sophisticated
with ongoing practice.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 15

 A New Model for Nursing Education
These Essentials represents a new direction for nursing education, influenced by AACN’s Vision
for Academic Nursing (AACN, 2019), setting in place a new model for preparing professional
nurses, which includes a transition to competency-based education. This model provides the
structure across education programs and provides a mechanism to adapt to future changes
within nursing education.
Currently, multiple educational programs and degree pathways exist that prepare nurses for
similar roles. As an example, there are several types of programs and degrees that prepare
students to become a registered nurse, and there are multiple education programs and paths
to prepare a nurse practitioner (NP) and multiple types of NP certification. These multiple
program options confuse external stakeholders as well as those within our own discipline
regarding differences between an academic degree and a role – as if the academic degree
signifies a specific nursing role. The new model is an intentional departure from the previous
versions of the Essentials that were aligned to an academic degree. Thus, a primary intent of the
Essentials is to create more consistency in graduate outcomes, influenced by the robustness of
the learning experiences and demonstration of competencies. By emphasizing the attainment
of competencies within an academic program, employers will have a clear expectation of
knowledge and skill sets of nursing graduates.
Two levels of sub-competencies reflect the educational stages of nurses as they enter
professional practice and as they return to school to advance their education (see Figure 1). The
first level sub-competencies set the foundation for nurses entering professional practice. These
level one (entry-level) competencies are used within curricula for prelicensure preparation as
well as professional nursing degree completion pathways for nurses with initial preparation at
the associate degree or diploma level. Although learning experiences may vary across individual
programs, they provide an opportunity for learners to demonstrate attainment of competencies
in multiple and authentic contexts over time (not a ‘one and done’/checklist approach).
The second level sub-competencies build and expand the competence of the nurse seeking
advanced education in nursing and broadens the breadth of experiences in context and
complexity as compared to graduates of entry-level programs. Advanced nursing education
affords the student the opportunity to focus on an advanced nursing practice specialty
or advanced nursing practice role. Level 2 sub-competencies form the foundation for all
advanced education, and as conceptualized, apply to all advanced nursing practice specialties
and advanced nursing practice roles. Referencing Thorne’s use of “nursing’s angle of vision”
reinforces the importance of nurses using the unique knowledge and insight of the profession to
inform any practice role and to impact the challenges in health care. Competencies designated
for an advanced nursing practice specialty (informatics, administration/practice leadership,
public health/population health, health policy) or an advanced practice nursing role (certified
nurse practitioner, certified nurse-midwife, certified clinical nurse specialist, certified registered
nurse anesthetist) are integrated with and complement the Essentials competencies.

16 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 ESSENTIALS MODEL

LEVEL 1 LEVEL 2

AACN Essentials
AACN Essentials Advanced-Level Nursing
Entry-Level Education sub-competencies
Professional Nursing Education – and —
sub-competencies Specialty/role requirements/
competencies
Used by programs preparing a Used by programs preparing a
nurse for an initial professional nurse for an advanced nursing
nursing degree. practice specialty or advanced
nursing practice role.

Figure 1: Model for Nursing Education

These Essentials represent an opportunity for a future characterized by greater clarity as it

relates to expectations of graduates and a more disciplined approach to nursing education.
Competencies are used within the academic program as core expectations, thus setting a
common standard. Additional elements within a degree plan will allow schools to differentiate
degree paths using the same sub-competencies and to distinguish themselves in alignment with
various institutional missions. This model adapts to the current state of nursing education, and
perhaps more importantly, provides a path for an evolving trajectory for nursing education. Over
time, higher education, stakeholder demands, nursing regulatory standards, and economics are
among the many forces that will drive the direction and pace of change for nursing education
in the future. This model has been designed to adapt to such future changes, not only for the
degrees offered, but also for recognized areas of emphasis at the advanced education level by
coupling with specialty competencies and/or certification standards.
The Essentials do not apply directly to the preparation of nurse researchers in a PhD (or other
nursing research-focused) program. However, the second-level sub-competencies could be used
by PhD programs to guide core courses for doctoral nursing, particularly for programs offering
baccalaureate to PhD degrees. Additionally, for nursing programs offering both DNP and PhD
degrees and/or PhD to DNP or DNP to PhD options, the second-level core sub-competencies
could form the basis for shared core courses between the two doctoral degree programs –
representing efficiencies in program delivery as well as for more seamless pathways from one
degree to the other.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 17

 Implementing the Essentials: Considerations for Curriculum
The domains, competencies, and concepts presented in the Essentials provide the platform for
curriculum design and program assessment with an intent to produce consistency in outcomes
expected of graduates. Although these are major elements incorporated within a curriculum
for learning and assessment, they are not to be interpreted as representing the curriculum
in its entirety. In other words, it is not intended for courses within nursing curricula to mirror
the 10 domains and eight concepts. Instead, the elements used as the Essentials framework
(domains, concepts, and competencies) should be integrated throughout and across the
curriculum. A scaffolded approach ensures students interface with competencies in multiple
contexts and with increasing complexity. Nursing programs have a great deal of flexibility in
the development and design of curricula, thus preserving the ability of nursing programs to be
unique or innovative.
Outcomes when referred to as student learning outcomes describe the desired outcomes of
the graduate at the completion of the program. The student learning outcomes will reflect
attainment of all competencies in addition to any relevant specialty/role competencies and
other identified expectations. Course design within curricula reflect the expectations of student
learning with clear linkage from course objectives/competencies from within and across courses
to end of program student learning outcomes, written as course learning outcomes or course
competencies. For this reason, course outcomes should link to the Essentials competencies
and concepts. Intentional teaching strategies are designed and incorporated throughout the
curriculum in multiple contexts and with increasing complexity to provide students multiple
opportunities for learning and demonstrating competencies. For the foreseeable future,
minimum requirements for practicum experiences are deemed important to provide consistent
and quality preparation at both the entry- and advanced-levels for professional nursing practice.
Competencies are assessed as the learner progresses throughout the program; therefore, a
robust program assessment plan is needed to measure students’ achievement of competencies
by the end of the program. Some programs may wish to create ‘progression indicators’ at
specified points within a program of study to track learners’ achievement of competencies.
To demonstrate the integration of competencies across multiple domains with increasing
complexity, performance assessments should be integrated in the curriculum throughout the
program of study. As such, assessments are performance based and serve as both a learning
experience and an evaluation tool. Performance assessment is a multidimensional process,
integral to learning, that involves observation and judgment of each student’s performance
on the basis of explicit criteria, with feedback to the student for improving learning
and competency.
In the previous section, the Essentials Model featuring two levels of professional nursing
education (entry and advanced) was introduced. While the domains, competencies, and
concepts are identical for both entry and advanced levels of education, sub-competencies are
used to differentiate expectations for entry (Level 1) and advanced (Level 2) professional nursing
education (see Figure 1). These two levels of sub-competencies reflect the educational stages
of nurses– as they enter professional nursing practice and as they advance their education
– regardless of the program of study they are completing to advance their education. The
following sections detail the expectations for curricula at each of these two levels.

18 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Entry-Level Professional Nursing Education
Programs preparing nurses to enter professional nursing practice (either through prelicensure
preparation or through a degree completion pathway for nurses with initial preparation with an
associate or diploma degree) use Level 1 sub-competencies within the curriculum. Entry-level
professional nursing programs prepare graduates as a generalist for practice across the lifespan
and with diverse populations and in four spheres of practice.

Entry-Level Professional Nursing Degree Options

Pre-licensure Programs
Entry-Level Professional Nursing Education sub-competencies (Level 1) are applied across
any curriculum preparing for entry to professional nursing practice. Content learned within
prerequisite courses is incorporated into the learning and assessment of the sub-competencies
as applicable, and attainment of sub-competencies are applied within prerequisite courses. This
does not mean that every sub-competency and concept is applied in every course, but it does
mean that sub-competencies are not addressed in one course and then disregarded for the
remainder of the program. Outcome measures include evidence of attainment of Level 1 sub-
competencies, pass rates on the NCLEX-RN® (for traditional and accelerated tracks), and other
institutional requirements.

Post-Licensure Degree Programs

Level 1 core sub-competencies also are used in post-licensure or degree completion, first
professional programs. Because learners in these programs are already licensed registered
nurses, the Level 1 sub-competencies build on knowledge and skills acquired in their initial
nursing education program. Verification of prior competency achievement in some domains
may result in a shorter timeframe needed to prepare learners in these programs.
All learners in entry-level professional nursing education programs (pre-licensure and post-
licensure [degree-completion] programs) will engage in direct patient care learning activities in
all four spheres of care and across the lifespan.

Spheres of Care and Entry-Level Professional Nursing Education

All entry-level professional nurses need knowledge and proficiencies to practice across a
variety of settings. Accordingly, curricula for entry-level professional nursing education prepare
the learner for generalist practice across the
lifespan and with diverse populations, focusing
Wellness, Disease Chronic Disease
on four spheres of care: promotion of health Prevention Management
and well-being/disease prevention; chronic
disease care; regenerative or restorative care; 4 Spheres of
and hospice/palliative/supportive care (AACN, Care
2019; Lipstein et al., 2016; Figure 2). Didactic,
simulated, laboratory, and clinical learning Regenerative / Hospice /
experiences prepare nurses to practice in these Restorative Care Palliative Care
diverse settings. Level 1 sub-competencies apply
across the spheres of care, requiring learners to Figure 2: Four Spheres of Care

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 19

demonstrate competencies in multiple contexts and settings. Demonstration of the Level 1 sub-
competencies by the end of the program will enable the new professional nurse to practice as a
generalist in any setting with diverse populations and with all ages.
Although all students will have learning experiences across all four spheres of care, entry-level
professional programs could create opportunities for students to gain additional education
(through immersion experiences, electives, badges, or certificates) in any of the four spheres.
Such a path would allow a graduate to have a defined area of emphasis (if desired) upon
graduation, and/or to attain a documented area of emphasis in a post-entry level program
certificate option.

Clinical Expectations
Entry-level professional nursing education programs provide rich and varied opportunities for
practice experiences (both direct and indirect care experiences) across the four spheres of
care, designed to assist the graduate to achieve Level 1 sub-competencies upon completion
of the program. Theoretical learning becomes a reality as students are coached to make
cognitive connections between the cases or situations presented in the classroom, simulation,
or laboratory and in actual practice settings. Clinical experiences also assist the graduate to
develop proficiency in cognitive, psychomotor, and affective learning. Clinical experiences are
essential for students to care for a variety of individuals, families, groups, and populations
across the lifespan and across the four spheres of care. Clinical learning provides opportunities
for a student to enhance the provision of care and gain the skills needed to be an effective
member of an interprofessional team; thus, interprofessional experiences in a variety of
practice settings are essential.
Graduates of all types of entry-level professional nursing education programs need sufficient
practice experiences (both direct and indirect care experiences) to demonstrate end-of-
program learning outcomes inclusive of all Level 1 sub-competencies. All learners in entry-level
professional nursing education programs (pre-licensure and post-licensure [degree-completion]
programs) will engage in direct patient care learning activities in all four spheres of care and
across the life span and provide clear evidence of student (Level 1) competency achievement.

Clinical Sites
Nursing programs are responsible for ensuring clinical placements are safe, supportive, and
conducive for learning by individual students or groups of students. The program is responsible
for providing sufficient and appropriate clinical sites/placements for students to demonstrate
attainment of Level 1 sub-competencies. The program faculty assesses clinical sites to
determine that, on the aggregate, clinical experiences provide students learning opportunities
to foster interprofessional team practice and to provide care within the four spheres of care
and with care recipients from diverse backgrounds and cultures, from different genders and
age groups and with different religious and spiritual practices, including those who may be
considered most vulnerable. Programs are responsible for informing clinical educators or
preceptors about the specific learning that is expected and occurring in didactic and laboratory
settings and provide appropriate learning opportunities across settings to reinforce learning as
well as demonstrate achievement of competencies (Level 1 sub-competencies) across the 10
Essentials domains.

20 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Simulation
Simulation experiences represent an important component of clinical education, serving as a
valuable augmentation to direct and indirect care within healthcare settings. Laboratory and
simulation experiences provide an effective, safe environment for learning and demonstrating
competencies. However, care experiences with actual individuals or groups continue to be the
most important component of clinical education. A landmark study conducted by the National
Council of State Boards of Nursing concluded that for pre-licensure students “substituting high-
quality simulation experiences for up to half of traditional clinical hours produces comparable
end-of-program educational outcomes” (Hayden et al., 2014, p. S3). Simulation cannot
substitute for all direct care practice experiences in any one sphere or for any one age group.
Also, simulation learning experiences should align with best practice standards such as those
developed by the International Nursing Association for Clinical Simulation and Learning (INACSL)
or the Society for Simulation in Healthcare (SSH). The use of simulation in the curriculum as
a replacement of direct patient clinical/practice hours or experiences is also determined by
requirements of regulatory entities (i.e., licensing and accrediting bodies).

Practice Synthesis Experience/Immersion

Development of competency attainment is facilitated through use of focused and sustained
practice experiences. Immersion experiences provide the learner with the opportunity to
integrate the Level 1 sub-competencies. Entry-level professional nursing programs (pre-and
post-licensure) must develop immersion or synthesis experiences that allow students to
integrate learning and gain experience that facilitates transition into practice. Such experiences
provide opportunities to enact principles of the nursing discipline and for building clinical
reasoning, management of care, and assessment of clinical outcomes. These opportunities
increase the student’s self-confidence, professional identity, and sense of belonging within
the profession. Immersion experiences also allow students to integrate previous learning and
demonstrate competencies in more complex situations and contexts. Immersion experiences
may afford the student an opportunity to focus on a population of interest and clinical role. The
immersion experience may occur towards the end of the program as a culminating synthesis
experience; and/or there may be one or more immersion experiences at various points in a
curriculum. The key is to provide for a concentrated practice experience that approximates
professional practice expectations (Fowler et al., 2018; Tratnack et al., 2011).

Advanced-Level Nursing Education

Nursing programs preparing nurses to advance their education beyond entry-level professional
nursing practice will incorporate advanced-level nursing education (Level 2) sub-competencies.
Advanced-level nursing education programs (degree granting and advanced nursing practice
post-graduate certificate programs) intentionally build on Level 1 sub-competencies. Although
Level 2 sub-competencies have been written with doctoral education in mind, the actual
differentiator for the degree attained does not lie within the sub-competencies themselves, but
rather the degree/program requirements – such as the DNP project (described below), role/
specialty requirements, and other requirements set by the faculty and institution. While it is
not expected that every sub-competency and concept will be applied in every course, sub-
competencies are not to be isolated in one or two courses and then disregarded for the rest of
the program.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 21

Advanced-level nursing education programs prepare graduates for practice in an advanced
nursing practice specialty (informatics, administration/practice leadership, public health/
population health, health policy) or an advanced practice nursing role (certified nurse
practitioner, certified nurse-midwife, certified clinical nurse specialist, certified registered
nurse anesthetist). Advanced-level nursing education programs focus on providing specialty
knowledge for graduates to enact specific advanced practice nursing roles or assume advanced
nursing specialty practice within the healthcare system. For this reason, specialty competencies,
defined by nationally recognized, specialty organizations, represent a major component of
advanced-level nursing education programs. Specialty competencies complement and build
upon the Level 2 sub-competencies. All graduates of an advanced nursing education program
are prepared and eligible for national, advanced nursing practice specialty certification or
advanced nursing practice role certification when available. It is noteworthy that specialties
evolve over time and new specialties may emerge.
All DNP programs (post-baccalaureate and post-master’s) demonstrate that graduates attain
and integrate Level 2 sub-competencies and competencies for at least one advanced nursing
practice specialty or advanced nursing practice role.
Individuals should seek to advance disciplinary expertise in a chosen nursing specialty or
advanced nursing practice role. This expertise is critical to advancing the profession, to expand
the influence of the profession for the transformation of health care, and to ensure an informed
disciplinary perspective for teaching in the discipline. Advancing education in nursing with
the emphasis on teaching and learning alone does not fulfill the achievement of disciplinary
expertise. Excellence as an educator is achieved by the collective enterprise for faculty teaching
and learning afforded by institutions and applied to discipline-specific teaching.

Advanced Level Practicum Experiences

Advanced-level nursing education programs provide rich and varied opportunities for practice
experiences (both direct and indirect care experiences) to prepare graduates with the Level
2 sub-competencies as well as applicable advanced nursing practice specialty/advanced
nursing practice role competencies and requirements. Practice experiences build on Level 1
sub-competency achievement and are designed to assist the graduate to achieve Level 2 sub-
competencies and applicable specialty competencies upon completion of the program. Practice
experiences are required to integrate didactic learning, promote innovative thinking, and test
new potential solutions to clinical practice or system issues. Therefore, the development of new
skills and practice expectations can be facilitated through use of creative learning opportunities
in diverse settings.
All graduates of advanced-level nursing education programs have structured, faculty-designed
practice experiences, which may include precepted experiences with faculty oversight and/or
experiences with direct faculty supervision. The program is responsible for providing sufficient
and appropriate clinical sites/placements for students to demonstrate attainment of Level 2
sub-competencies and applicable specialty competencies. Clinical/practice learning experiences
may be accomplished through diverse methodologies, including simulation and virtual
technology, and assist the graduate to develop greater proficiency in these competencies,
including cognitive, psychomotor, and affective competencies. Use of simulation should align
with specialty requirements.

22 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

All advanced education practicum experiences must have faculty oversight and be verified and
documented as a component of a formal course or plan of study. Programs provide practice
placements that are safe, supportive, and conducive for learning. The nursing program faculty
determine and assess practice sites to ensure that the site supports student learning with
the intended population or scope of practice. Faculty, students, and preceptors must be well
informed about the specific competencies that are integrated in the didactic, laboratory, and
practice experiences and the method(s) to assess the achievement of the competencies.

Competency Attainment and Practice Experiences

All learners in advanced nursing education programs engage in practice learning activities (both
direct and indirect care experiences). Graduates of all advanced nursing education programs
need sufficient clinical/practice experiences to demonstrate end-of-program student outcomes,
Level 2 sub-competencies, and competencies required by applicable national, specialty
organizations and/or for national advanced nursing practice specialty or advanced nursing
practice role certification. Programs document clear evidence of competency achievement.

Advanced Education Clinical/Practice Hours

The application of competency-based education to prepare advanced nursing professionals
inherently calls to question the role of more traditional time-based requirements. In this
Essentials model, there is an emphasis on ensuring that all nurses pursuing advanced education
attain Level 2 sub-competencies as well as competencies required for an advanced nursing
practice specialty or advanced nursing practice role being pursued. The number of required
practice (direct and indirect care) hours vary based on advanced specialty/role requirements.
These Essentials represent a commitment that required hours prepare a consistent product in
terms of breadth of preparation and quality to reinforce confidence in our graduates by nursing
practice colleagues, other health professionals, and consumers.
Some learners will achieve select competency outcomes more quickly than others. “One and
done,” however, does not demonstrate the progressive and consistent nature of competency
attainment and the assessment necessary in nursing professional education. Repetition plays a
role in reinforcing previously acquired knowledge, skills, values, and attitudes. Repetition also
allows for intentional and unintentional complexities and context nuances to be introduced,
thus building on minimum competency thresholds. Given the paucity of evidence to support
specific experience quantities, case numbers, or hourly requirements that should be achieved, a
minimum threshold of hours of practice engagement remains necessary at this time.
The specific clinical/practice experiences and number of practice hours and/or credit hours
required depends on these Essentials, advanced nursing practice specialty and advanced
nursing practice role requirements, and regulatory standards for specialty certifications and
licensure. The program must include adequate experiences (in terms of time, diversity, depth,
and breadth) to allow attainment and demonstration of all relevant competencies (Level 2
sub-competencies and applicable specialty/role competences and other requirements) and
successful transition to practice demonstrated through program outcomes. The number of in-
person practice hours will vary based on student needs and curriculum design. Participation
in a minimum of 500 practice hours in the discipline of nursing, post entry-level education,
and attainment of Level 1 sub-competencies is required for demonstration of the advanced

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 23

level sub-competencies. Some students may require more. These practice hours also provide
a foundation for the additional time-based requirements set by specialty organizations or
external licensing/certifying bodies, which will require additional practice time for preparation
in advanced nursing specialties or advanced nursing practice roles. Hours of practice do not
necessarily need to be delineated by competency type (Essentials or specialty/role). Some, but
not all, Level 2 sub-competencies and/or specialty/role competencies may be demonstrated and
assessed concurrently. It is expected that faculty create clinical/practice learning experiences
that provide for active learning, repetition, interprofessional engagement, and successive levels
of difficulty. As the strength of evidence to support valid and reliable assessment techniques
builds, the role of practice experiences and number of hours (e.g., time-based requirements)
may evolve in the future.

Immersion Practicum Experiences

Development of competency attainment is facilitated through use of focused and sustained
practice experiences. Immersion experiences, expected in advanced nursing education
programs, provide the learner with the opportunity to integrate the advanced level sub-
competencies and applicable specialty competencies. An immersion also provides an
opportunity for the learner to focus on a population of interest, an advanced nursing role, or
specialty area of study. Placement of integrated or immersion experiences may vary and depend
upon the program’s design, curriculum, and specialty requirements.

Simulation
Simulation experiences represent an important component of clinical/practice education,
serving as a valuable augmentation to direct clinical care or practice within healthcare settings.
Laboratory and simulation experiences provide an effective, safe environment for learning and
demonstrating competencies, particularly high-risk and low-frequency experiences. However,
practice experiences in actual practice settings continue to represent the most important
component of nursing practice education and are required in advanced nursing programs for
the learning and demonstration of the Level 2 sub-competencies and integration of specialty
competencies. Simulation learning experiences align with best practice standards such as those
developed by the International Nursing Association for Clinical Simulation and Learning (INACSL)
or the Society for Simulation in Healthcare (SSH). The use of simulation in the curriculum as
a replacement of direct patient clinical/practice hours or experiences is also determined by
requirements of national specialty education, certification entities, and regulatory entities.
Practice experiences may include simulated experiences for the attainment of a portion of the
Level 2 sub-competencies, particularly for experiences that are high risk and low frequency or
may not be available to all students, and in accordance with requirements set forth by specialty
organizations and/or licensing/certifying bodies. Regardless of the design of the experiences,
programs are expected to document attainment of these sub-competencies through varied and
comprehensive assessment methods across the curriculum.

DNP Scholarly Project/Product

There are many past, present, and projected healthcare dilemmas that call for healthcare
transformation. Nurses, as members of the healthcare team, are expected to assume a
prominent role in addressing these dilemmas. Nurses cannot be expected to significantly

24 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

impact healthcare transformation unless their educational preparation provides them with
opportunities to learn and employ scholarship, leadership, and teamwork skills to advance
practice. A scholarly work that aims to improve clinical practice, therefore, is required of
students completing a practice doctorate in nursing. Collaboration with practice partners
whenever possible will maximize the impact of the student experience.
The scholarly work may take on various final forms depending on the academic institution’s
requirements and the student’s area (specialty or role) of study/practice. Key elements of
the scholarly work include problem identification; a search, analysis, and synthesis of the
literature and evidence; translating evidence to construct a strategy or method to address a
problem; designing a plan for implementation and actual implementation when possible, and
an evaluation of the outcomes, process, and/or experience. Faculty may identify additional
elements deemed necessary to meet the expected outcomes of the curriculum. Programs are
encouraged to support innovation in the design and dissemination of the final project without
reducing the substantive nature of the work. A literature review that lacks applicability to affect
a practice improvement or the other elements identified above would not constitute a scholarly
work that aligns with this Essentials.
Model. Similarly, a portfolio may be used as a tool to enhance the development and
presentation of a project but may not be the sole deliverable product of the student’s
scholarly work.
The scholarly work should not be a separate disaggregated part of the plan of study. Instead,
faculty should consider how the development of the scholarly work is integrated throughout
the curriculum, allowing for dissemination of the results prior to program completion. The
intent is that this scholarly work reflects the longitudinal attainment of advanced level sub-
competencies, going across the curriculum and allowing for the evolution of ideas. There also
is a need to ensure an understanding by the student of the connection between the scholarly
work and application to future practice. This will promote integration of advanced nursing
education competencies into future practice.
Dissemination methods for the scholarly work are determined by the student in consultation
with the faculty and may include a variety of methods. Dissemination may include a final written
product that is presented to a defined group of stakeholders, such as members of the practice
and/or university community or participants at a local, state, or national professional meeting.
Other possible examples of dissemination include poster presentations, a manuscript under
review and/or submission for publication, an educational presentation, or a podcast.
Faculty with appropriate specialty and academic credentials are involved in the planning,
formation, and evaluation of the student’s scholarly work. In some instances, additional
experts/mentors/ partners/facilitators can be formal or informal collaborators and provide
intermittent or limited support throughout the project phases as needed. Evaluation of the
student’s scholarly work may include a combination of methods, including faculty, expert,
and/or peer evaluation. Programs tailor scholarly work evaluation and approval processes per
institution’s, the program’s, and/or appropriate committee’s requirements. Evaluation of the
final DNP project is the responsibility of the faculty.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 25

In summary:
• These program requirements do not modify any additional requirements for any
advanced specialty or role preparation, including the requirement for all Advanced
Practice Registered Nurse (APRNs) education to include three graduate-level courses
delineated in The Consensus Model for APRN Regulation: Licensure, Accreditation,
Certification, and Education (2006; see glossary).
• All graduates of an advanced-level nursing education program are prepared for practice
in an advanced nursing specialty (informatics, administration/practice leadership, pub-
lic health/population health, or health policy) or for an advanced nursing practice role
(nurse practitioner, certified nurse-midwife, certified clinical nurse specialist, certified
registered nurse anesthetist).
• All DNP students will complete a scholarly project/project, which will be evaluated by
faculty; DNP students will demonstrate the attainment and integration of the Level 1
sub-competencies, Level 2 sub-competencies, and advanced specialty/role competen-
cies into practice.

26 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 Domains, Competencies, and Sub-Competencies for
Entry-level Professional Nursing Education and Advanced-level
Nursing Education
Domain 1: Knowledge for Nursing Practice
Descriptor: Integration, translation, and application of established and evolving disciplinary
nursing knowledge and ways of knowing, as well as knowledge from other disciplines, including
a foundation in liberal arts and natural and social sciences. This distinguishes the practice of
professional nursing and forms the basis for clinical judgment and innovation in nursing practice.
Contextual Statement: Knowledge for Nursing Practice provides the context for understanding
nursing as a scientific discipline. The lens of nursing, informed by nursing history, knowledge,
and science, reflects nursing’s desire to incorporate multiple perspectives into nursing practice,
leading to nursing’s unique way of knowing and caring.
Preparation in both liberal arts and sciences and professional nursing coursework provides
graduates with the essential abilities to function as independent, intellectually curious, socially
responsible, competent practitioners (Tobbell, 2018). A liberal education creates the foundation
for the development of intellectual and practical abilities within the context of nursing. Further,
liberal education is the key to understanding self and others; contributes to safe, quality care;
and informs the development of clinical judgment.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

1.1 Demonstrate an understanding of the discipline of nursing’s distinct perspective and where shared
perspectives exist with other disciplines

1.1a Identify concepts, derived from theories from 1.1e Translate evidence from nursing science as
nursing and other disciplines, which distinguish the well as other sciences into practice.
practice of nursing.

1.1b Apply knowledge of nursing science that 1.1f Demonstrate the application of nursing science
develops a foundation for nursing practice. to practice.

1.1c Understand the historical foundation of 1.1g Integrate an understanding of nursing history
nursing as the relationship developed between the in advancing nursing’s influence in health care.
individual and nurse.

1.1d Articulate nursing’s distinct perspective to

practice.

1.2 Apply theory and research-based knowledge from nursing, the arts, humanities, and other sciences.

1.2a Apply or employ knowledge from nursing 1.2f Synthesize knowledge from nursing and other
science as well as the natural, physical, and social disciplines to inform education, practice, and
sciences to build an understanding of the human research.
experience and nursing practice.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 27

 1.2b Demonstrate intellectual curiosity. 1.2g Apply a systematic and defendable approach
to nursing practice decisions.

1.2c Demonstrate social responsibility as a 1.2h Employ ethical decision making to assess,
global citizen who fosters the attainment of intervene, and evaluate nursing care.
health equity for all.

1.2d Examine influence of personal values in 1.2i Demonstrate socially responsible leadership.
decision making for nursing practice.

1.2e Demonstrate ethical decision making. 1.2j Translate theories from nursing and other
disciplines to
practice.

1.3 Demonstrate clinical judgment founded on a broad knowledge base.

1.3a Demonstrate clinical reasoning. 1.3d Integrate foundational and advanced specialty
knowledge into clinical reasoning.

1.3b Integrate nursing knowledge (theories, 1.3e Synthesize current and emerging evidence to
multiple ways of knowing, evidence) and Influence practice.
knowledge from other disciplines and inquiry to
inform clinical judgment.

1.3c Incorporate knowledge from nursing and 1.3f Analyze decision models from nursing and
other disciplines to support clinical judgment. other knowledge domains to improve clinical
judgment.

28 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 2: Person-Centered Care
Descriptor: Person-centered care focuses on the individual within multiple complicated
contexts, including family and/or important others. Person-centered care is holistic,
individualized, just, respectful, compassionate, coordinated, evidence-based, and
developmentally appropriate. Person-centered care builds on a scientific body of knowledge
that guides nursing practice regardless of specialty or functional area.
Contextual Statement: Person-centered care is the core purpose of nursing as a discipline.
This purpose intertwines with any functional area of nursing practice, from the point of care
where the hands of those that give and receive care meet, to the point of systems-level
nursing leadership. Foundational to person-centered care is respect for diversity, differences,
preferences, values, needs, resources, and the determinants of health unique to the individual.
The person is a full partner and the source of control in team-based care. Person-centered
care requires the intentional presence of the nurse seeking to know the totality of the
individual’s lived experiences and connections to others (family, important others, community).
As a scientific and practice discipline, nurses employ a relational lens that fosters mutuality,
active participation, and individual empowerment. This focus is foundational to educational
preparation from entry to advanced levels irrespective of practice areas.
With an emphasis on diversity, equity, and inclusion, person-centered care is based on best
evidence and clinical judgment in the planning and delivery of care across time, spheres of
care, and developmental levels. Contributing to or making diagnoses is one essential aspect of
nursing practice and critical to an informed plan of care and improving outcomes of care (Olson
et al., 2019). Diagnoses at the system-level are equally as relevant, affecting operations that
impact care for individuals. Person-centered care results in shared meaning with the healthcare
team, recipient of care, and the healthcare system, thus creating humanization of wellness and
healing from birth to death.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

2.1 Engage with the individual in establishing a caring relationship.

2.1a Demonstrate qualities of empathy. 2.1d Promote caring relationships to effect positive
outcomes.

2.1b Demonstrate compassionate care. 2.1e Foster caring relationships.

2.1c Establish mutual respect with the individual

and family.

2.2 Communicate effectively with individuals.

2.2a Demonstrate relationship-centered care. 2.2g Demonstrate advanced communication skills

and techniques using a variety of modalities with
diverse audiences.

2.2b Consider individual beliefs, values, and 2.2h Design evidence-based, person-centered
personalized information in communications. engagement materials.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 29

 2.2c Use a variety of communication modes 2.2i Apply individualized information, such
appropriate for the context. as genetic/genomic, pharmacogenetic, and
environmental exposure information in the
delivery of personalized health care.

2.2d Demonstrate the ability to conduct sensitive or 2.2j Facilitate difficult conversations and disclosure
difficult conversations. of sensitive information.

2.2e Use evidence-based patient teaching

materials, considering health literacy, vision,
hearing, and cultural sensitivity.

2.2f Demonstrate emotional intelligence in

communications.

2.3 Integrate assessment skills in practice.

2.3a Create an environment during assessment that 2.3h Demonstrate that one’s practice is informed
promotes a dynamic interactive experience. by a comprehensive assessment appropriate to the
functional area of advanced nursing practice.

2.3b Obtain a complete and accurate history in a

systematic manner.

2.3c Perform a clinically relevant, holistic health

assessment.

2.3d Perform point of care screening/diagnostic

testing (e.g. blood glucose, PO2, EKG).

2.3e Distinguish between normal and abnormal

health findings.

2.3f Apply nursing knowledge to gain a holistic

perspective of the person, family, community, and
population.

2.3g Communicate findings of a comprehensive

assessment.

2.4 Diagnose actual or potential health problems and needs.

2.4a Synthesize assessment data in the context of 2.4f Employ context driven, advanced reasoning to
the individual’s current preferences, situation, and the diagnostic and decision-making process.
experience.

2.4b Create a list of problems/health concerns. 2.4g Integrate advanced scientific knowledge to
guide decision making.

2.4c Prioritize problems/health concerns.

30 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

2.4d Understand and apply the results of social
screening, psychological testing, laboratory data,
imaging studies, and other diagnostic tests in
actions and plans of care.

2.4e Contribute as a team member to the formation

and improvement of diagnoses.

2.5 Develop a plan of care.

2.5a Engage the individual and the team in plan 2.5h Lead and collaborate with an interprofessional
development. team to develop a comprehensive plan of care.

2.5b Organize care based on mutual health goals. 2.5i Prioritize risk mitigation strategies to prevent
or reduce adverse outcomes.

2.5c Prioritize care based on best evidence. 2.5j Develop evidence-based interventions to
improve outcomes and safety.

2.5d Incorporate evidence-based intervention to 2.5k Incorporate innovations into practice when
improve outcomes and safety. evidence is not available.

2.5e Anticipate outcomes of care (expected,

unexpected, and potentially adverse).

2.5f Demonstrate rationale for plan.

2.5g Address individuals’ experiences and

perspectives in designing plans of care.

2.6 Demonstrate accountability for care delivery.

2.6a Implement individualized plan of care using 2.6e Model best care practices to the team.
established protocols.

2.6b Communicate care delivery through multiple 2.6f Monitor aggregate metrics to assure
modalities. accountability for care outcomes.

2.6c Delegate appropriately to team members. 2.6g Promote delivery of care that supports
practice at the full scope of education.

2.6d Monitor the implementation of the plan of 2.6h Contribute to the development of policies
care. and processes that promote transparency and
accountability.

2.6i Apply current and emerging evidence to the

development of care guidelines/tools.

2.6j Ensure accountability throughout transitions of

care across the health continuum.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 31

 2.7 Evaluate outcomes of care.

2.7a Reassess the individual to evaluate health 2.7d Analyze data to identify gaps and inequities in
outcomes/goals. care and monitor trends in outcomes.

2.7b Modify plan of care as needed. 2.7e Monitor epidemiological and system-level
aggregate data to determine healthcare outcomes
and trends.

2.7c Recognize the need for modifications to 2.7f Synthesize outcome data to inform evidence-
standard practice. based practice, guidelines, and policies.

2.8 Promote self-care management.

2.8a Assist the individual to engage in self-care 2.8f Develop strategies that promote self-care
management. management.

2.8b Employ individualized educational strategies 2.8g Incorporate the use of current and emerging
based on learning theories, methodologies, and technologies to support self-care management.
health literacy.

2.8c Educate individuals and families regarding self- 2.8h Employ counseling techniques, including
care for health promotion, illness prevention, and motivational interviewing, to advance wellness and
illness management. self-care management.

2.8d Respect individuals and families’ self- 2.8i Evaluate adequacy of resources available to
determination in their healthcare decisions. support self-care management.

2.8e Identify personal, system, and community 2.8j Foster partnerships with community
resources available to support self-care organizations to support self-care management.
management.

2.9 Provide care coordination.

2.9a Facilitate continuity of care based on 2.9f Evaluate communication pathways among
assessment of assets and needs. providers and others across settings, systems, and
communities.

2.9b Communicate with relevant stakeholders 2.9g Develop strategies to optimize care
across health systems. coordination and transitions of care.

2.9c Promote collaboration by clarifying 2.9h Guide the coordination of care across health
responsibilities among individual, family, and team systems.
members.

2.9d Recognize when additional expertise and 2.9i Analyze system-level and public policy
knowledge is needed to manage the patient. influence on care coordination.

2.9e Provide coordination of care of individuals and 2.9j Participate in system-level change to improve
families in collaboration with care team. care coordination across settings.

32 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 3: Population Health
Descriptor: Population health spans the healthcare delivery continuum from public health
prevention to disease management of populations and describes collaborative activities with
both traditional and non-traditional partnerships from affected communities, public health,
industry, academia, health care, local government entities, and others for the improvement
of equitable population health outcomes. (Kindig & Stoddart, 2003; Kindig, 2007; Swartout &
Bishop, 2017; CDC, 2020).
Contextual Statement: A population is a discrete group that the nurse and others care for
across settings at local, regional, national, and global levels. Population health spans the
healthcare delivery continuum, including public health, acute care, ambulatory care, and long-
term care. Population health also encompasses collaborative activities among stakeholders – all
relevant individuals and organizations involved in care, including patients and communities
themselves - for the improvement of a population’s health status. The purpose of these
collaborative activities, including development of interventions and policies, is to strive
towards health equity and improved health for all. Diversity, equity, inclusion, and ethics
must be emphasized and valued. Accountability for outcomes is shared by all, since outcomes
arise from multiple factors that influence the health of a defined group. Population health
includes population management through systems thinking, including health promotion and
illness prevention, to achieve population health goals (Storfjell, Wehtle, Winslow, & Saunders,
2017). Nurses play a critical role in advocating for, developing, and implementing policies that
impact population health globally and locally. In addition, nurses respond to crises and provide
care during emergencies, disasters, epidemics, or pandemics. They play an essential role in
system preparedness and ethical response initiatives. Although each type of public health
emergency will likely require a unique set of competencies, preparedness for responding begins
with a population health perspective and a particular focus on surveillance, prevention, and
containment of factors contributing to the emergency.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

3.1 Manage population health.

3.1a Define a target population including its 3.1j Assess the efficacy of a system’s capability to
functional and problem-solving capabilities serve a target sub-population’s healthcare needs.
(anywhere in the continuum of care).

3.1b Assess population health data. 3.1k Analyze primary and secondary population
health data for multiple populations against
relevant benchmarks.

3.1c Assess the priorities of the community and/or 3.1l Use established or evolving methods to
the affected clinical population. determine population-focused priorities for care.

3.1d Compare and contrast local, regional, national, 3.1m Develop a collaborative approach with
and global benchmarks to identify health patterns relevant stakeholders to address population
across populations. healthcare needs, including evaluation methods.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 33

 3.1e Apply an understanding of the public health 3.1n Collaborate with appropriate stakeholders
system and its interfaces with clinical health care in to implement a sociocultural and linguistically
addressing population health needs. responsive intervention plan.

3.1f Develop an action plan to meet an identified

need(s), including evaluation methods.

3.1g Participate in the implementation of

sociocultural and linguistically responsive
interventions.

3.1h Describe general principles and practices for

the clinical management of populations across the
age continuum.

3.1i Identify ethical principles to protect the health

and safety of diverse populations.

3.2 Engage in effective partnerships.

3.2a Engage with other health professionals to 3.2d Ascertain collaborative opportunities for
address population health issues. individuals and organizations to improve population
health.

3.2b Demonstrate effective collaboration and 3.2e Challenge biases and barriers that impact
mutual accountability with relevant stakeholders. population health outcomes.

3.2c Use culturally and linguistically responsive 3.2f Evaluate the effectiveness of partnerships for
communication strategies. achieving health equity.

3.2g Lead partnerships to improve population

health outcomes.

3.2h Assess preparation and readiness of partners

to organize during natural and manmade disasters.

3.3 Consider the socioeconomic impact of the delivery of health care.

3.3a Describe access and equity implications of 3.3c Analyze cost-benefits of selected population-
proposed intervention(s). based interventions.

3.3b Prioritize patient-focused and/or community 3.3d Collaborate with partners to secure and
action plans that are safe, effective, and efficient in leverage resources necessary for effective,
the context of available resources. sustainable interventions.

3.3e Advocate for interventions that maximize cost-

effective, accessible, and equitable resources for
populations.

3.3f Incorporate ethical principles in resource

allocation in achieving equitable health.

34 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

3.4 Advance equitable population health policy.

3.4a Describe policy development processes. 3.4f Identify opportunities to influence the policy
process.

3.4b Describe the impact of policies on population 3.4g Design comprehensive advocacy strategies to
outcomes, including social justice and health support the policy process.
equity.

3.4c Identify best evidence to support policy 3.4h Engage in strategies to influence policy
development. change.

3.4d Propose modifications to or development of 3.4i Contribute to policy development at the

policy based on population findings. system, local, regional, or national levels.

3.4e Develop an awareness of the 3.4j Assess the impact of policy changes.
interconnectedness of population health across
borders.

3.4k Evaluate the ability of policy to address

disparities and inequities within segments of the
population.

3.4l Evaluate the risks to population health

associated with globalization.

3.5 Demonstrate advocacy strategies.

3.5a Articulate a need for change. 3.5f Appraise advocacy priorities for a population.

3.5b Describe the intent of the proposed change. 3.5g Strategize with an interdisciplinary group and
others to develop effective advocacy approaches.

3.5c Define stakeholders, including members of the 3.5h Engage in relationship-building activities with
community and/or clinical populations, and their stakeholders at any level of influence, including
level of influence. system, local, state, national, and/or global.

3.5d Implement messaging strategies appropriate 3.5i Demonstrate leadership skills to promote
to audience and stakeholders. advocacy efforts that include principles of social
justice, diversity, equity, and inclusion.

3.5e Evaluate the effectiveness of advocacy actions.

3.6 Advance preparedness to protect population health during disasters and public health emergencies.

3.6a Identify changes in conditions that might 3.6f Collaboratively initiate rapid response activities
indicate a disaster or public health emergency. to protect population health.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 35

 3.6b Understand the impact of climate change on 3.6g Participate in ethical decision making that
environmental and population health. includes diversity, equity, and inclusion in advanced
preparedness to protect populations.

3.6c Describe the health and safety hazards of 3.6h Collaborate with interdisciplinary teams to
disasters and public health emergencies. lead preparedness and mitigation efforts to protect
population health with attention to the most
vulnerable populations.

3.6d Describe the overarching principles and 3.6i Coordinate the implementation of evidence-
methods regarding personal safety measures, based infection control measures and proper use of
including personal protective equipment (PPE). personal protective equipment.

3.6e Implement infection control measures and 3.6j Contribute to system-level planning, decision
proper use of personal protective equipment. making, and evaluation for disasters and public
health emergencies.

36 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 4: Scholarship for the Nursing Discipline
Descriptor: The generation, synthesis, translation, application, and dissemination of nursing
knowledge to improve health and transform health care (AACN, 2018).
Contextual Statement: Nursing scholarship informs science, enhances clinical practice,
influences policy, and impacts best practices for educating nurses as clinicians, scholars, and
leaders. Scholarship is inclusive of discovery, application, integration, and teaching. While not all
inclusive, the scholarship of discovery includes primary empirical research, analysis of large data
sets, theory development, and methodological studies. The scholarship of practice interprets,
draws together, applies, and brings new insight to original research (Boyer, 1990; AACN 2018).
Knowledge of the basic principles of the research process, including the ability to critique
research and determine its applicability to nursing’s body of knowledge, is critical. Ethical
comportment in the conduct and dissemination of research and advocacy for human subjects
are essential components of nursing’s role in the process of improving health and health care.
Whereas the research process is the generation of new knowledge, evidence-based practice
(EBP) is the process for the application, translation, and implementation of best evidence into
clinical decision-making. While evidence may emerge from research, EBP extends beyond just
data to include patient preferences and values as well as clinical expertise. Nurses, as innovators
and leaders within the interprofessional team, use the uniqueness of nursing in nurse-patient
relationships to provide optimal care and address health inequities, structural racism, and
systemic inequity.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

4.1 Advance the scholarship of nursing.

4.1a Demonstrate an understanding of different 4.1h Apply and critically evaluate advanced
approaches to scholarly practice. knowledge in a defined area of nursing practice.

4.1b Demonstrate application of different levels of 4.1i Engage in scholarship to advance health.
evidence.

4.1c Apply theoretical framework(s)/models in 4.1j Discern appropriate applications of

practice. quality improvement, research, and evaluation
methodologies.

4.1d Demonstrate an understanding of basic 4.1k Collaborate to advance one’s scholarship.

elements of the research process.

4.1e Participate in scholarly inquiry as a team 4.1l Disseminate one’s scholarship to diverse
member. audiences using a variety of app roaches or
modalities.

4.1f Evaluate research. 4.1m Advocate within the interprofessional team

and with other stakeholders for the contributions
of nursing scholarship.

4.1g Communicate scholarly findings.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 37

 4.2 Integrate best evidence into nursing practice.

4.2a Evaluate clinical practice to generate questions 4.2f Use diverse sources of evidence to inform
to improve nursing care. practice.

4.2b Evaluate appropriateness and strength of the 4.2g Lead the translation of evidence into practice.
evidence.

4.2c Use best evidence in practice. 4.2h Address opportunities for innovation and
changes in practice.

4.2d Participate in the implementation of a practice 4.2i Collaborate in the development of new/revised
change to improve nursing care. policy or regulation in the light of new evidence.

4.2e Participate in the evaluation of outcomes and 4.2 j Articulate inconsistencies between practice
their implications for practice. policies and best evidence.

4.2k Evaluate outcomes and impact of new

practices based on the evidence.

4.3 Promote the ethical conduct of scholarly activities.

4.3a Explain the rationale for ethical research 4.3e Identify and mitigate potential risks and areas
guidelines, including Institutional Review Board of ethical concern in the conduct of scholarly
(IRB) guidelines. activities.

4.3b Demonstrate ethical behaviors in scholarly 4.3f Apply IRB guidelines throughout the
projects including quality improvement and EBP scholarship process.
initiatives.

4.3c Advocate for the protection of participants in 4.3g Ensure the protection of participants in the
the conduct of scholarly initiatives. conduct of scholarship.

4.3d Recognize the impact of equity issues in 4.3h Implement processes that support ethical
research. conduct in practice and scholarship.

4.3i Apply ethical principles to the dissemination of

nursing scholarship.

38 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 5: Quality and Safety
Descriptor: Employment of established and emerging principles of safety and improvement
science. Quality and safety, as core values of nursing practice, enhance quality and
minimize risk of harm to patients and providers through both system effectiveness and
individual performance.
Contextual Statement: Provision of safe, quality care necessitates knowing and using
established and emerging principles of safety science in care delivery. Quality and safety
encompass provider and recipient safety and the recognition of synergy between the two.
Quality or safety challenges are viewed primarily as the result of system failures, as opposed
to the errors of an individual. In an environment fostering quality and safety, caregivers
are empowered and encouraged to promote safety and take appropriate action to prevent
and report adverse events and near misses. Fundamental to the provision of safe, quality
care, providers of care adopt, integrate, and disseminate current practice guidelines and
evidence-based interventions.
Safety is inclusive of attending to work environment hazards, such as violence, burnout,
ergonomics, and chemical and biological agents; there is a synergistic relationship between
employee safety and patient safety. A safe and just environment minimizes risk to both
recipients and providers of care. It requires a shared commitment to create and maintain a
physically, psychologically, secure, and just environment. Safety demands an obligation to
remain non-punitive in detecting, reporting, and analyzing errors, possible exposures, and near
misses when they occur.
Quality and safety are interdependent, as safety is a necessary attribute of quality care. For
quality health care to exist, care must be safe, effective, timely, efficient, equitable, and person-
centered. Quality care is the extent to which care services improve desired health outcomes
and are consistent with patient preferences and current professional knowledge (IOM, 2001).
Additionally, quality care includes collaborative engagement with the recipient of care in
assuming responsibility for health promotion and illness treatment behaviors. Quality care both
improves desired health outcomes, and prevents harm (IOM, 2001). Addressing contributors
and barriers to quality and safety, at both individual and system levels, are necessary.
Essentially, everyone in health care is responsible for quality care and patient safety. Nurses
are uniquely positioned to lead or co-lead teams that address the improvement of quality and
safety because of their knowledge and ethical code (ANA Code of Ethics, 2015). Increasing
complexity of care has contributed to continued gaps in healthcare safety.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

5.1 Apply quality improvement principles in care delivery.

5.1a Recognize nursing’s essential role in improving 5.1i Establish and incorporate data driven
healthcare quality and safety. benchmarks to monitor system performance.

5.1b Identify sources and applications of national 5.1j Use national safety resources to lead team-
safety and quality standards to guide nursing based change initiatives.
practice.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 39

 5.1c Implement standardized, evidence-based 5.1k Integrate outcome metrics to inform change
processes for care delivery. and policy recommendations.

5.1d Interpret benchmark and unit outcome data 5.1l Collaborate in analyzing organizational process
to inform individual and microsystem practice. improvement initiatives.

5.1e Compare quality improvement methods in the 5.1m Lead the development of a business plan for
delivery of patient care. quality improvement initiatives.

5.1f Identify strategies to improve outcomes of 5.1n Advocate for change related to financial
patient care in practice. policies that impact the relationship between
economics and quality care delivery.

5.1g Participate in the implementation of a practice 5.1o Advance quality improvement practices
change. through dissemination of outcomes.

5.1h Develop a plan for monitoring quality

improvement change.

5.2 Contribute to a culture of patient safety.

5.2a Describe the factors that create a culture of 5.2g Evaluate the alignment of system data and
safety. comparative patient safety benchmarks.

5.2b Articulate the nurse’s role within an 5.2h Lead analysis of actual errors, near misses,
interprofessional team in promoting safety and and potential situations that would impact safety.
preventing errors and near misses.

5.2c Examine basic safety design principles to 5.2i Design evidence-based interventions to
reduce risk of harm. mitigate risk.

5.2d Assume accountability for reporting unsafe 5.2j Evaluate emergency preparedness system-level
conditions, near misses, and errors to reduce harm. plans to protect safety.

5.2e Describe processes used in understanding

causes of error.

5.2f Use national patient safety resources,

initiatives, and regulations at the point of care.

40 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

5.3 Contribute to a culture of provider and work environment safety.

5.3a Identify actual and potential level of risks to 5.3e Advocate for structures, policies, and
providers within the workplace. processes that promote a culture of safety and
prevent workplace risks and injury.

5.3b Recognize how to prevent workplace violence 5.3f Foster a just culture reflecting civility and
and injury. respect.

5.3c Promote policies for prevention of violence 5.3g Create a safe and transparent culture for
and risk mitigation. reporting incidents.

5.3d Recognize one’s role in sustaining a just 5.3h Role model and lead well-being and resiliency
culture reflecting civility and respect. for self and team.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 41

Domain 6: Interprofessional Partnerships
Descriptor: Intentional collaboration across professions and with care team members, patients,
families, communities, and other stakeholders to optimize care, enhance the healthcare
experience, and strengthen outcomes.
Contextual Statement: Professional partnerships that include interprofessional,
intraprofessional, and paraprofessional partnerships, build on a consistent demonstration of
core professional values (altruism, excellence, caring, ethics, respect, communication, and
shared accountability) in the provision of team-based, person-centered care. Nursing knowledge
and expertise uniquely contributes to the intentional work within teams and in concert with
patient, family, and community preferences and goals. Interprofessional partnerships require
a coordinated, integrated, and collaborative implementation of the unique knowledge, beliefs,
and skills of the full team for the end purpose of optimized care delivery. Effective collaboration
requires an understanding of team dynamics and an ability to work effectively in care-oriented
teams. Leadership of the team varies depending on needs of the individual, community,
population, and context of care.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

6.1 Communicate in a manner that facilitates a partnership approach to quality care delivery.

6.1a Communicate the nurse’s roles and 6.1g Evaluate effectiveness of interprofessional
responsibilities clearly. communication tools and techniques to support
and improve the efficacy of team-based
interactions.

6.1b Use various communication tools and 6.1h Facilitate improvements in interprofessional
techniques effectively. communications of individual information (e.g.
EHR).

6.1c Elicit the perspectives of team members to 6.1i Role model respect for diversity, equity, and
inform person-centered care decision making. inclusion in team-based communications.

6.1d Articulate impact of diversity, equity, and 6.1j Communicate nursing’s unique disciplinary
inclusion on team-based communications. knowledge to strengthen interprofessional
partnerships.

6.1e Communicate individual information in a 6.1k Provide expert consultation for other members
professional, accurate, and timely manner. of the healthcare team in one’s area of practice.

6.1f Communicate as informed by legal, regulatory, 6.1l Demonstrate capacity to resolve

and policy guidelines. interprofessional conflict.

6.2 Perform effectively in different team roles, using principles and values of team dynamics.

6.2a Apply principles of team dynamics, including 6.2g Integrate evidence-based strategies and
team roles, to facilitate effective team functioning. processes to improve team effectiveness and
outcomes.

42 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

6.2b Delegate work to team members based on 6.2h Evaluate the impact of team dynamics and
their roles and competency. performance on desired outcomes.

6.2c Engage in the work of the team as appropriate 6.2i Reflect on how one’s role and expertise
to one’s scope of practice and competency. influences team performance.

6.2d Recognize how one’s uniqueness (as a 6.2j Foster positive team dynamics to strengthen
person and a nurse) contributes to effective desired outcomes.
interprofessional working relationships.

6.2e Apply principles of team leadership and

management. performance to improve quality and
assure safety.

6.2f Evaluate performance of individual and team

to improve quality and promote safety.

6.3 Use knowledge of nursing and other professions to address healthcare needs.

6.3a Integrate the roles and responsibilities of 6.3d Direct interprofessional activities and
healthcare professionals through interprofessional initiatives.
collaborative practice.

6.3b Leverage roles and abilities of team members

to optimize care.

6.3c Communicate with team members to clarify

responsibilities in executing plan of care.

6.4 Work with other professions to maintain a climate of mutual learning, respect, and shared values.

6.4a Demonstrate an awareness of one’s biases 6.4e Practice self-assessment to mitigate conscious
and how they may affect mutual respect and and implicit biases toward other team members.
communication with team members.

6.4b Demonstrate respect for the perspectives and 6.4f Foster an environment that supports the
experiences of other professions. constructive sharing of multiple perspectives and
enhances interprofessional learning.

6.4c Engage in constructive communication to 6.4g Integrate diversity, equity, and inclusion into
facilitate conflict management. team practices.

6.4d Collaborate with interprofessional team 6.4h Manage disagreements, conflicts, and
members to establish mutual healthcare goals for challenging conversations among team members.
individuals, communities, or populations.

6.4i Promote an environment that advances

interprofessional learning.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 43

Domain 7: Systems-Based Practice
Descriptor: Responding to and leading within complex systems of health care. Nurses
effectively and proactively coordinate resources to provide safe, quality, and equitable care to
diverse populations.
Contextual Statement: Using evidence-based methodologies, nurses lead innovative solutions
to address complex health problems and ensure optimal care. Understanding of systems-
based practice is foundational to the delivery of quality care and incorporates key concepts of
organizational structure, including relationships among macro-, meso-, and microsystems across
healthcare settings. Knowledge of financial and payment models relative to reimbursement
and healthcare costs is essential. In addition, the impact of local, regional, national, and
global structures, systems, and regulations on individuals and diverse populations must be
considered when evaluating patient outcomes. As change agents and leaders, nurses possess
the intellectual capacity to be agile in response to continually evolving healthcare systems, to
address structural racism and other forms of discrimination, and to advocate for the needs of
diverse populations. Systems-based practice is predicated on an ethical practice environment
where professional and organizational values are aligned, and structures and processes enable
ethical practice by all members of the institution.
Integrated healthcare systems are highly complex, and gaps or failures in service and delivery
can cause ineffective, harmful outcomes. These outcomes also span individual through global
networks. Cognitive shifting from focused to big picture is a crucial skill set. Similarly, the ability
for nurses to predict change, employ improvement strategies, and exercise fiscal prudence are
critical skills. System awareness, innovation, and design also are needed to address such issues
as structural racism and systemic inequity.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

7.1 Apply knowledge of systems to work effectively across the continuum of care.

7.1a Describe organizational structure, mission, 7.1e Participate in organizational strategic planning.
vision, philosophy, and values.

7.1b Explain the relationships of macrosystems, 7.1f Participate in system-wide initiatives that
mesosystems, and microsystems. improve care delivery and/or outcomes.

7.1c Differentiate between various healthcare 7.1g Analyze system-wide processes to optimize
delivery environments across the continuum of outcomes.
care.

7.1d Recognize internal and external system 7.1h Design policies to impact health equity and
processes that impact care coordination and structural racism within systems, communities, and
transition of care. populations.

7.2 Incorporate consideration of cost-effectiveness of care.

7.2a Describe the financial and payment models of 7.2g Analyze relevant internal and external factors
health care. that drive healthcare costs and reimbursement.

44 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

7.2b Recognize the impact of health disparities and 7.2h Design practices that enhance value, access,
social determinants of health on care outcomes. quality, and cost-effectiveness.

7.2c Describe the impact of healthcare cost and 7.2i Advocate for healthcare economic policies and
payment models on the delivery, access, and regulations to enhance value, quality, and cost-
quality of care. effectiveness.

7.2d Explain the relationship of policy, regulatory 7.2j Formulate, document, and disseminate the
requirements, and economics on care outcomes. return on investment for improvement initiatives
collaboratively with an interdisciplinary team.

7.2e Incorporate considerations of efficiency, value, 7.2k Recommend system-wide strategies that
and cost in providing care. improve cost- effectiveness considering structure,
leadership, and workforce needs.

7.2f Identify the impact of differing system 7.2l Evaluate health policies based on an ethical
structures, leadership, and workforce needs on framework
care outcomes. considering cost-effectiveness, health equity, and
care outcomes.

7.3 Optimize system effectiveness through application of innovation and evidence-based practice.

7.3a Demonstrate a systematic approach for 7.3e Apply innovative and evidence-based
decision-making. strategies focusing on system preparedness and
capabilities.

7.3b Use reported performance metrics to 7.3f Design system improvement strategies based
compare/monitor outcomes. on performance data and metrics.

7.3c Participate in evaluating system effectiveness. 7.3g Manage change to sustain system
effectiveness.

7.3d Recognize internal and external system 7.3h Design system improvement strategies that
processes and structures that perpetuate racism address internal and external system processes
and other forms of discrimination within health and structures that perpetuate structural racism
care. and other forms of discrimination in healthcare
systems.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 45

Domain 8: Informatics and Healthcare Technologies
Descriptor: Information and communication technologies and informatics processes are used to
provide care, gather data, form information to drive decision making, and support professionals
as they expand knowledge and wisdom for practice. Informatics processes and technologies are
used to manage and improve the delivery of safe, high-quality, and efficient healthcare services
in accordance with best practice and professional and regulatory standards.
Contextual Statement: Healthcare professionals interact with patients, families, communities,
and populations in technology-rich environments. Nurses, as essential members of the
healthcare team, use information and communication technologies and informatics tools in
their direct and indirect care roles. The technologies, the locations in which they are used,
the users interacting with the technology, the communication occurring, and the work being
done all impact the data collected, information formed, decisions made, and the knowledge
generated. Additionally, the utilization of information and communication technologies in
healthcare settings changes how people, processes, and policies interact. Using these tools
in the provision of care has both short- and long-term consequences for the quality of care,
efficiency of communications, and connections between team members, patients, and
consumers. It is essential that nurses at all levels understand their role and the value of their
input in health information technology analysis, planning, implementation, and evaluation.
With the prevalence of patient-focused health information technologies, all nurses have a
responsibility to advocate for equitable access and assist patients and consumers to optimally
use these tools to engage in care, improve health, and manage health conditions.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

8.1 Describe the various information and communication technology tools used in the care of patients,
communities, and populations.

8.1a Identify the variety of information and 8.1g Identify best evidence and practices for the
communication technologies used in care settings. application of information and communication
technologies to support care.

8.1b Identify the basic concepts of electronic 8.1h Evaluate the unintended consequences of
health, mobile health, and telehealth systems for information and communication technologies on
enabling patient care. care processes, communications, and information
flow across care settings.

8.1c Effectively use electronic communication tools. 8.1i Propose a plan to influence the selection
and implementation of new information and
communication technologies.

8.1d Describe the appropriate use of multimedia 8.1j Explore the fiscal impact of information and
applications in health care. communication technologies on health care.

8.1e Demonstrate best practice use of social 8.1k Identify the impact of information and
networking applications. communication technologies on workflow
processes and healthcare outcomes.

46 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

8.1f Explain the importance of nursing engagement
in the planning and selection of healthcare
technologies.

8.2 Use information and communication technology to gather data, create information, and generate
knowledge.

8.2a Enter accurate data when chronicling care. 8.2f Generate information and knowledge from
health information technology databases.

8.2b Explain how data entered on one patient 8.2g Evaluate the use of communication technology
impacts public and population health data. to improve consumer health information literacy.

8.2c Use appropriate data when planning care. 8.2h Use standardized data to evaluate decision-
making and outcomes across all systems levels.

8.2d Demonstrate the appropriate use of health 8.2i Clarify how the collection of standardized data
information literacy assessments and improvement advances the practice, understanding, and value of
strategies. nursing and supports care.

8.2e Describe the importance of standardized 8.2j Interpret primary and secondary data and
nursing data to reflect the unique contribution of other information to support care.
nursing practice.

8.3 Use information and communication technologies and informatics processes to deliver
safe nursing care to diverse populations in a variety of settings.

8.3a Demonstrate appropriate use of information 8.3g Evaluate the use of information and
and communication technologies. communication technology to address needs, gaps,
and inefficiencies in care.

8.3b Evaluate how decision support tools impact 8.3h Formulate a plan to influence decision-
clinical judgment and safe patient care. making processes for selecting, implementing, and
evaluating support tools.

8.3c Use information and communication 8.3i Appraise the role of information and
technology in a manner that supports the nurse- communication technologies in engaging the
patient relationship. patient and supporting the nurse-patient
relationship.

8.3d Examine how emerging technologies influence 8.3j Evaluate the potential uses and impact of
healthcare delivery and clinical decision making. emerging technologies in health care.

8.3e Identify impact of information and 8.3k Pose strategies to reduce inequities in digital
communication technology on quality and safety of access to data and information.
care.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 47

 8.3f Identify the importance of reporting system
processes and functional issues (error messages,
mis-directions, device malfunctions, etc.) according
to organizational policies and procedures.

8.4 Use information and communication technology to support documentation of care and
communication among providers, patients, and all system levels.

8.4a Explain the role of communication technology 8.4e Assess best practices for the use of advanced
in enhancing clinical information flows. information and communication technologies to
support patient and team communications.

8.4b Describe how information and communication 8.4f Employ electronic health, mobile health, and
technology tools support patient and team telehealth systems to enable quality, ethical, and
communications. efficient patient care.

8.4c Identify the basic concepts of electronic 8.4g Evaluate the impact of health information
health, mobile health, and telehealth systems in exchange, interoperability, and integration to
enabling patient care. support patient-centered care.

8.4d Explain the impact of health information

exchange, interoperability, and integration on
health care.

8.5 Use information and communication technologies in accordance with ethical, legal, professional,
and regulatory standards, and workplace policies in the delivery of care.

8.5a Identify common risks associated with using 8.5g Apply risk mitigation and security strategies to
information and communication technology. reduce misuse of information and communication
technology.

8.5b Demonstrate ethical use of social networking 8.5h Assess potential ethical and legal issues
applications. associated with the use of information and
communication technology.

8.5c Comply with legal and regulatory requirements 8.5i Recommend strategies to protect health
while using communication and information information when using communication and
technologies. information technology.

8.5d Educate patients on their rights to access, 8.5j Promote patient engagement with their
review, and correct personal data and medical personal health data.
records.

8.5e Discuss how clinical judgment and critical 8.5k Advocate for policies and regulations that
thinking must prevail in the presence of support the appropriate use of technologies
information and communication technologies. impacting health care.

8.5f Deliver care using remote technology. 8.5l Analyze the impact of federal and state policies
and regulation on health data and technology in
care settings.

48 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 9: Professionalism
Descriptor: Formation and cultivation of a sustainable professional identity, including
accountability, perspective, collaborative disposition, and comportment, that reflects nursing’s
characteristics and values.
Contextual Statement: Professionalism encompasses the development of a nursing identity
embracing the values of integrity, altruism, inclusivity, compassion, courage, humility, advocacy,
caring, autonomy, humanity, and social justice. Professional identity formation necessitates the
development of emotional intelligence to promote social good, engage in social justice, and
demonstrate ethical comportment, moral courage, and assertiveness in decision making and
actions. Nursing professionalism is a continuous process of socialization that requires the nurse
to give back to the profession through the mentorship and development of others.
Professional identity, influenced by one’s personal identity and unique background, is formed
throughout one’s education and career. Nursing identity flourishes through engagement and
reflection in multiple experiences that is defined by differing perspectives and voices. As a
result, nurses embrace the history, characteristics, and values of the discipline and think, act,
and feel like a nurse. Professional identity formation is not a linear process but rather one
that responds to challenges and matures through professional experiences as one develops
confidence as a nurse.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society.

9.1a Apply principles of professional nursing ethics 9.1h Analyze current policies and practices in the
and human rights in patient care and professional context of an ethical framework.
situations.

9.1b Reflect on one’s actions and their 9.1i Model ethical behaviors in practice and
consequences. leadership roles.

9.1c Demonstrate ethical behaviors in practice. 9.1j Suggest solutions when unethical behaviors are
observed.

9.1d Change behavior based on self and situational 9.1k Assume accountability for working to resolve
awareness. ethical dilemmas.

9.1e Report unethical behaviors when observed.

9.1f Safeguard privacy, confidentiality, and

autonomy in all interactions.

9.1g Advocate for the individual’s right to self-

determination.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 49

 9.2 Employ participatory approach to nursing care.

9.2a Employ the use of intentional presence to 9.2h Foster opportunities for intentional presence
facilitate shared meaning of the experience between in practice.
nurse and recipient of care.

9.2b Facilitate health and healing through 9.2i Identify innovative and evidence-based
compassionate caring. practices that promote person-centered care.

9.2c Demonstrate empathy to the individual’s life 9.2j Advocate for practices that advance diversity,
experience. equity, and inclusion.

9.2d Advocate for practices that advance diversity, 9.2k Model professional expectations for
equity, and inclusion. therapeutic relationships.

9.2e Demonstrate cultural sensitivity and humility 9.2l Facilitate communication that promotes a
in practice. participatory approach.

9.2f Apply principles of therapeutic relationships

and professional boundaries.

9.2g Communicate in a professional manner.

9.3 Demonstrate accountability to the individual, society, and the profession.

9.3a Engage in advocacy that promotes the 9.3i Advocate for nursing’s professional
best interest of the individual, community, and responsibility for ensuring optimal care outcomes
profession.

9.3b Demonstrate the moral courage to report 9.3j Demonstrate leadership skills when
concerns related to actual or potential hazards and/ participating in professional activities and/or
or errors. organizations.

9.3c Demonstrate professional and personal 9.3k Address actual or potential hazards and/or
honesty and integrity. errors.

9.3d Take responsibility for one’s roles, decisions, 9.3l Foster a practice environment that promotes
obligations, Actions, and care outcomes. accountability for care outcomes.

9.3e Engage in professional activities and/or 9.3m Advocate for policies/practices that promote
organizations. social justice and health equity.

9.3f Demonstrate adherence to a culture of civility. 9.3n Foster strategies that promote a culture of
civility across a variety of settings.

9.3g Advocate for social justice and health equity, 9.3o Lead in the development of opportunities for
including addressing the health of vulnerable professional and interprofessional activities.
populations.

9.3h Engage in peer evaluation.

50 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

9.4 Comply with relevant laws, policies, and regulations.

9.4a Advocate for policies that promote health and 9.4d Advocate for polices that enable nurses to
prevent harm. practice to the full extent of their education.

9.4b Adhere to the registered nurse scope and 9.4e Assess the interaction between regulatory
standards of practice. agency requirements and quality, fiscal, and value-
based indicators.

9.4c Adhere to regulatory requirements and 9.4f Evaluate the effect of legal and regulatory
workplace policies consistent with one’s policies on nursing practice and healthcare
educational preparation. outcomes.

9.4g Analyze efforts to change legal and regulatory

policies that improve nursing practice and health
outcomes.

9.4h Participate in the implementation of policies

and regulations to improve the professional
practice environment and healthcare outcomes.

9.5 Demonstrate the professional identity of nursing.

9.5a Describe nursing’s professional identity and 9.5f Articulate nursing’s unique professional
contributions to the healthcare team. identity to other interprofessional team members
and the public.

9.5b Demonstrate the core values of professional 9.5g Evaluate practice environment to ensure that
nursing identity. nursing core values are demonstrated.

9.5c Demonstrate sensitivity to the values of 9.5h Identify opportunities to lead with moral
others. courage to influence team decision-making.

9.5d Demonstrate ethical comportment and moral 9.5i Engage in professional organizations that
courage in decision making and actions. reflect nursing’s values and identity.

9.5e Demonstrate emotional intelligence.

9.6 Integrate diversity, equity, and inclusion as core to one’s professional identity.

9.6a Demonstrate respect for diverse individual 9.6d Model respect for diversity, equity, and
differences and diverse communities and inclusion for all team members.
populations

9.6b Demonstrate awareness of personal and 9.6e Critique one’s personal and professional
professional values and conscious and unconscious practices in the context of nursing’s core values.
biases.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 51

 9.6c Integrate core principles of social justice and 9.6f Analyze the impact of structural and cultural
human rights into practice. influences on
nursing’s professional identity.

9.6g Ensure that care provided by self and others is

reflective of nursing’s core values.

9.6h Structure the practice environment to

facilitate care that is culturally and linguistically
appropriate.

9.6i Ensure self and others are accountable in

upholding moral, legal, and humanistic principles
related to health.

52 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 10: Personal, Professional, and Leadership Development
Descriptor: Participation in activities and self-reflection that fosters personal health, resilience,
and well-being; contributes to lifelong learning; and supports the acquisition of nursing
expertise and the assertion of leadership.
Contextual Statement: Competency in personal, professional, and leadership development
encompasses three areas: 1) development of the nurse as an individual who is resilient, agile,
and capable of adapting to ambiguity and change; 2) development of the nurse as a professional
responsible for lifelong learning and ongoing self-reflection; and 3) development of the nurse
as a leader proficient in asserting control, influence, and power in professional and personal
contexts, which includes advocacy for patients and the nursing profession as leaders within
the healthcare arena. Development of these dimensions requires a commitment to personal
growth, sustained expansion of professional knowledge and expertise, and determined
leadership practice in a variety of contexts.
Graduates must develop attributes and skills critical to the viability of the profession and
practice environments. The aim is to promote diversity and retention in the profession, self-
awareness, avoidance of stress-induced emotional and mental exhaustion, and re-direction of
energy from negative perceptions to positive influence through leadership opportunities.

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

10.1 Demonstrate a commitment to personal health and well-being.

10.1a Demonstrate healthy, self-care behaviors that 10.1c Contribute to an environment that promotes
promote wellness and resiliency. self-care, personal health, and well-being.

10.1b Manage conflict between personal and 10.1d Evaluate the workplace environment to
professional responsibilities. determine level of health and well-being.

10.2 Demonstrate a spirit of inquiry that fosters flexibility and professional maturity.

10.2a Engage in guided and spontaneous reflection 10.2g Demonstrate cognitive flexibility in managing
of one’s practice. change within complex environments.

10.2b Integrate comprehensive feedback to 10.2h Mentor others in the development of their
improve performance. professional growth and accountability.

10.2c Commit to personal and professional 10.2i Foster activities that support a culture of
development. lifelong learning.

10.2d Expand personal knowledge to inform clinical 10.2j Expand leadership skills through professional
judgment. service.

10.2e Identify role models and mentors to support

professional growth.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 53

 10.2f Participate in ongoing activities that embrace
principles of diversity, equity, inclusion, and anti-
discrimination.

10.3 Develop capacity for leadership.

10.3a Compare and contrast leadership principles 10.3j Provide leadership to advance the nursing
and theories. profession.

10.3b Formulate a personal leadership style. 10.3k Influence intentional change guided by
leadership principles and theories.

10.3c Demonstrate leadership behaviors in 10.3l Evaluate the outcomes of intentional change.
professional situations.

10.3d Demonstrate self-efficacy consistent with 10.3m Evaluate strategies/methods for peer review.
one’s professional development.

10.3e Use appropriate resources when dealing with 10.3n Participate in the evaluation of other
ambiguity. members of the care team.

10.3f Modify one’s own leadership behaviors based 10.3o Demonstrate leadership skills in times of
on guided self-reflection. uncertainty and crisis.

10.3g Demonstrate self-awareness of one’s own 10.3p Advocate for the promotion of social justice
implicit biases and their relationship to one’s and eradication of structural racism and systematic
culture and environment. inequity in nursing and society.

10.3h Communicate a consistent image of the 10.3q Advocate for the nursing profession in a
nurse as a leader. manner that is consistent, positive, relevant,
accurate, and distinctive.

10.3i Recognize the importance of nursing’s

contributions as leaders in practice and policy
issues.

54 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

 Glossary
Accountability: Obligation or willingness to accept responsibility or to account for one’s actions.
Advanced nursing practice role: One of the four Advanced Practice Registered Nurse (APRN)
roles – certified registered nurse anesthetist, certified nurse-midwife, certified clinical nurse
specialist, and certified nurse practitioner.
Advanced nursing practice specialty: See Specialty.
Advanced Practice Registered Nurse (APRN): Designation given to one of four nursing roles:
certified registered nurse anesthetists, certified nurse-midwives, certified clinical nurse
specialists, and certified nurse practitioners. An APRN is a nurse who has 1.) completed an
accredited graduate-level education program preparing him/her for one of the four recognized
APRN roles; 2.) passed a national certification examination that measures APRN role and
population-focused competencies and who maintains continued competence as evidenced
by recertification in the role and population through the national certification program; 3.)
acquired advanced clinical knowledge and skills preparing him/her to provide direct care to
patients, as well as a component of indirect care; 4.) built on the competencies of registered
nurses by demonstrating a greater depth and breadth of knowledge, a greater synthesis of
data, increased complexity of skills and interventions, and greater role autonomy; 5.) been
educationally prepared to assume responsibility and accountability for health promotion and/or
maintenance as well as the assessment, diagnosis, and management of patient problems, which
includes the use and prescription of pharmacologic and non-pharmacologic interventions;
6.) clinical experience of sufficient depth and breadth to reflect the intended license; and 7.)
obtained a license to practice in one of the four APRN roles (APRN Consensus Work Group &
NCSBN APRN Advisory Committee, 2008).
APRN Core: APRN education programs include at a minimum, three separate comprehensive
graduate-level courses in: Advanced physiology and pathophysiology, which includes general
principles that apply across the lifespan; Advanced health assessment, which includes
assessment of all human systems, advanced assessment techniques, concepts and approaches;
and Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and
pharmacotherapeutics of all broad categories of agents (APRN Consensus Work Group & NCSBN
APRN Advisory Committee, 2008).
Advocacy: The act or process of supporting a cause or proposal: the act or process of
advocating. Advocacy is a pillar of nursing. Nurses instinctively advocate for their patients, in
their workplaces, and in their communities; but legislative and political advocacy is equally
important to advancing patient care.
Analytic approach: Any method based on breaking down a complex process into its parts so as
to better understand the whole.
Authentic or intentional presence: Being fully present in the moment This extends to
possessing an awareness of when you drift and how to intentionally bring yourself back to the
interaction (Altman, 2014).

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Care: A focused attention on, and when possible, engagement with a patient to determine a
person’s particular needs and the use of clinical judgment to meet those needs (Grace, 2018).
Care outcomes: Harris (1991) defined outcomes as the end points of care, substantial changes
in the health condition of a patient, and changes in patient behavior caused by medical
interventions. Given these definitions, outcomes related to clinical practice are any change that
resulted from health care.
Caring relationship: Caring constitutes the essence of what it is to be human, having a profound
effect on well‐being and recovery, being at ease, and being healed. When hospitality is received,
patients feel a connection, they begin to trust, and their healing begins.
Clinical immersion: A brief, structured, intense nursing practicum where the entire focus is in a
particular clinical setting without the distraction of other academic classes (Tratnack, et al., 2011).
Clinical judgment: The skill of recognizing cues regarding a clinical situation, generating and
weighing hypotheses, taking action, and evaluating outcomes for the purpose of arriving at a
satisfactory clinical outcome. Clinical judgment is the observed outcome of two unobserved
underlying mental processes, critical thinking and decision making (NCSBN, 2018).
Clinical reasoning: Thought processes that allow healthcare providers to arrive at a conclusion.
Cognitive flexibility: A critical executive function involving the ability to adapt behaviors in
response to changes in the environment. Cognitive flexibility generally refers to the ability to
adapt flexibly to a constantly changing environment.
Complex systems: Systems whose behavior is intrinsically difficult to model due to the
dependencies, competitions, relationships, or other types of interactions between their parts
or between a given system and its environment. Complex systems have distinct properties that
arise from these relationships, such as nonlinearity, emergence, spontaneous order, adaptation,
and feedback loops, among others.
Competence: The array of abilities (knowledge, skills, and attitudes) across multiple domains
or aspects of performance in a certain context. Competence is multi-dimensional and dynamic
(Frank, Snell, Cate, et al., 2010).
Competency: An observable ability of a health professional, integrating multiple components
such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be
measured and assessed to ensure their acquisition (Frank, Snell, Cate, et al., 2010).
Competency framework: An organized and structured representation of a set of interrelated
and purposeful competencies (Englander et al., 2013, p. 1089).
Competency list: The delineation of the specific competencies within a competency framework
(Englander, et al., 2013, p.1089).
Concepts: A concept is an organizing idea or mental construct represented by common
attributes. Rodgers (1989, p. 332) describes concepts as “an abstraction that is expressed in
some form.”

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Core values: In nursing, core nursing values include human dignity, integrity, autonomy,
altruism, and social justice.
Core disciplinary knowledge: The intellectual structures within which the discipline delineates
its unique focus of vision and social mandate. AACN has identified core disciplinary knowledge
as having three components: historic and philosophic foundations to the development of
nursing knowledge; existing and evolving substantive nursing knowledge; and methods and
processes of theory/knowledge development (AACN, 2002, p. 289).
Cost effectiveness: A way to examine both the costs and health outcomes of one or more
interventions; it compares one intervention to another (or the status quo) by estimating how
much it costs to gain a unit of a health outcome, like a life year gained or a death prevented.
Critical thinking: The skill of using logic and reasoning to identify the strengths and weaknesses
of alternative healthcare solutions, conclusions, or approaches to clinical or practice problems.
Cultural awareness: The deliberate self-examination and in-depth exploration of one’s biases,
stereotypes, prejudices, assumptions, and “isms” that one holds regarding individuals and
groups who are different from them (Campinha-Bacote, 1998).
Cultural competence: The ability to effectively work within the client’s cultural context.
Structural competence is recognition of the economic and political conditions that produce
health inequalities in the first place. It is the ability to understand how institutions, markets,
or healthcare delivery systems shape symptom presentations and to mobilize for correction of
health and wealth inequalities in society (Drevdahl, 2018; Metzl et al., 2018; Metzl et al., 2020).
Cultural and linguistic competence: A set of congruent behaviors, attitudes, and policies that
come together in a system, agency, or among professionals that enables effective work in
cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include
the language, thoughts, communications, actions, customs, beliefs, values, and institutions of
racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function
effectively as an individual and an organization within the context of the cultural beliefs,
behaviors, and needs presented by consumers and their communities (Cross et al., 1989).
Cultural competence is a developmental process that evolves over an extended period.
Culturally sensitive: “The ability to be appropriately responsive to the attitudes, feelings,
or circumstances of groups of people that share a common and distinctive racial, national,
religious, linguistic, or cultural heritage” (DHHS, OMH, 2001, p. 131).
Cultural humility: A lifelong process of self-reflection and self-critique whereby the individual
not only learns about another’s culture, but also examines her/his own beliefs and cultural
identities.
Determinants of health: The range of personal, social, economic, and environmental
factors that interrelate to determine individual and population health. These factors include
policymaking, social factors, health services, individual behaviors, and biology and genetics.
Determinants of health reach beyond the boundaries of traditional health care and public
health sectors. Sectors such as education, housing, transportation, agriculture, and environment
can be important allies in improving population health (Healthy People 2020).

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Diagnose: To identify the nature of an illness or other problem by examination of the symptoms.
Diversity: A broad range of individual, population, and social characteristics, including but
not limited to age; sex; race; ethnicity; sexual orientation; gender identity; family structures;
geographic locations; national origin; immigrants and refugees; language; any impairment that
substantially limits a major life activity; religious beliefs; and socioeconomic status. Inclusion
represents environmental and organizational cultures in which faculty, students, staff, and
administrators with diverse characteristics thrive. Inclusive environments require intentionality
and embrace differences, not merely tolerate them. Everyone works to ensure the perspectives
and experiences of others are invited, welcomed, acknowledged, and respected in inclusive
environments.
Domains of competence: Broad distinguishable areas of competence that in the aggregate
constitute a general descriptive framework for a profession (Englander et al., 2013, p. 1089).
Emotional intelligence: The ability to perceive, appraise and express emotion, access and
process emotional information, generate feelings, understand emotional knowledge and
regulate emotions for emotional and intellectual growth (Mayer, et al, 1997, p. 10). Emotional
intelligence, like academic intelligence, can be learned, increases with age, and is predictive of
how emotional processing contributes to success in life (Mayer et al., 2004).
Equity: The ability to recognize the differences in the resources or knowledge needed to allow
individuals to fully participate in society, including access to higher education, with the goal
of overcoming obstacles to ensure fairness (Kranich, 2001). To have equitable systems, all
people should be treated fairly, unhampered by artificial barriers, stereotypes, or prejudices
(Cooper, 2016).
Ethical comportment: The way in which nurses embody the ability to relate to others respectfully
and responsively (Benner, 2009. Ethical comportment consists of four critical attributes: 1)
embodiment, 2) skilled relational know-how, 3) caring, and 4) salience (Hardin, 2018).
Ethical competence: The ability to recognize an ethical situation/issue (awareness/sensitivity),
the ability to determine a justifiable action (reflection/decision-making), and have the
motivation, knowledge, and skills to implement a decision (comportment and action) (ANA
Scope & Standards, 2021).
Evidence-based practice: A conscientious, problem-solving approach to clinical practice that
incorporates the best evidence from well-designed studies, patient values and preferences, and
a clinician’s expertise in making decisions regarding a patient’s care. Being knowledgeable about
evidence-based practice and levels of evidence is important for clinicians to be confident about
how much emphasis they should place on a study, report, practice alert or practice guideline
when making decisions about a patient’s care.
Explicit biases: Conscious positive or negative feelings and/or thoughts about groups or identity
characteristics. Because these attitudes are explicit in nature, they are espoused openly,
through overt and deliberate thoughts and actions (Harrison et al., 2019; Wilson et al., 2000)

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Family: An individual’s closest support structure that is inclusive of birth family, single parent
families, blended families, families with stepparents, and families with homosexual parents to
name a few. The concept of the contemporary family has evolved into a fluid ideology that is
constantly shifting and changing throughout society.
Health disparities: “A particular type of health difference that is closely linked with economic,
social, or environmental disadvantage. Health disparities adversely affect groups of people who
have systematically experienced greater social or economic obstacles to health based on their
racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive,
sensory, or physical disability; sexual orientation or gender identity; geographic location; or
other characteristics historically linked to discrimination or exclusion” (US Department of Health
and Human Services (2010).
Health equity: When every person has an opportunity to attain his or her full health potential”
and no one is “disadvantaged from achieving this potential because of social position or other
socially determined circumstances (National Academies of Sciences, Engineering, and Medicine,
2017). Health inequities are reflected in differences in length of life; quality of life; rates of
disease, disability, and death; severity of disease; and access to treatment.
Health inequity: The distribution and allocation of power and resources differentially, which
manifest in unequal social, economic, and environmental conditions (National Academies of
Sciences, Engineering, and Medicine, 2017).
Health Information Technology (HIT): The electronic systems healthcare professionals and
patients use to store, share, and analyze health information. HIT consists of many types of
applications such as Electronic Health Records, personal health records, electronic prescribing,
mobile applications, social networks, monitors, wearables, nanotechnology, genomics, and
robotics (Office of the National Coordinator for Health Information Technology [ONC], 2018).
Healthcare team: The collective of individuals who contribute to the care and treatment of an
individual, family, group, or population.
Healthy lifestyle: A way of living that lowers the risk of being seriously ill or dying early.
Scientific studies have identified certain types of behavior that contribute to the development
of noncommunicable diseases and early death. Health is not only just about avoiding disease. It
involves physical, mental and social wellbeing.
Holistic admissions review: An admissions strategy that assesses an applicant’s unique
experiences alongside traditional measures of academic achievement, such as grades and test
scores. This process is used to help schools consider a broad range of factors reflecting the
applicant’s academic readiness, contribution to the incoming class, and potential for success
both in school and later as a professional.
Holistic nursing: “All nursing practice that has healing the whole person as its goal” (American
Holistic Nurses’ Association, 1998).

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Implicit and unconscious biases: The tendency to process information based on unconscious
associations and feelings, even when these are contrary to one’s conscious or declared beliefs.
They are automatically activated and may occur unconsciously (Metzl et al., 2018, 2020; Van
Ryn et al. 2011).
Inclusive environments: Environmental and organizational cultures in which faculty, students,
staff, and administrators with diverse characteristics thrive. Inclusive environments require
intentionality and embrace differences, not merely tolerate them. Everyone works to ensure the
perspectives and experiences of others are invited, welcomed, acknowledged, and respected.
Inequities: Characterized by a lack of equity, injustice, unfairness.
Informatics: The intersection between the work of stakeholders across the health and
healthcare delivery system who seek to improve outcomes, lower costs, increase safety and
promote the use of high-quality services. It is frequently confused with data science, big data,
health information management and data analytics, informatics is the overarching field of study
that pulls all these subdomains into one discipline focused on improving health and healthcare.
Emerging topics like artificial intelligence and machine learning are incorporating in the field of
informatics (AMIA, 2021).
Information and Communications Technologies (ICT): Technologies that provide access to
information through telecommunications, including the internet, telephones, cell phones,
wireless signals, networks, satellite systems, telehealth/telenursing, and video conferencing.
Innovation: A great idea to develop and deliver new or improved health policies, systems,
products and technologies, and services and delivery methods that improve people’s health
(WHO Health Innovation Group, 2021).
Integration: An experience designed to provide the student with an opportunity to synthesize
the knowledge and skills acquired during previous and current coursework and learning
experiences.
Intentional change theory: The essential components and processes of desirable, sustainable
change in one’s behavior, thoughts, feelings, and perceptions. The “change” maybe in a person’s
actions, habits, competencies, or aspirations as well as in the way one feels in certain situations
or around certain people. The change may impact how one looks at events at work or in life.
The change is “desired” in that person wishes it so or would like to occur and is “sustainable” in
that it endures and lasts a relatively long time (Boyatzis, 2006).
Interdisciplinary: Refers to a group of healthcare providers with various areas of expertise who
work together toward the goals of their clients.
Interoperability: The ability of different information systems, devices, and applications
(systems) to access, exchange, integrate, and cooperatively use data in a coordinated manner,
within and across organizational, regional, and national boundaries to provide timely and
seamless portability of information and optimize the health of individuals and populations
globally. Health data exchange architectures, application interfaces, and standards enable data
to be accessed and shared appropriately and securely across the complete spectrum of care,
within all applicable settings and with relevant stakeholders, including the individual.

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Interprofessional: Engagement involving two or more professions or professionals.
Interprofessional team: The cooperation, coordination, and collaboration expected among
members of different professions in delivering patient-centered care collectively.
Just culture: Balances the need for an open and honest reporting environment with a quality
learning environment and culture. All individuals within this environment are held responsible
for the quality of their choices. Just culture requires a change in focus from errors and outcomes
to system design and management of the behavioral choices of all employees.
Lifelong learning: The provision or use of both formal and informal learning opportunities
throughout one’s life to foster the continuous development and improvement of the knowledge
and skills needed for employment and personal fulfillment.
Macrosystem: The highest system level represents the whole of the organization and is led by
senior leaders such as the CEO, chief operations officer (COO), chief nursing officer (CNO), and
chief information officer (CIO) and is guided by a board of trustees (Nelson, et al., 2007).
Managing disease: To improve the health of persons with chronic conditions and reduce
associated costs from avoidable complications by identifying and treating chronic conditions
more quickly and more effectively, thus slowing the progression of diseases.
Mesosystem: The interrelated units and clinical leadership that provide care to certain
populations (McKinley et al., 2008).
Microsystem: Small, functional frontline units that provide the most health care to most people
(Nelson et al., 2007, p.3). A clinical microsystem is a small group of people who work together
on a regular basis to provide care to discrete subpopulations of patients. These units have
clinical and business aims, linked processes, and a shared information environment, and focus
on producing performance outcomes. Microsystems are complex adaptive systems, and as such
they must do the primary work associated with core aims, meet the needs of internal staff, and
maintain themselves over time as clinical units (Nelson, et al., 2002).
Mitigation: The action of reducing the severity, seriousness, or painfulness of something.
Mobile health (mHealth): The use of mobile and wireless technologies to support the
achievement of health objectives. The expanding use of mobile health is driven rapid advances
in mobile technologies and applications, a rise in new opportunities for the integration of
mobile health into existing eHealth services, and the continued growth in coverage of mobile
cellular networks.
Moral courage: The willingness of individuals to take hold of, and fully support, ethical
responsibilities essential to professional values (Day, 2007). This highly esteemed trait is
displayed by individuals, who, despite adversity and personal risk, decide to act upon their
ethical values to help others during difficult ethical dilemmas. Moral courage entails doing the
right thing, even when others choose less ethical behavior, which may include taking no action
at all (Lachman, 2009; 2007a; 2007b; Sekerka & Bagozzi, 2007).
Moral ethical behaviors: Prevailing standards of behavior used to judge right and wrong.

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Nurse sensitive indicators: Reflect three aspects of nursing care: structure, process, and
outcomes. Structural indicators include the supply of nursing staff, the skill level of nursing staff,
and the education and certification levels of nursing staff. Process indicators measure methods
of patient assessment and nursing interventions. Nursing job satisfaction is also considered a
process indicator. Outcome indicators reflect patient outcomes that depend on the quantity or
quality of nursing care (e.g., pressure ulcers and falls).
Nursing informatics: The specialty that integrates nursing science with multiple information and
analytical sciences to identify, define, manage, and communicate data, information, knowledge,
and wisdom in nursing practice (HIMSS, 2021).
Participatory approach: Calls for involving stakeholders, particularly the participants in a
program or those affected by a given policy, in specific aspects of the evaluation process. The
approach covers a wide range of different types of participation, and stakeholders can be
involved at any stage of the impact evaluation process, including its design, data collection,
analysis, reporting, and managing a study.
Partnerships: Close cooperation between parties having specified and joint rights and
responsibilities.
Patient: The recipient of a healthcare service or intervention at the individual, family,
community, or aggregate level. Patients may function in independent, interdependent, or
dependent roles, and may seek or receive nursing interventions related to disease prevention,
health promotion, or health maintenance, as well as illness and end-of-life care (AACN, 2006).
Person-Centered Care: “Empowering people to take charge of their own health rather than
being passive recipients of services” (WHO, 2021). This care strategy is based on the belief that
patient views, input, and experiences can help improve overall health outcomes.
Point of Care: Where care is delivered, including in diverse settings where individuals live, learn,
work, play, and worship.
Population: A collection of individuals who have one or more personal or environmental
characteristics in common.
Practice: Any form of nursing intervention that influences healthcare outcomes for individuals
or populations, including the direct care of individual patients, management of care for
individuals and populations, administration of nursing and healthcare organizations, and the
development and implementation of health policy (AACN, 2004). Practice includes both direct
and indirect care experiences (defined below).
Direct Care/Indirect Care:
• Direct care refers to a professional encounter between a nurse and an actual individual
or family, either face to face or virtual, that is intended to achieve specific health goals
or achieve selected health outcomes. Direct care may be provided in a wide range of
settings, including acute and critical care, long term care, home health, community-
based settings, and telehealth. (AACN, 2004, 2006; Suby, 2009; Upenieks, Akhavan,
Kotlerman et al., 2007).

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 • Indirect care refers to nursing decisions, actions, or interventions that are provided
through or on behalf of individuals, families, or groups. These decisions or
interventions create the conditions under which nursing care or selfcare may occur.
Nurses might use administrative decisions, population or aggregate health planning,
or policy development to affect health outcomes in this way. Nurses who function
in administrative capacities are responsible for direct care provided by other nurses.
Their administrative decisions create the conditions under which direct care is
provided. Public health nurses organize care for populations or aggregates to create
the conditions under which improved health outcomes are more likely to occur. Health
policies create broad scale conditions for delivery of nursing and health care (AACN,
2004, 2006; Suby, 2009; Upenieks et al., 2007).
Preparedness: The readiness of the nation’s medical and public health infrastructure to
respond to and recover from disasters and public health emergencies. Preparedness requires
collaboration with hospitals, healthcare coalitions, biotech firms, community members, state,
local, tribal, and territorial governments, and other partners across the country to improve
readiness and response capabilities.
Primary and secondary data: Primary data is collected by an investigator for a specific purpose.
Secondary data is collected by someone else for another purpose (but being utilized by the
investigator for another purpose).
Profession: An occupation (e.g., nursing, medicine, law, teaching) that is not mechanical or
agricultural and requires special education.
Professional agility: The power to move quickly and easily; the ability to think and draw
conclusions quickly drawing on intellectual acuity.
Professional development: Taking purposeful action to engage in structured activities to advance
career development, education, leadership, program management, and/or compliance initiatives.
Professional identity: The representation of self, achieved in stages over time during which
the characteristics, values, and norms of a profession are internalized, resulting in an individual
thinking, acting, and feeling like a member of the profession (Cruess et al., 2014).
Quality Improvement (QI): A process that uses data to monitor the outcomes of care processes.
QI uses improvement methods to design and test changes to continuously improve the quality
and safety of health care systems (Cronenwett et al., 2007).
Resilience: The ability to survive and thrive in the face of adversity. Resilience can be developed
and internalized as a measure to improve retention and reduce burnout. Building positive
relationships, maintaining positivity, developing emotional insight, creating work-life balance,
and reflecting on successes and challenges are effective strategies for resilience building.
Response and recovery in an emergency/disaster: Identifying resources and expertise in
advance and planning how these can be used in a disaster. Preparedness, however, is only
one phase of emergency management. There are four phases of emergency management:
mitigation, preparedness, response, and recovery.

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Responsibility: The state or fact of being responsible, answerable, or accountable for something
within one’s power, control, or management.
Return on investment (ROI): A performance measure used to evaluate the efficiency of an
investment or compare the efficiency of a number of different investments. ROI seeks to
directly measure the amount of return on a particular investment, relative to the investment’s
cost. To calculate ROI, the benefit (or return) of an investment is divided by the cost of the
investment. The result is expressed as a percentage or a ratio.
Risk assessment: A process to identify potential hazards and analyze what could happen if a
hazard occurs. To assess risk, organizations often consider possible scenarios that could unfold
and what the potential impacts may be.
Scholarship: The generation, synthesis, translation, application, and dissemination of knowledge
that aims to improve health and transform health care. Scholarship is the communication of
knowledge generated through multiple forms of inquiry that inform clinical practice, nursing
education, policy, and healthcare delivery. Scholarship is inclusive of discovery, integration,
application, and teaching (Boyer, 1990). The hallmark attribute of scholarship is the cumulative
impact of the scholar’s work on the field of nursing and health care.
Self-care: The act of attending to one’s physical or mental health, generally without medical or
other professional consultation.
Self-management: The management of or by oneself; the taking of responsibility for one’s own
behavior and well-being.
Service: is the action of helping or doing work for someone.
Simulation: A technique that creates a situation or environment to allow persons to experience
a representation of a real event for the purpose of practice, learning, evaluation, testing, or to
gain understanding of systems or human actions (AHRQ, 2020).
Social Determinants of Health: See Determinants of Health
Social Justice: The expectation that everyone deserves equal economic, political,
and social rights and opportunities. Equity, access, participation, and human rights are four
principles of social justice including to ensure fair distribution of available resources across
society, to ensure all people have access to goods and services regardless of age, gender, race,
ethnicity etc.; to enable people to participate in decisions that affect their lives, and to protect
individual liberties to information about circumstances and decisions affecting them and to
appeal decisions believed to be unfair (Morgaine, 2014; Nemetchek, 2019).
Social Responsibility: An ethical theory in which individuals are accountable for fulfilling their
civic duty, and the actions of an individual must benefit the whole of society. This typically
involves a balance between economic growth and the welfare of society and the environment.
(Pachchamama Alliance, 2021)

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Specialty: The pursuit, area of study, or skill to which someone has devoted much time and effort
and in which they are expert. Nursing specialization involves focusing on nursing practice in an
identified specific area within the discipline of professional nursing. A defined specialty scope of
practice statement and standards of professional practice, with accompanying competencies,
are unique to each nursing specialty. These documents help assure continued understanding and
recognition of nursing’s diverse professional contributions (Finnell, et al, 2015).
• Advanced nursing practice specialties: Currently, advanced nursing practice specialties
include informatics, administration/practice leadership, public health/population
health, and health policy. Specialties may evolve over time to address future
healthcare needs.
Spheres of Care: Encompass the healthcare needs of individuals, families, populations, and
the care/services required to address these needs and promote desired health outcomes. In
this document, four spheres of care are delineated 1) disease prevention/promotion of health
and well-being, which includes the promotion of physical and mental health in all patients as
well as management of minor acute and intermittent care needs of generally healthy patients;
2) chronic disease care, which includes management of chronic diseases and prevention of
negative sequelae; 3) regenerative or restorative care, which includes critical/trauma care,
complex acute care, acute exacerbations of chronic conditions, and treatment of physiologically
unstable patients that generally requires care in a mega-acute care institution; and, 4) hospice/
palliative/supportive care which includes end-of-life care as well as palliative and supportive
care for individuals requiring extended care or those with complex, chronic disease states or
those requiring rehabilitative care (Lipstein, et al, 2016; AACN, 2019).
Standardized data: The process of ensuring that one data set can be compared to
other data sets. In statistics, standardized data is the process of putting different variables on
the same scale. This process allows one to compare scores between different types of variables.
Stress management: A range of strategies to help one better deal with stress and difficulty
(adversity). Managing stress can help an individual lead a more balanced, healthier life.
Stress is an automatic physical, mental and emotional response to a challenging event. Stress
management approaches include learning skills such as problem-solving, prioritizing tasks, and
time management to enhance the ability to cope with adversity.
Structural racism: A complex system of conferring social benefits in some groups and imposing
burdens on others resulting in segregation, poverty, and denial of opportunity for people of
color. Structural racism comprises cultural beliefs, historical legacies, and institutions, policies
within and among public and private organizations that interweave to create drastic racial
disparities in life outcomes (Wiecek, 2011).
Support care: Treatment given to prevent, control, or relieve complications and side effects and
to improve the patient’s comfort and quality of life.
System decision: A computerized program used to support determinations, judgments, and
courses of action in an organization or a business. A system decision sifts through and analyzes
massive amounts of data, compiling comprehensive information that can be used to solve
problems and in decision-making.

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Systemic inequity: A condition where one category of people is attributed an unequal status
in relation to other categories of people. This relationship is perpetuated and reinforced by a
confluence of unequal relations in roles, functions, decisions, rights, and opportunities.
Systemic racism (also known as institutionalized racism): Terms similar to structural racism
which focuses more on the historical, cultural and social psychological aspects of the currently
racialized society. The term institutional racism may be used to differentiate “access to the
goods, services, and opportunities of society by race. Institutionalized racism is normative,
sometimes legalized, and often manifests as inherited disadvantage. It is structural, having been
codified in our institutions of custom, practice, and law, so there is no identifiable perpetrator.
Institutionalized racism is often evident as inaction in the face of need” (Jones, 2000).
Systems: A set of elements or components working together as parts of a mechanism or an
interconnecting network.
Systems-based practice: An analytic tool and a way of viewing the world, which can
make caregiving and change efforts more successful. The focus is on understanding the
interdependencies of a system or series of systems and the changes identified to improve care
that can be made and measured in the system.
Team-based care: The provision of health services to individuals, families, and/or their
communities by at least two health providers who work collaboratively with patients and their
caregivers—to the extent preferred by each patient—to accomplish shared goals within and across
settings to achieve coordinated, high-quality care (Naylor, 2010; NAM, 2012; AANP, 2020).
Telehealth systems: The use of a technology-based virtual platform to deliver various aspects of
health information, prevention, monitoring, and medical care.
Translation: The process of turning observations in the laboratory, clinic, and community into
interventions that improve the health of individuals and the public — from diagnostics and
therapeutics to medical procedures and behavioral changes.
Translational science: The field of investigation focused on understanding the scientific and
operational principles underlying each step of the translational process. Translational scientists
are innovative and collaborative, searching for ways to break down barriers in the translation
process and ultimately deliver more treatments to more patients more quickly.
Wellness and well-being: A state of being marked by emotional stability (e.g., coping effectively
with life and creating satisfying relationships) and physical health (e.g., recognizing the need for
physical activity, healthy foods, and sleep).

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 Essentials Task Force
Essentials Leadership Team

Jean Giddens, PhD, RN, FAAN Jean Bartels, PhD, RN

Co-Chair of the Essentials Task Force Consultant
Virginia Commonwealth University
Linda Caldwell, DNSc, ANP-BC
Cynthia McCurren, PhD, RN Consultant
Co-Chair of the Essentials Task Force
University of Michigan-Flint Nancy DeBasio, PhD, RN, FAAN
Consultant
John McFadden, PhD, CRNA
Co-Chair of the Essentials Task Force
Barry University
Lin Zhan, PhD, RN, FAAN
AACN Board Liaison
University of Memphis
Essentials Task Force Members

Angela Amar, PhD, RN, ANEF, FAAN Kristin Lee, PhD, MSN, RN, CNE
University of Nevada Las Vegas University of Missouri-Kansas City
Jacklyn Barber, EdD, RN, CNL, CNS Kim Litwack, PhD, RN, FAAN, APNP
Morningside College University of Wisconsin-Milwaukee
Carol Buck-Rolland, EdD, APRN Mary Morin, MSN, RN, NEA-BC
University of Vermont Sentara Healthcare (Practice)
Jill Case-Wirth, MHA, BSN, RN Connie Miller, DNP, RNC-OB, CNE
WellStar Health System (Practice) University of Arizona
Lori Escallier, PhD, RN, CPNP-PC, FAAN Susan Mullaney, DNP, APRN, GNP-BC,
SUNY Downstate Health Sciences University GS-C, FAANP
UnitedHealth Group (Practice)
Eileen Fry-Bowers, PhD, JD, RN, CPNP, FAAN
University of San Diego Susan Ruppert, PhD, RN, FNP-C,
ANP-BC, FCCM, FNAP, FAANP, FAAN
Vincent Hall, PhD, RN, CNE University of Texas Health Science Center
Walden University at Houston
Beverly Foster, PhD, MN, MPH, RN Marcella Rutherford, PhD, MBA, MSN, RN
University of North Carolina – Chapel Hill Nova Southeastern University
Jacqueline Hill, PhD, RN Martha Scheckel, PhD, MSN, RN
Bowie State University University of St Thomas
Erica Hooper-Arana, DNP, RN, PHN, CNS, CNL Jenny Schuessler, PhD, RN, CNE
University of San Francisco University of West Georgia

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 75

Casey Shillam, PhD, RN Marisa Wilson, DNSc, MHSc, RN, CPHIMS,
University of Portland RN-BC, FAMIA, FAAN
University of Alabama-Birmingham
Mary Stachowiak, DNP, RN, CNL
Rutgers School of Nursing Danuta Wojnar, PhD, RN, MN, MED,
IBCLC, FAAN
Rachel Start, MSN, RN, NEA-BC, FAAN Seattle University
Rush University Medical Center (Practice)
Geraldine Young, DNP, MSN, APRN, FNP-BC,
Allison Squires, PhD, RN, FAAN CDCES, FAANP
New York University Frontier Nursing University
Susan Swider, PhD, PHNA-BC, FAAN
Rush University
Marjorie Splaine Wiggins, DNP, MBA, RN,
NEA-BC, FAAN
Maine Health System (Practice)
AACN Staff Liaisons

Joan Stanley, PhD, NP, FAAN, FAANP Shirin Samimi-Farr

Chief Academic Officer Project Manager
Rick García, PhD, RN Krisi Yosifova
Director of Nursing Education Nursing Education Coordinator
Kathy McGuinn, MSN, RN
Director of Interprofessional Education and
Practice Partnerships

Approved by the AACN Membership on April 6, 2021.

76 THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION