The Essentials: Competencies for Professional Nursing Education

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

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iii

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

The Essenals: Core Competencies for Professional Nursing Educaon

April 6, 2021

TABLE OF CONTENTS

Introducon .................................................................................................................................. 1

Foundaonal Elements ........................................................................................................ 2

Nursing Educaon for the 21

Century ............................................................................... 5

Domains and Concepts ............................................................................................................... 10

Domains for Nursing .......................................................................................................... 10

Concepts for Nursing Pracce ........................................................................................... 11

Competencies and Sub-Competencies ....................................................................................... 15

A New Model for Nursing Educaon .......................................................................................... 16

Implemenng the Essenals: Consideraons for Curriculum .................................................... 18

Entry-Level Professional Nursing Educaon ...................................................................... 19

Advanced-Level Nursing Educaon ................................................................................... 21

Domains, Competencies, and Sub-Competencies for Entry-level Professional Nursing

Educaon and Advanced-level Nursing Educaon ..................................................................... 27

1. Knowledge for Nursing Pracce................................................................................... 27

2. Person-Centered Care.................................................................................................. 29

3. Populaon Health ........................................................................................................ 33

4. Scholarship for the Nursing Discipline ......................................................................... 37

5. Quality and Safety ....................................................................................................... 39

6. Interprofessional Partnerships .................................................................................... 42

7. Systems-Based Pracce ............................................................................................... 44

8. Informacs and Healthcare Technologies .................................................................... 46

9. Professionalism ............................................................................................................ 49

10. Personal, Professional, and Leadership Development ................................................. 53

Glossary ...................................................................................................................................... 55

Reference List ............................................................................................................................. 67

Essenals Task Force .................................................................................................................. 75

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

The Essenals: Core Competencies for

Professional Nursing Educaon

Introducon

Since 1986, the American Associaon of Colleges of Nursing (AACN) has published the

Essenals series that provides the educaonal framework for the preparaon of nurses at

four-year colleges and universies. In the past, three versions of Essenals were published:

The Essenals of Baccalaureate Educaon for Professional Nursing Pracce, last published in

2008; The Essenals of Master’s Educaon in Nursing, last published in 2011; and The Essenals

of Doctoral Educaon for Advanced Nursing Pracce, last published in 2006. Each of these

documents has provided specic guidance for the development and revision of nursing curricula

at a specic degree level. Given changes in higher educaon, learner expectaons, and the

rapidly evolving healthcare system outlined in AACN’s Vision for Academic Nursing (2019), new

thinking and new approaches to nursing educaon are needed to prepare the nursing workforce

of the future.

The Essenals: Core Competencies for Professional Nursing Educaon provides a framework for

preparing individuals as members of the discipline of nursing, reecng expectaons across

the trajectory of nursing educaon and applied experience. In this document competencies

for professional nursing pracce are made explicit. These Essenals introduce 10 domains that

represent the essence of professional nursing pracce and the expected competencies for each

domain (see page 26). The domains and competencies exemplify the uniqueness of nursing

as a profession and reect the diversity of pracce sengs 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 prevenon/promoon of health and wellbeing, chronic disease care,

regenerave or restorave care, and hospice/palliave/supporve care), across the lifespan,

and with diverse paent populaons. While the domains and competencies are idencal for

both entry and advanced levels of educaon, the sub-competencies build from entry into

professional nursing pracce to advanced levels of knowledge and pracce. The intent is that

any curricular model should lead to the ability of the learner to achieve the competencies. The

Essenals also feature eight concepts that are central to professional nursing pracce and are

integrated within and across the domains and competencies.

Because this document has been shared with pracce partners and with other nursing

colleagues, the Essenals serve to bridge the gap between educaon and pracce. The core

competencies are informed by the expanse of higher educaon, nursing educaon, 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 pracce and the

synthesis of knowledge and acon intersect. The collecve understanding allows all nurses

to have a shared vision; promotes open discourse and exchange about nursing pracce; and

expresses a unied voice that represents the nursing profession.

This introducon provides an overview of the evoluon of nursing as a discipline, crical

aspects of the profession that serve as a framework, and sucient depth to inform nursing

educaon across the educaonal trajectory (entry into pracce through advanced educaon).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Specic citaons throughout provide immediate access to pernent references that

substanate relevancy.

Foundaonal Elements

The Essenals: Core Competencies for Professional Nursing Educaon has been built on the

strong foundaon of nursing as a discipline, the foundaon of a liberal educaon, and principles

of competency-based educaon.

Nursing as a Discipline

The Essenals, as the framework for preparing nursing’s future workforce, intenonally reect

and integrate nursing as a discipline. The emergence of nursing as a discipline had its earliest

roots in Florence Nighngale’s thoughts about the nature of nursing. Believing nursing to be

both a science and an art, she conceptualized the whole paent (mind, body, and spirit) as

the center of nursing’s focus. The inuence 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 muldimensional environment also were noted in her work.

Although Nighngale did not use the word “caring” explicitly, the concept of care and a

commitment to others were evident through her acons (Dunphy, 2015). In the same era of

Florence Nighngale, nurse pioneer Mary Seacole was devoted to healing the wounded during

the Crimean war.

Following Nighngale, the nursing profession underwent a period of disorganizaon and

confusion as it began to dene itself as a disnct scienc discipline. Early nursing leaders

(including Mary Eliza Mahoney, Ee Taylor, Annie Goodrich, Agatha Hodgins, Esther

Lucille Brown, and Lorea Ford) sought to dene the funcons of the nurse (Gunn, 1991;

Keeling, Hehman, & Kirchgessner, 2017). Other leaders devoted their eorts to addressing

discriminaon, advancing policies, and creang a collecve voice for the profession. It would

be dicult 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 pracced 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 paerning of human behavior and the constant interacon with

the environment, including relaonships with others, health, and the nurse (Rogers, 1970;

Donaldson & Crowley, 1978; Fawce, 1984; Chinn & Kramer 1983, 2018; Chinn, 2019; Roy &

Jones, 2007). The concept of caring also was described as the dening aribute of the nursing

discipline (Leininger, 1978; Watson, 1985). Newman (1991) spoke to the need to sharpen the

focus of the discipline of nursing to beer dene its social relevance and the nature of its

service. Newman, Smith, Pharris, and Jones (2008) armed caring as the focus of the discipline,

suggesng that relaonships were the unifying construct. Smith and Parker (2010) later posited

that relaonships were built on partnership, presence, and shared meaning.

In a historical analysis of literature on the discipline of nursing, ve concepts emerged as

dening the discipline: human wholeness; health; healing and well-being; environment-health

relaonship; and caring. When praccing from a holisc perspecve, nurses understand the

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

dynamic, ongoing body-brain-mind-spirit interacons of the person, between and among

individuals, groups, communies, 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

foundaonal for the next generaon (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 quesons

and shapes vital discipline concepts, tradions, policies, and even relaonships. D’Antonio, et.

al (2010) also emphasize the disciplinary insights gained by considering the dierent histories

that challenge the dominant and accepted historical narrave. 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

dening the nature of nursing as a discipline. No doubt, nursing as a discipline will connue to

evolve as society and health care evolves.

Advancing the Discipline of Nursing

The connued development of nursing as a unique discipline requires an intenonal approach.

Jairath et. al (2018) stated that any further development of the discipline should have the

capacity to directly transform the paent’s health experience. A new social order may be

necessary in which sciensts, theorists, and praconers work together to address quesons

related to the interplay of big data and nursing theory. Nursing graduates, parcularly at

the advanced nursing pracce level, must be well-prepared to think ethically, conceptually,

and theorecally to beer inform nursing care. Students must not only be introduced to the

knowledge and values of the discipline, but they must be guided to pracce from a disciplinary

perspecve – by seeing paents through the lens of wholeness and interconnectedness with

family and community; appreciang how the social, polical, and economic environment

inuences health; aending to what is most important to well-being; developing a caring-

healing relaonship; and honoring personal dignity, choice, and meaning. Smith and McCarthy

(2010) spoke to the need to provide a foundaon for praconers in the knowledge of the

discipline. Without this knowledge, the persistent challenge of dierenang nursing and the

professional levels of pracce will connue.

Knowledge of the discipline grows in graduate educaon, as students apply and generate

nursing knowledge in their advanced nursing roles or develop and test theories as researchers.

Nursing pracce should be guided by a nursing perspecve while funconing within an

interdisciplinary arena. To appropriately educate the next generaon of nurses, disciplinary

knowledge must be leveled to reect the competencies or roles expected at each level.

The Value of a Liberal Educaon

In higher educaon, every academic discipline is grounded in a unique body of knowledge that

disnguishes that discipline. Through the study of the humanies, social sciences, and natural

sciences, students develop the capacity to engage in socially valued work and civic leadership in

society. Liberal educaon exposes students to a broad worldview, mulple disciplines, and ways

of knowing through specic coursework; however, the richness of perspecve 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

pracce (Hermann, 2004). Successful integraon of liberal and nursing educaon provides

graduates with knowledge of human cultures, including spiritual beliefs, as well as the physical

and natural worlds supporng an approach to pracce. The study of history, crical race

theories, crical theories of nursing, crical digital studies, planetary health and climate science,

polics, public policies, policy formaon, ne 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 educaon creates the foundaon for intellectual and praccal abilies within the

context of nursing pracce as well as for engagement with the larger community, locally

and globally. A hallmark of liberal educaon is the development of a personal value

system

that includes the ability to act ethically regardless of the situaon and where students are

encouraged to dene meaningful personal and professional goals with a commitment to

integrity, equity, and social jusce. Liberally educated graduates are well prepared to integrate

knowledge, skills, and values from the arts, sciences, and humanies to provide safe, quality

care; advocate for paents, families, communies, and populaons; and promote health equity

and social jusce. Equally important, nursing educaon needs to ensure an understanding of

the intersecon of bias, structural racism, and social determinants with healthcare inequies

and promote a call to acon.

Competency-Based Educaon

Competency-based educaon is a process whereby students are held accountable to the

mastery of competencies deemed crical for an area of study. Competency-based educaon

is inherently anchored to the outputs of an educaonal experience versus the inputs of the

educaonal environment and system. Students are the center of the learning experience,

and performance expectaons are clearly delineated along all pathways of educaon and

pracce. Across the health professions, curriculum, course work, and pracce experiences

are designed to promote responsible learning and assure the development of competencies

that are reliably demonstrated and transferable across sengs. By consistently assessing

their own performance, students develop the ability to reect on their own progress towards

the achievement of learning goals and the ongoing aainment of competencies required

for pracce.

Advances in learning approaches and technologies, understanding of evolving student learning

styles and preferences, and the move to outcome-driven educaon and assessment all point

to a transion to competency-based educaon. This learning approach is linked to explicitly

dened performance expectaons, based on observable behavior, and requires frequent

assessment using diverse methodologies and formats. Designed in this fashion, competency-

based educaon produces learning and behavior that endures, since it encourages conscious

connecons between knowledge and acon. Learners who put knowledge into acon grasp

the interrelatedness of their learning with both theorecal perspecves and the world of their

professional work. Achieving a specic competency gives meaning to the theorecal and assists

in understanding and taking on a professional identy.

Further, today’s students increasingly are taking responsibility for their own learning and, varied

as they are in age and experience, respond to acve learning strategies. Acve learning involves

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

making an acon out of knowledge—using knowledge to reect, analyze, judge, resolve,

discover, interact, and create. Acve learning requires clear informaon regarding what is to

be learned, including guided pracce in using that informaon 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. Addionally, students must learn

how to assess their own performances to develop the skill of connual self-reecon in their

own pracce.

Stakeholders (employers, students, and the public) expect all nursing graduates to exit their

educaon programs with dened 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 intenonality of

learning by dening domains, associated competencies, and performance indicators for those

competencies. Currently, there is wide variability in graduate capabilies. Therefore, there is a

need for consistency enabled by a competency-based approach to nursing educaon.

A standard set of denions frame competency-based educaon in the health professions and

was adopted for these Essenals. Adopon of common denions allows mulple stakeholders

involved in health educaon and pracce to share much of the same language. These

denions are included in the glossary (p. 59).

Nursing Educaon for the 21

Century

In addion to the foundaonal elements on which the Essenals has been developed, other

factors have served as design inuencers. What does the nursing workforce need to look like

for the future, and how do nursing educaon programs prepare graduates to be “work ready”?

Nursing educaon for the 21

century ought to reect 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

pracce; informacs and technology; academic-pracce partnerships; and career-long learning.

Diversity, Equity, and Inclusion

Shiing U.S. populaon demographics, health workforce shortages, and persistent health

inequies necessitate the preparaon of nurses able to address systemic racism and pervasive

inequies in health care. The exisng inequitable distribuon of the nursing workforce

across the United States, parcularly in underserved urban and rural areas, impacts access

to healthcare services across the connuum from health promoon and disease prevenon,

to chronic disease management, to restorave and supporve 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 populaons (AACN, 2019). Diversity, equity, and inclusion require intenonality,

an instuonal structure of social jusce, and individually concerted eorts. The integraon

of diversity, equity, and inclusion in this Essenals document moves away from an isolated

focus on these crical concepts. Instead, these concepts, dened 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

Making nursing educaon equitable and inclusive requires acvely combang structural

racism, discriminaon, systemic inequity, exclusion, and bias. Holisc admission reviews are

recommended to enhance the admission of a more diverse student populaon to the profession

(AACN, 2020). Addionally, an equitable and inclusive learning environment will support the

recruitment, retenon, and graduaon of nursing students from disadvantaged and diverse

backgrounds. Diverse and inclusive environments allow examinaon of any implicit or explicit

biases, which can undermine eorts to enhance diversity, equity, and inclusion. When diversity

is integrated within inclusive educaonal environments with equitable systems in place, biases

are examined, assumpons are challenged, crical conversaons are engaged, perspecves

are broadened, civil readiness and engagement are enhanced, and socializaon occurs. These

environments recognize the value of and need for diversity, equity, and inclusion to achieve

excellence in teaching, learning, research, scholarship, service, and pracce.

Academic nursing must address structural racism, systemic inequity, and discriminaon in

how nurses are prepared. Nurse educators are called to crically evaluate policies, processes,

curricula, and structures for homogeneity, classism, color-blindness, and non-inclusive

environments. Evidence-based, instuon-wide approaches focused on equity in student

learning and catalyzing culture shis in the academy are fundamental to eliminang structural

racism in higher educaon (Barber et al., 2020). Only through deconstrucve 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, acng as stewards of the profession, they

can fulll their responsibility to inuence both nursing and societal atudes and behaviors

toward eradicang structural/systemic racism and discriminaon and promong social jusce.

Four Spheres of Care

Historically, nursing educaon has emphasized clinical educaon 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 prevenon/promoon of health and

well-being, which includes the promoon of physical and mental health in all paents as well

as management of minor acute and intermient care needs of generally healthy paents;

2) chronic disease care, which includes management of chronic diseases and prevenon of

negave sequelae; 3) regenerave or restorave care, which includes crical/trauma care,

complex acute care, acute exacerbaons of chronic condions, and treatment of physiologically

unstable paents that generally requires care in a mega-acute care instuon; and 4) hospice/

palliave/supporve care, which includes end-of-life care as well as palliave and supporve

care for individuals requiring extended care, those with complex, chronic disease states, or

those requiring rehabilitave care (Lipstein et al., 2016; AACN, 2019).

Entry-level professional nursing educaon ensures that graduates demonstrate competencies

through pracce experiences with individuals, families, communies, and populaons across

the lifespan and within each of these four spheres of care. The workforce of the future needs

to aract and retain registered nurses who choose to pracce in diverse sengs, including

community sengs to sustain the naon’s health. Expanding primary care into communies

will enable our healthcare delivery systems to achieve the Quadruple Aim of improving paent

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

experiences (quality and sasfacon), improving the health of populaons, decreasing per

capita costs of health care, and improving care team well-being (Bowles et al., 2018). It is me

for nursing educaon to refocus and move beyond some long-held beliefs such as: primary care

content is not important because it is not on the naonal licensing exam for registered nurses;

students only value those skills required in acute care sengs; and faculty preceptors only have

limited community-based experiences. Recommendaons from the Josiah Macy Foundaon

Conference (2016) on expanding the use of registered nursing in primary care provides a call

to educaon and pracce to place more value on primary care as a career choice, eecvely

changing the culture of nursing and health care. A collaborave eort between academic and

pracce leaders is needed to ensure this culture change and educate primary care praconers

about the value of the registered nurse role.

Systems-Based Pracce

Integrated healthcare systems that require coordinaon across sengs as well as across the

lifespan of diverse individuals and populaons are emerging. Healthcare systems are revising

strategic goals and reorganizing services to move more care from the most expensive venues

– inpaent facilies and emergency departments – to primary care and community sengs.

Consequently, nurse employment sengs also are shiing, creang a change in workforce

distribuon and the requisite knowledge and skills necessary to provide care in those sengs.

Knowledge dierenang equity and equality in healthcare systems and systems-based pracce

is essenal. Nurses in the future are needed to lead iniaves to address structural racism,

systemic inequity, and discriminaon. Equitable healthcare beer serves the needs of all

individuals, populaons, and communies.

Importantly, an understanding of how local, naonal, and global structures, systems, polics,

and rules and regulaons contribute to the health outcomes of individual paents, populaons,

and communies will support students in developing agility and advocacy skills. Factors such as

structural racism, cost containment, resource allocaon, and interdisciplinary collaboraon are

considered and implemented to ensure the delivery of high quality, equitable, and safe paent

care (Plack et al., 2018).

Informacs and Technology

Informacs increasingly has been a focus in nursing educaon, correlang with the

advancement in sophiscaon and reach of informaon technologies, the use of technology to

support healthcare processes and clinical thinking, and the ability of informacs and technology

to posively impact paent outcomes. Health informaon technology is required for person-

centered service across the connuum and requires consistency in user input, proper process,

and quality management. While dierent specialty roles in nursing may require varying depth

and breadth of informacs competency, basic informacs competencies are foundaonal to all

nursing pracce. Much work will be required to achieve full integraon of core informaon and

communicaon technologies competencies into nursing curricula.

Engagement and Experience

The future consumers of health care are changing. They are transioning from passive

parcipants in medically focused acute care environments to engaged parcipants of healthcare

services. They acvely parcipate in managing not only their chronic illnesses but also acute

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

care exacerbaons with an increasing focus on prevenon and wellness. Thus, nurses need

an understanding of consumer engagement and experience across all sengs as an essenal

component of person-centered, quality care.

In today’s society, many people seek informaon and use technology to help make informed

decisions about their health. Nurses seek to help paents determine what informaon to use

and how to use it. Individuals want to know about their opons when it comes to healthcare

services, which extends to using websites to provide informaon on provider quality and

performance, comparing prices for common procedures, and reviewing the eecveness of

treatments and care approaches (Adler-Milstein & Sinaiko, 2019). Ganey (2015) stated that

as consumers shoulder more of the nancial responsibility for their health care, they became

more educated about available opons. Studies have shown that paents who are engaged in

decision-making regarding their care have beer outcomes and lower costs (Ganey, 2015).

Meaningful pracce experiences in health care start with the individual who is acvely engaged

in the journey throughout the connuum of care. Each interacon between the recipient of

care and the nurse or healthcare provider creates an experience. Pracce experience is dened

as “the sum of all interacons, shaped by an organizaon’s culture that inuence paent

percepons across the connuum of care.” (Wolf, Niederhauser, Marshburn, & LaVela, 2014,

p. 8). Within that interacve experience, the atudes and the behaviors of the nurse maer a

great deal. Nurses are idened as one of the most trusted professionals in the United States.

Mutual trust is foundaonal to an interacve and ongoing relaonship that will enhance a

posive experience of care. Those with posive experiences of care oen have beer outcomes.

Individual engagement has been described as “the blockbuster drug of the 21st century”

(Dentzer, 2013). Who beer to engage individuals in their care than nurses? Nursing pracce

has focused consistently on individual care and ongoing communicaon with family members

and care providers. Sherman points to the fact that eecve individual/family involvement

leads to safer and higher quality care. In addion, individual/paent engagement can be directly

correlated with increased reimbursement to hospitals based on achieving health outcomes.

Nurses in all sengs and across the connuum of care contribute to creang 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-Pracce Partnerships

Partnerships and collaborave team-based care are the cornerstones of safe, eecve care

whether it be for individuals, families, communies, or populaons. Academic-pracce

partnerships serve to recruit and retain nurses and to support the pracce and academic

enterprise in relaon to mutual research, leadership development, and a shared commitment

to redesign pracce environments. Such partnerships also have the potenal to facilitate the

ability of nurses to achieve educaonal and career advancement, prepare nurses of the future

to pracce and lead, provide mechanisms for career-long learning, and provide a structure for

transion to pracce programs. Successful academic-pracce partnerships are predicated on

respect, relaonship, reciprocity, and co-design.

The 2016 report Advancing Healthcare Transformaon: A New Era for Academic Nursing

idened a path for achieving enhanced partnerships between nursing schools and academic

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

health centers with the goals of achieving improved healthcare outcomes, fostering new models

for innovaon, and advancing integrated systems of health care. While focused primarily on

academic health centers, the recommendaons apply to partnerships between non-academic

health centers and schools of nursing as well. The recommendaons include enhancing the

clinical pracce of academic nursing; partnering in the preparaon of the nurses of the future;

collaborang to develop workforce plans in partnership with the health system; integrang

academic nursing into populaon health iniaves; partnering in the implementaon

of Accountable Care; and partnering for opmal paent care and healthcare delivery

(AACN, 2016).

Career-Long Learning

Current trends in higher educaon focus on supplemental methods of awarding credit and

recognion for addional learning which has implicaons for career-long learning. Emerging

educaonal methods should be considered as possible addions in the development of

curriculum pathways in contemporary nursing educaon. For example, the use of e-porolios,

which may be used to record competency achievement and educaonal milestones and

connued throughout one’s career, can be used to document personal development plans,

badges, cercaons, employment appraisals, and reecons on clinical events to establish

meaning from various encounters.

Awarding of micro-credenals or badges by academic instuons also is becoming popular.

Badges recognize incremental learning in visible ways and can support career development

(Educause, 2018). Stackable credenals can be accumulated over me 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 maer. All of these are

important consideraons in basic and advanced nursing educaon.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domains and Concepts

Domains for Nursing

Domains are broad disnguishable areas of competence that, when considered in the

aggregate, constute a descripve framework for the pracce of nursing. These Essenals

include 10 domains that were adapted from the interprofessional work iniated by Englander

(2013) and tailored to reect the discipline of nursing.

This document delineates the domains that are essenal to nursing pracce, including how

these are dened, what competencies should be expected for each domain at each level of

nursing, and how those domains and competencies both disnguish nursing and relate to

other health professions. Each domain has a descriptor (or working denion) 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 pracce – thus providing an explanaon for how the competencies within the

domain should be interpreted. The domain designaons, descriptors, and contextual statements

may evolve over me to reect future changes in healthcare and nursing pracce. Although the

domains are presented as discrete enes, the expert pracce of nursing requires integraon

of most of the domains in every pracce situaon or paent encounter, thus they provide a

robust framework for competency-based educaon. The domains and descriptors used in the

Essenals are listed below.

• Domain 1: Knowledge for Nursing Pracce

Descriptor: Integraon, translaon, and applicaon of established and evolving

disciplinary nursing knowledge and ways of knowing, as well as knowledge from

other disciplines, including a foundaon in liberal arts and natural and social sciences.

This disnguishes the pracce of professional nursing and forms the basis for clinical

judgment and innovaon in nursing pracce.

• Domain 2: Person-Centered Care

Descriptor: Person-centered care focuses on the individual within mulple complicated

contexts, including family and/or important others. Person-centered care is holisc,

individualized, just, respecul, compassionate, coordinated, evidence-based, and

developmentally appropriate. Person-centered care builds on a scienc body of

knowledge that guides nursing pracce regardless of specialty or funconal area.

• Domain 3: Populaon Health

Descriptor: Populaon health spans the healthcare delivery connuum from public

health prevenon to disease management of populaons and describes collaborave

acvies with both tradional and non-tradional partnerships from aected

communies, public health, industry, academia, health care, local government enes,

and others for the improvement of equitable populaon health outcomes.

• Domain 4: Scholarship for Nursing Discipline

Descriptor: The generaon, synthesis, translaon, applicaon, and disseminaon of

nursing knowledge to improve health and transform health care.

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 pracce, enhance

quality and minimize risk of harm to paents and providers through both system

eecveness and individual performance.

• Domain 6: Interprofessional Partnerships

Descriptor: Intenonal collaboraon across professions and with care team members,

paents, families, communies, and other stakeholders to opmize care, enhance the

healthcare experience, and strengthen outcomes.

• Domain 7: Systems-Based Pracce

Descriptor: Responding to and leading within complex systems of health care. Nurses

eecvely and proacvely coordinate resources to provide safe, quality, equitable care

to diverse populaons.

• Domain 8: Informacs and Healthcare Technologies

Descriptor: Informaon and communicaon technologies and informacs processes

are used to provide care, gather data, form informaon to drive decision making, and

support professionals as they expand knowledge and wisdom for pracce. Informacs

processes and technologies are used to manage and improve the delivery of safe,

high-quality, and ecient healthcare services in accordance with best pracce and

professional and regulatory standards.

• Domain 9: Professionalism

Descriptor: Formaon and culvaon of a sustainable professional nursing identy,

accountability, perspecve, collaborave disposion, and comportment that reects

nursing’s characteriscs and values.

• Domain 10: Personal, Professional, and Leadership Development

Descriptor: Parcipaon in acvies and self-reecon that foster personal health,

resilience, and well-being, lifelong learning, and support the acquision of nursing

experse and asseron of leadership.

Concepts for Nursing Pracce

In addion to domains, there are featured concepts associated with professional nursing

pracce that are integrated within the Essenals. A concept is an organizing idea or a mental

abstracon that represents important areas of knowledge. A common understanding of each

concept is achieved through characteriscs and aributes. Many disciplines, like nursing, have

numerous concepts. The featured concepts are well-represented in the nursing literature

and thus also are found throughout the Essenals and veried through a crosswalk analysis.

Specically, the featured concepts are found in the introducon, 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 mulple concepts represented.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

The featured concepts found within the Essenals are not of ‘lesser importance’ than a domain.

Each of these concepts serves as a core component of knowledge, facts, and skills across

mulple situaons and contexts within nursing pracce. Each concept funcons as a hub for

transferable knowledge, thus enhancing learning when learners make cognive links to other

informaon through mental constructs. The integraon of concepts within the competencies

and sub-competencies is essenal for the applicaon throughout the educaonal experience. As

an example, can you imagine delivering person-centered care without also considering diversity,

equity, and inclusion? Can you imagine having a conversaon about populaon health without

considering ethics and health policy? These concepts truly are interrelated and interwoven

within the domains and competencies, serving as a foundaon to students’ learning. The

featured concepts are:

• Clinical Judgment

As one of the key aributes of professional nursing, clinical judgment refers to the

process by which nurses make decisions based on nursing knowledge (evidence,

theories, ways/paerns of knowing), other disciplinary knowledge, crical thinking,

and clinical reasoning (Mane, 2019). This process is used to understand and interpret

informaon in the delivery of care. Clinical decision making based on clinical judgment

is directly related to care outcomes.

• Communicaon

Communicaon, informed by nursing and other theories, is a central component in all

areas of nursing pracce. Communicaon is dened as an exchange of informaon,

thoughts, and feelings through a variety of mechanisms. The denion encompasses

the various ways people interact with each other, including verbal, wrien, behavioral,

body language, touch, and emoon. Communicaon also includes intenonality,

mutuality, partnerships, trust, and presence. Eecve communicaon 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,

communicaon is delivered through technological modalies. Communicaon 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 essenal principle of person-centered care, compassionate care refers to the

way nurses relate to others as human beings and involves “nocing another person’s

vulnerability, experiencing an emoonal reacon to this, and acng 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 paent sasfacon.

• Diversity, Equity, and Inclusion

Collecvely, diversity, equity, and inclusion (DEI) refers to a broad range of individual,

populaon, and social constructs and is adapted in the Essenals as one of the most

visible concepts. Although these are collecvely considered a concept, dierenaon

of each conceptual element leads to enhanced understanding.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Diversity references a broad range of individual, populaon, and social characteriscs,

including but not limited to age; sex; race; ethnicity; sexual orientaon; gender identy;

family structures; geographic locaons; naonal origin; immigrants and refugees;

language; any impairment that substanally limits a major life acvity; religious beliefs;

and socioeconomic status. Inclusion represents environmental and organizaonal

cultures in which faculty, students, sta, and administrators with diverse characteriscs

thrive. Inclusive environments require intenonality and embrace dierences, not

merely tolerate them (AACN, 2017; Bloomberg, 2019). Everyone works to ensure the

perspecves and experiences of others are invited, welcomed, acknowledged, and

respected in inclusive environments. Equity is the ability to recognize the dierences in

the resources or knowledge needed to allow individuals to fully parcipate in society,

including access to higher educaon, with the goal of overcoming obstacles to ensure

fairness (Kranich, 2001). To have equitable systems, all people should be treated fairly,

unhampered by arcial barriers, stereotypes, or prejudices (Cooper, 2016). Two

related concepts that t within DEI include structural racism and social jusce. (See the

glossary for denions of structural racism and social jusce.)

• Ethics

Core to professional nursing pracce, ethics refers to principles that guide a

person’s behavior. Ethics is closely ed to moral philosophy involving the study of or

examinaon of morality through a variety of dierent approaches (Tubbs, 2009). There

are commonly accepted principles in bioethics that include autonomy, benecence,

non-malecence, and jusce (ANA 2015; ACNM, 2015; AANA, 2018; ICN, 2012). The

study of ethics as it relates to nursing pracce has led to the exploraon of other

relevant concepts, including moral distress, moral hazard, moral community, and moral

or crical resilience.

• Evidence-Based Pracce

The delivery of opmal health care requires the integraon of current evidence and

clinical experse with individual and family preferences. Evidence-based pracce is a

problem-solving approach to the delivery of health care that integrates best evidence

from studies and paent care data with clinician experse and paent preferences

and values (Melnyk, Fineout-Overhold, Sllwell, & Williamson, 2010). In addion

there is a need to consider those scienc studies that ask: whose perspecves are

solicited, who creates the evidence, how is that evidence created, what quesons

remain unanswered, and what harm may be created? Answers to these quesons

are paramount to incorporang meaningful, culturally safe, evidence-based pracce

(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 crical roles in advocang for policy that impacts paents and the profession,

especially when speaking with a united voice on issues that aect nursing pracce and

health outcomes. Nurses can have a profound inuence on health policy by becoming

engaged in the policy process on many levels, which includes interpreng, evaluang,

and leading policy change.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

• 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 condions in the environment where

people are born, live, learn, work, play, worship, and age that aect a wide range of

health, funconing, and quality of life outcomes and risks.”

The social determinants of health contribute to wide health disparies and inequies

in areas such as economic stability, educaon quality and access, healthcare quality

and access, neighborhood and built environment, and social and community context

(Healthy People, 2030). Nursing pracces such as assessment, health promoon, access

to care, and paent 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 communicaon.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Competencies and Sub-Competencies

The competencies idened in this Essenals document provide a bridge between the current

and future needs of pracce and the requisite educaon to prepare a competent praconer.

Competence develops over me, is progressive, and reects the impact of internal and

external factors and experiences of the student. Internal factors include educaon, experience,

knowledge, and professional orientaon, among others. External forces include the complexity

of the learning experience and professional autonomy. While knowledge is essenal 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 demonstrang achievement of

expectaons across the span of their educaon and pracce experience. Students are successful

when they meet and sustain measurable competence at each level of performance expectaon

and are able to transfer their competence across dierent pracce experiences and sengs

(Josiah Macy Foundaon, 2017).

All competencies, organized within the 10 domains, are broad in scope and cross all levels

and areas of nursing pracce. The competency is intenonally wrien 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 intenonal overlap

of competencies in several domains to account for dierences in the competency or sub-

competency context in dierent domains.

Each competency statement has mulple sub-competencies wrien at two levels to reect

learner expectaons for entry-level and advanced nursing educaon. 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 me and become more sophiscated

with ongoing pracce.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

A New Model for Nursing Educaon

These Essenals represents a new direcon for nursing educaon, inuenced by AACN’s Vision

for Academic Nursing (AACN, 2019), seng in place a new model for preparing professional

nurses, which includes a transion to competency-based educaon. This model provides the

structure across educaon programs and provides a mechanism to adapt to future changes

within nursing educaon.

Currently, mulple educaonal 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 mulple educaon programs and paths

to prepare a nurse praconer (NP) and mulple types of NP cercaon. These mulple

program opons confuse external stakeholders as well as those within our own discipline

regarding dierences between an academic degree and a role – as if the academic degree

signies a specic nursing role. The new model is an intenonal departure from the previous

versions of the Essenals that were aligned to an academic degree. Thus, a primary intent of the

Essenals is to create more consistency in graduate outcomes, inuenced by the robustness of

the learning experiences and demonstraon of competencies. By emphasizing the aainment

of competencies within an academic program, employers will have a clear expectaon of

knowledge and skill sets of nursing graduates.

Two levels of sub-competencies reect the educaonal stages of nurses as they enter

professional pracce and as they return to school to advance their educaon (see Figure 1). The

rst level sub-competencies set the foundaon for nurses entering professional pracce. These

level one (entry-level) competencies are used within curricula for prelicensure preparaon as

well as professional nursing degree compleon pathways for nurses with inial preparaon at

the associate degree or diploma level. Although learning experiences may vary across individual

programs, they provide an opportunity for learners to demonstrate aainment of competencies

in mulple and authenc contexts over me (not a “one and done”/checklist approach).

The second level sub-competencies build and expand the competence of the nurse seeking

advanced educaon in nursing and broadens the breadth of experiences in context and

complexity as compared to graduates of entry-level programs. Advanced nursing educaon

aords the student the opportunity to focus on an advanced nursing pracce specialty

or advanced nursing pracce role. Level 2 sub-competencies form the foundaon for all

advanced educaon, and as conceptualized, apply to all advanced nursing pracce speciales

and advanced nursing pracce 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 pracce role and to impact the challenges in health care. Competencies designated

for an advanced nursing pracce specialty (informacs, administraon/pracce leadership,

public health/populaon health, health policy) or an advanced pracce nursing role (cered

nurse praconer, cered nurse-midwife, cered clinical nurse specialist, cered registered

nurse anesthest) are integrated with and complement the Essenals competencies.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Figure 1: Model for Nursing Educaon

AACN Essenals

Entry-Level

Professional Nursing Educaon

sub-competencies

Used by programs preparing a

nurse for an inial professional

nursing degree.

Used by programs preparing a

nurse for an advanced nursing

pracce specialty or advanced

nursing pracce role.

AACN Essenals

Advanced-Level Nursing

Educaon sub-competencies

– and —

Specialty/role requirements/

competencies

ESSENTIALS MODEL

LEVEL 1

LEVEL 2

These Essenals represent an opportunity for a future characterized by greater clarity as it

relates to expectaons of graduates and a more disciplined approach to nursing educaon.

Competencies are used within the academic program as core expectaons, thus seng a

common standard. Addional elements within a degree plan will allow schools to dierenate

degree paths using the same sub-competencies and to disnguish themselves in alignment with

various instuonal missions. This model adapts to the current state of nursing educaon, and

perhaps more importantly, provides a path for an evolving trajectory for nursing educaon. Over

me, higher educaon, stakeholder demands, nursing regulatory standards, and economics are

among the many forces that will drive the direcon and pace of change for nursing educaon

in the future. This model has been designed to adapt to such future changes, not only for the

degrees oered, but also for recognized areas of emphasis at the advanced educaon level by

coupling with specialty competencies and/or cercaon standards.

The Essenals do not apply directly to the preparaon 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, parcularly for programs oering

baccalaureate to PhD degrees. Addionally, for nursing programs oering both DNP and PhD

degrees and/or PhD to DNP or DNP to PhD opons, the second-level core sub-competencies

could form the basis for shared core courses between the two doctoral degree programs –

represenng eciencies in program delivery as well as for more seamless pathways from one

degree to the other.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Implemenng the Essenals: Consideraons for Curriculum

The domains, competencies, and concepts presented in the Essenals provide the plaorm 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 represenng the curriculum

in its enrety. 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 Essenals framework

(domains, concepts, and competencies) should be integrated throughout and across the

curriculum. A scaolded approach ensures students interface with competencies in mulple

contexts and with increasing complexity. Nursing programs have a great deal of exibility in

the development and design of curricula, thus preserving the ability of nursing programs to be

unique or innovave.

Outcomes, when referred to as student learning outcomes, describe the desired outcomes

of the graduate at the compleon of the program. The student learning outcomes will reect

aainment of all competencies in addion to any relevant specialty/role competencies and

other idened expectaons. Course design within curricula reect the expectaons of student

learning with clear linkage from course objecves/competencies from within and across courses

to end of program student learning outcomes, wrien as course learning outcomes or course

competencies. For this reason, course outcomes should link to the Essenals competencies

and concepts. Intenonal teaching strategies are designed and incorporated throughout the

curriculum in mulple contexts and with increasing complexity to provide students mulple

opportunies for learning and demonstrang competencies. For the foreseeable future,

minimum requirements for praccum experiences are deemed important to provide consistent

and quality preparaon at both the entry- and advanced-levels for professional nursing pracce.

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

specied points within a program of study to track learners’ achievement of competencies.

To demonstrate the integraon of competencies across mulple 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 evaluaon tool. Performance assessment is a muldimensional process,

integral to learning, that involves observaon 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 secon, the Essenals Model featuring two levels of professional nursing

educaon (entry and advanced) was introduced. While the domains, competencies, and

concepts are idencal for both entry and advanced levels of educaon, sub-competencies are

used to dierenate expectaons for entry (Level 1) and advanced (Level 2) professional nursing

educaon (see Figure 1). These two levels of sub-competencies reect the educaonal stages

of nurses—as they enter professional nursing pracce and as they advance their educaon—

regardless of the program of study they are compleng to advance their educaon. The

following secons detail the expectaons for curricula at each of these two levels.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Entry-Level Professional Nursing Educaon

Programs preparing nurses to enter professional nursing pracce (either through prelicensure

preparaon or through a degree compleon pathway for nurses with inial preparaon 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 pracce across the lifespan

and with diverse populaons and in four spheres of pracce.

Entry-Level Professional Nursing Degree Opons

Pre-licensure Programs

Entry-Level Professional Nursing Educaon sub-competencies (Level 1) are applied across

any curriculum preparing for entry to professional nursing pracce. Content learned within

prerequisite courses is incorporated into the learning and assessment of the sub-competencies

as applicable, and aainment 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 aainment of Level 1 sub-

competencies, pass rates on the NCLEX-RN® (for tradional and accelerated tracks), and other

instuonal requirements.

Post-Licensure Degree Programs

Level 1 core sub-competencies also are used in post-licensure or degree compleon, rst

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 inial

nursing educaon program. Vericaon of prior competency achievement in some domains

may result in a shorter meframe needed to prepare learners in these programs.

All learners in entry-level professional nursing educaon programs (pre-licensure and post-

licensure [degree-compleon] programs) will engage in direct paent care learning acvies in

all four spheres of care and across the lifespan.

Spheres of Care and Entry-Level Professional Nursing Educaon

All entry-level professional nurses need knowledge and prociencies to pracce across a

variety of sengs. Accordingly, curricula for entry-level professional nursing educaon prepare

the learner for generalist pracce across the

lifespan and with diverse populaons, focusing

on four spheres of care: promoon of health

and well-being/disease prevenon; chronic

disease care; regenerave or restorave care;

and hospice/palliave/supporve care (AACN,

2019; Lipstein et al., 2016; Figure 2). Didacc,

simulated, laboratory, and clinical learning

experiences prepare nurses to pracce in these

diverse sengs. Level 1 sub-competencies apply

across the spheres of care, requiring learners to

Wellness, Disease

Prevenon

Regenerave /

Restorave Care

Chronic Disease

Care

Hospice /

Palliave Care

4 Spheres of

Care

Figure 2: Four Spheres of Care

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

demonstrate competencies in mulple contexts and sengs. Demonstraon of the Level 1 sub-

competencies by the end of the program will enable the new professional nurse to pracce as a

generalist in any seng with diverse populaons and with all ages.

Although all students will have learning experiences across all four spheres of care, entry-level

professional programs could create opportunies for students to gain addional educaon

(through immersion experiences, elecves, badges, or cercates) in any of the four spheres.

Such a path would allow a graduate to have a dened area of emphasis (if desired) upon

graduaon, and/or to aain a documented area of emphasis in a post-entry level program

cercate opon.

Clinical Expectaons

Entry-level professional nursing educaon programs provide rich and varied opportunies for

pracce 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 compleon

of the program. Theorecal learning becomes a reality as students are coached to make

cognive connecons between the cases or situaons presented in the classroom, simulaon,

or laboratory and in actual pracce sengs. Clinical experiences also assist the graduate to

develop prociency in cognive, psychomotor, and aecve learning. Clinical experiences are

essenal for students to care for a variety of individuals, families, groups, and populaons

across the lifespan and across the four spheres of care. Clinical learning provides opportunies

for a student to enhance the provision of care and gain the skills needed to be an eecve

member of an interprofessional team; thus, interprofessional experiences in a variety of

pracce sengs are essenal.

Graduates of all types of entry-level professional nursing educaon programs need sucient

pracce 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 educaon programs (pre-licensure and post-licensure [degree-compleon]

programs) will engage in direct paent care learning acvies 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, supporve, and

conducive for learning by individual students or groups of students. The program is responsible

for providing sucient and appropriate clinical sites/placements for students to demonstrate

aainment of Level 1 sub-competencies. The program faculty assesses clinical sites to

determine that, on the aggregate, clinical experiences provide students learning opportunies

to foster interprofessional team pracce and to provide care within the four spheres of care

and with care recipients from diverse backgrounds and cultures, from dierent genders and

age groups and with dierent religious and spiritual pracces, including those who may be

considered most vulnerable. Programs are responsible for informing clinical educators or

preceptors about the specic learning that is expected and occurring in didacc and laboratory

sengs and provide appropriate learning opportunies across sengs to reinforce learning as

well as demonstrate achievement of competencies (Level 1 sub-competencies) across the 10

Essenals domains.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Simulaon

Simulaon experiences represent an important component of clinical educaon, serving as a

valuable augmentaon to direct and indirect care within healthcare sengs. Laboratory and

simulaon experiences provide an eecve, safe environment for learning and demonstrang

competencies. However, care experiences with actual individuals or groups connue to be the

most important component of clinical educaon. A landmark study conducted by the Naonal

Council of State Boards of Nursing concluded that for pre-licensure students “substung high-

quality simulaon experiences for up to half of tradional clinical hours produces comparable

end-of-program educaonal outcomes” (Hayden et al., 2014, p. S3). Simulaon cannot

substute for all direct care pracce experiences in any one sphere or for any one age group.

Also, simulaon learning experiences should align with best pracce standards such as those

developed by the Internaonal Nursing Associaon for Clinical Simulaon and Learning (INACSL)

or the Society for Simulaon in Healthcare (SSH). The use of simulaon in the curriculum as

a replacement of direct paent clinical/pracce hours or experiences is also determined by

requirements of regulatory enes (i.e., licensing and accreding bodies).

Pracce Synthesis Experience/Immersion

Development of competency aainment is facilitated through use of focused and sustained

pracce 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 transion into pracce. Such experiences

provide opportunies to enact principles of the nursing discipline and for building clinical

reasoning, management of care, and assessment of clinical outcomes. These opportunies

increase the student’s self-condence, professional identy, and sense of belonging within

the profession. Immersion experiences also allow students to integrate previous learning and

demonstrate competencies in more complex situaons and contexts. Immersion experiences

may aord the student an opportunity to focus on a populaon of interest and clinical role. The

immersion experience may occur towards the end of the program as a culminang 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 pracce experience that approximates

professional pracce expectaons (Fowler et al., 2018; Tratnack et al., 2011).

Advanced-Level Nursing Educaon

Nursing programs preparing nurses to advance their educaon beyond entry-level professional

nursing pracce will incorporate advanced-level nursing educaon (Level 2) sub-competencies.

Advanced-level nursing educaon programs (degree granng and advanced nursing pracce

post-graduate cercate programs) intenonally build on Level 1 sub-competencies. Although

Level 2 sub-competencies have been wrien with doctoral educaon in mind, the actual

dierenator for the degree aained 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 instuon. 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

Advanced-level nursing educaon programs prepare graduates for pracce in an advanced

nursing pracce specialty (informacs, administraon/pracce leadership, public health/

populaon health, health policy) or an advanced pracce nursing role (cered nurse

praconer, cered nurse-midwife, cered clinical nurse specialist, cered registered

nurse anesthest). Advanced-level nursing educaon programs focus on providing specialty

knowledge for graduates to enact specic advanced pracce nursing roles or assume advanced

nursing specialty pracce within the healthcare system. For this reason, specialty competencies,

dened by naonally recognized, specialty organizaons, represent a major component of

advanced-level nursing educaon programs. Specialty competencies complement and build

upon the Level 2 sub-competencies. All graduates of an advanced nursing educaon program

are prepared and eligible for naonal, advanced nursing pracce specialty cercaon or

advanced nursing pracce role cercaon when available. It is noteworthy that speciales

evolve over me and new speciales may emerge.

All DNP programs (post-baccalaureate and post-master’s) demonstrate that graduates aain

and integrate Level 2 sub-competencies and competencies for at least one advanced nursing

pracce specialty or advanced nursing pracce role.

Individuals should seek to advance disciplinary experse in a chosen nursing specialty or

advanced nursing pracce role. This experse is crical to advancing the profession, to expand

the inuence of the profession for the transformaon of health care, and to ensure an informed

disciplinary perspecve for teaching in the discipline. Advancing educaon in nursing with

the emphasis on teaching and learning alone does not fulll the achievement of disciplinary

experse. Excellence as an educator is achieved by the collecve enterprise for faculty teaching

and learning aorded by instuons and applied to discipline-specic teaching.

Advanced Level Praccum Experiences

Advanced-level nursing educaon programs provide rich and varied opportunies for pracce

experiences (both direct and indirect care experiences) to prepare graduates with the Level

2 sub-competencies as well as applicable advanced nursing pracce specialty/advanced

nursing pracce role competencies and requirements. Pracce 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 compleon of the program. Pracce

experiences are required to integrate didacc learning, promote innovave thinking, and test

new potenal soluons to clinical pracce or system issues. Therefore, the development of new

skills and pracce expectaons can be facilitated through use of creave learning opportunies

in diverse sengs.

All graduates of advanced-level nursing educaon programs have structured, faculty-designed

pracce experiences, which may include precepted experiences with faculty oversight and/or

experiences with direct faculty supervision. The program is responsible for providing sucient

and appropriate clinical sites/placements for students to demonstrate aainment of Level 2

sub-competencies and applicable specialty competencies. Clinical/pracce learning experiences

may be accomplished through diverse methodologies, including simulaon and virtual

technology, and assist the graduate to develop greater prociency in these competencies,

including cognive, psychomotor, and aecve competencies. Use of simulaon should align

with specialty requirements.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

All advanced educaon praccum experiences must have faculty oversight and be veried and

documented as a component of a formal course or plan of study. Programs provide pracce

placements that are safe, supporve, and conducive for learning. The nursing program faculty

determine and assess pracce sites to ensure that the site supports student learning with

the intended populaon or scope of pracce. Faculty, students, and preceptors must be well

informed about the specic competencies that are integrated in the didacc, laboratory, and

pracce experiences and the method(s) to assess the achievement of the competencies.

Competency Aainment and Pracce Experiences

All learners in advanced nursing educaon programs engage in pracce learning acvies (both

direct and indirect care experiences). Graduates of all advanced nursing educaon programs

need sucient clinical/pracce experiences to demonstrate end-of-program student outcomes,

Level 2 sub-competencies, and competencies required by applicable naonal, specialty

organizaons and/or for naonal advanced nursing pracce specialty or advanced nursing

pracce role cercaon. Programs document clear evidence of competency achievement.

Advanced Educaon Clinical/Pracce Hours

The applicaon of competency-based educaon to prepare advanced nursing professionals

inherently calls to queson the role of more tradional me-based requirements. In this

Essenals model, there is an emphasis on ensuring that all nurses pursuing advanced educaon

aain Level 2 sub-competencies as well as competencies required for an advanced nursing

pracce specialty or advanced nursing pracce role being pursued. The number of required

pracce (direct and indirect care) hours vary based on advanced specialty/role requirements.

These Essenals represent a commitment that required hours prepare a consistent product in

terms of breadth of preparaon and quality to reinforce condence in our graduates by nursing

pracce 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

aainment and the assessment necessary in nursing professional educaon. Repeon plays a

role in reinforcing previously acquired knowledge, skills, values, and atudes. Repeon also

allows for intenonal and unintenonal complexies and context nuances to be introduced,

thus building on minimum competency thresholds. Given the paucity of evidence to support

specic experience quanes, case numbers, or hourly requirements that should be achieved, a

minimum threshold of hours of pracce engagement remains necessary at this me.

The specic clinical/pracce experiences and number of pracce hours and/or credit hours

required depends on these Essenals, advanced nursing pracce specialty and advanced

nursing pracce role requirements, and regulatory standards for specialty cercaons and

licensure. The program must include adequate experiences (in terms of me, diversity, depth,

and breadth) to allow aainment and demonstraon of all relevant competencies (Level 2

sub-competencies and applicable specialty/role competences and other requirements) and

successful transion to pracce demonstrated through program outcomes. The number of in-

person pracce hours will vary based on student needs and curriculum design. Parcipaon

in a minimum of 500 pracce hours in the discipline of nursing, post entry-level educaon,

and aainment of Level 1 sub-competencies is required for demonstraon of the advanced

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

level sub-competencies. Some students may require more. These pracce hours also provide

a foundaon for the addional me-based requirements set by specialty organizaons or

external licensing/cerfying bodies, which will require addional pracce me for preparaon

in advanced nursing speciales or advanced nursing pracce roles. Hours of pracce do not

necessarily need to be delineated by competency type (Essenals 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/pracce learning experiences

that provide for acve learning, repeon, interprofessional engagement, and successive levels

of diculty. As the strength of evidence to support valid and reliable assessment techniques

builds, the role of pracce experiences and number of hours (e.g., me-based requirements)

may evolve in the future.

Immersion Praccum Experiences

Development of competency aainment is facilitated through use of focused and sustained

pracce experiences. Immersion experiences, expected in advanced nursing educaon

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 populaon 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.

Simulaon

Simulaon experiences represent an important component of clinical/pracce educaon,

serving as a valuable augmentaon to direct clinical care or pracce within healthcare sengs.

Laboratory and simulaon experiences provide an eecve, safe environment for learning and

demonstrang competencies, parcularly high-risk and low-frequency experiences. However,

pracce experiences in actual pracce sengs connue to represent the most important

component of nursing pracce educaon and are required in advanced nursing programs for

the learning and demonstraon of the Level 2 sub-competencies and integraon of specialty

competencies. Simulaon learning experiences align with best pracce standards such as those

developed by the Internaonal Nursing Associaon for Clinical Simulaon and Learning (INACSL)

or the Society for Simulaon in Healthcare (SSH). The use of simulaon in the curriculum as

a replacement of direct paent clinical/pracce hours or experiences is also determined by

requirements of naonal specialty educaon, cercaon enes, and regulatory enes.

Pracce experiences may include simulated experiences for the aainment of a poron of the

Level 2 sub-competencies, parcularly 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

organizaons and/or licensing/cerfying bodies. Regardless of the design of the experiences,

programs are expected to document aainment 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

transformaon. Nurses, as members of the healthcare team, are expected to assume a

prominent role in addressing these dilemmas. Nurses cannot be expected to signicantly

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

impact healthcare transformaon unless their educaonal preparaon provides them with

opportunies to learn and employ scholarship, leadership, and teamwork skills to advance

pracce. A scholarly work that aims to improve clinical pracce, therefore, is required of

students compleng a pracce doctorate in nursing. Collaboraon with pracce partners

whenever possible will maximize the impact of the student experience.

The scholarly work may take on various nal forms depending on the academic instuon’s

requirements and the student’s area (specialty or role) of study/pracce. Key elements of

the scholarly work include problem idencaon; a search, analysis, and synthesis of the

literature and evidence; translang evidence to construct a strategy or method to address a

problem; designing a plan for implementaon and actual implementaon when possible, and

an evaluaon of the outcomes, process, and/or experience. Faculty may idenfy addional

elements deemed necessary to meet the expected outcomes of the curriculum. Programs are

encouraged to support innovaon in the design and disseminaon of the nal project without

reducing the substanve nature of the work. A literature review that lacks applicability to

aect a pracce improvement or the other elements idened above would not constute a

scholarly work that aligns with this Essenals model. Similarly, a porolio may be used as a tool

to enhance the development and presentaon 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 disseminaon of the results prior to program compleon. The

intent is that this scholarly work reects the longitudinal aainment of advanced level sub-

competencies, going across the curriculum and allowing for the evoluon of ideas. There also

is a need to ensure an understanding by the student of the connecon between the scholarly

work and applicaon to future pracce. This will promote integraon of advanced nursing

educaon competencies into future pracce.

Disseminaon methods for the scholarly work are determined by the student in consultaon

with the faculty and may include a variety of methods. Disseminaon may include a nal wrien

product that is presented to a dened group of stakeholders, such as members of the pracce

and/or university community or parcipants at a local, state, or naonal professional meeng.

Other possible examples of disseminaon include poster presentaons, a manuscript under

review and/or submission for publicaon, an educaonal presentaon, or a podcast.

Faculty with appropriate specialty and academic credenals are involved in the planning,

formaon, and evaluaon of the student’s scholarly work. In some instances, addional

experts/mentors/ partners/facilitators can be formal or informal collaborators and provide

intermient or limited support throughout the project phases as needed. Evaluaon of the

student’s scholarly work may include a combinaon of methods, including faculty, expert,

and/or peer evaluaon. Programs tailor scholarly work evaluaon and approval processes per

instuon’s, the program’s, and/or appropriate commiee’s requirements. Evaluaon of the

nal DNP project is the responsibility of the faculty.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

In summary:

• These program requirements do not modify any addional requirements for any

advanced specialty or role preparaon, including the requirement for all Advanced

Pracce Registered Nurse (APRNs) educaon to include three graduate-level courses

delineated in The Consensus Model for APRN Regulaon: Licensure, Accreditaon,

Cercaon, and Educaon (2006; see glossary).

• All graduates of an advanced-level nursing educaon program are prepared for pracce

in an advanced nursing specialty (informacs, administraon/pracce leadership, pub-

lic health/populaon health, or health policy) or for an advanced nursing pracce role

(nurse praconer, cered nurse-midwife, cered clinical nurse specialist, cered

registered nurse anesthest).

• All DNP students will complete a scholarly project/product, which will be evaluated by

faculty; DNP students will demonstrate the aainment and integraon of the Level 1

sub-competencies, Level 2 sub-competencies, and advanced specialty/role competen-

cies into pracce.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domains, Competencies, and Sub-Competencies for

Entry-level Professional Nursing Educaon and Advanced-level

Nursing Educaon

Domain 1: Knowledge for Nursing Pracce

Descriptor: Integraon, translaon, and applicaon of established and evolving disciplinary

nursing knowledge and ways of knowing, as well as knowledge from other disciplines, including

a foundaon in liberal arts and natural and social sciences. This disnguishes the pracce of

professional nursing and forms the basis for clinical judgment and innovaon in nursing pracce.

Contextual Statement: Knowledge for Nursing Pracce provides the context for understanding

nursing as a scienc discipline. The lens of nursing, informed by nursing history, knowledge,

and science, reects nursing’s desire to incorporate mulple perspecves into nursing pracce,

leading to nursing’s unique way of knowing and caring.

Preparaon in both liberal arts and sciences and professional nursing coursework provides

graduates with the essenal abilies to funcon as independent, intellectually curious, socially

responsible, competent praconers (Tobbell, 2018). A liberal educaon creates the foundaon

for the development of intellectual and praccal abilies within the context of nursing. Further,

liberal educaon is the key to understanding self and others; contributes to safe, quality care;

and informs the development of clinical judgment.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

1.1 Demonstrate an understanding of the discipline of nursing’s disnct perspecve and where shared

perspecves exist with other disciplines

1.1a Idenfy concepts, derived from theories from

nursing and other disciplines, which disnguish the

pracce of nursing.

1.1e Translate evidence from nursing science as

well as other sciences into pracce.

1.1b Apply knowledge of nursing science that

develops a foundaon for nursing pracce.

1.1f Demonstrate the applicaon of nursing science

to pracce.

1.1c Understand the historical foundaon of

nursing as the relaonship developed between the

individual and nurse.

1.1g Integrate an understanding of nursing history

in advancing nursing’s inuence in health care.

1.1d Arculate nursing’s disnct perspecve to

pracce.

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

1.2a Apply or employ knowledge from nursing

science as well as the natural, physical, and social

sciences to build an understanding of the human

experience and nursing pracce.

1.2f Synthesize knowledge from nursing and other

disciplines to inform educaon, pracce, and

research.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

1.2b Demonstrate intellectual curiosity. 1.2g Apply a systemac and defendable approach

to nursing pracce decisions.

1.2c Demonstrate social responsibility as a

global cizen who fosters the aainment of

health equity for all.

1.2h Employ ethical decision making to assess,

intervene, and evaluate nursing care.

1.2d Examine inuence of personal values in

decision making for nursing pracce.

1.2i Demonstrate socially responsible leadership.

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

disciplines to pracce.

1.3 Demonstrate clinical judgment founded on a broad knowledge base.

1.3a Demonstrate clinical reasoning. 1.3d Integrate foundaonal and advanced specialty

knowledge into clinical reasoning.

1.3b Integrate nursing knowledge (theories,

mulple ways of knowing, evidence) and

knowledge from other disciplines and inquiry to

inform clinical judgment.

1.3e Synthesize current and emerging evidence to

Inuence pracce.

1.3c Incorporate knowledge from nursing and

other disciplines to support clinical judgment.

1.3f Analyze decision models from nursing and

other knowledge domains to improve clinical

judgment.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 2: Person-Centered Care

Descriptor: Person-centered care focuses on the individual within mulple complicated

contexts, including family and/or important others. Person-centered care is holisc,

individualized, just, respecul, compassionate, coordinated, evidence-based, and

developmentally appropriate. Person-centered care builds on a scienc body of knowledge

that guides nursing pracce regardless of specialty or funconal area.

Contextual Statement: Person-centered care is the core purpose of nursing as a discipline.

This purpose intertwines with any funconal area of nursing pracce, from the point of care

where the hands of those that give and receive care meet, to the point of systems-level

nursing leadership. Foundaonal to person-centered care is respect for diversity, dierences,

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 intenonal presence of the nurse seeking to know the totality of the

individual’s lived experiences and connecons to others (family, important others, community).

As a scienc and pracce discipline, nurses employ a relaonal lens that fosters mutuality,

acve parcipaon, and individual empowerment. This focus is foundaonal to educaonal

preparaon from entry to advanced levels irrespecve of pracce 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 me, spheres of

care, and developmental levels. Contribung to or making diagnoses is one essenal aspect of

nursing pracce and crical to an informed plan of care and improving outcomes of care (Olson

et al., 2019). Diagnoses at the system-level are equally as relevant, aecng operaons that

impact care for individuals. Person-centered care results in shared meaning with the healthcare

team, recipient of care, and the healthcare system, thus creang humanizaon of wellness and

healing from birth to death.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

2.1 Engage with the individual in establishing a caring relaonship.

2.1a Demonstrate qualies of empathy. 2.1d Promote caring relaonships to eect posive

outcomes.

2.1b Demonstrate compassionate care. 2.1e Foster caring relaonships.

2.1c Establish mutual respect with the individual

and family.

2.2 Communicate eecvely with individuals.

2.2a Demonstrate relaonship-centered care. 2.2g Demonstrate advanced communicaon skills

and techniques using a variety of modalies with

diverse audiences.

2.2b Consider individual beliefs, values, and

personalized informaon in communicaons.

2.2h Design evidence-based, person-centered

engagement materials.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

2.2c Use a variety of communicaon modes

appropriate for the context.

2.2i Apply individualized informaon, such

as genec/genomic, pharmacogenec, and

environmental exposure informaon in the

delivery of personalized health care.

2.2d Demonstrate the ability to conduct sensive or

dicult conversaons.

2.2j Facilitate dicult conversaons and disclosure

of sensive informaon.

2.2e Use evidence-based paent teaching

materials, considering health literacy, vision,

hearing, and cultural sensivity.

2.2f Demonstrate emoonal intelligence in

communicaons.

2.3 Integrate assessment skills in pracce.

2.3a Create an environment during assessment that

promotes a dynamic interacve experience.

2.3h Demonstrate that one’s pracce is informed

by a comprehensive assessment appropriate to the

funconal area of advanced nursing pracce.

2.3b Obtain a complete and accurate history in a

systemac manner.

2.3c Perform a clinically relevant, holisc health

assessment.

2.3d Perform point of care screening/diagnosc

tesng (e.g. blood glucose, PO2, EKG).

2.3e Disnguish between normal and abnormal

health ndings.

2.3f Apply nursing knowledge to gain a holisc

perspecve of the person, family, community, and

populaon.

2.3g Communicate ndings of a comprehensive

assessment.

2.4 Diagnose actual or potenal health problems and needs.

2.4a Synthesize assessment data in the context of

the individual’s current preferences, situaon, and

experience.

2.4f Employ context driven, advanced reasoning to

the diagnosc and decision-making process.

2.4b Create a list of problems/health concerns. 2.4g Integrate advanced scienc knowledge to

guide decision making.

2.4c Priorize problems/health concerns.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

2.4d Understand and apply the results of social

screening, psychological tesng, laboratory data,

imaging studies, and other diagnosc tests in

acons and plans of care.

2.4e Contribute as a team member to the formaon

and improvement of diagnoses.

2.5 Develop a plan of care.

2.5a Engage the individual and the team in plan

development.

2.5h Lead and collaborate with an interprofessional

team to develop a comprehensive plan of care.

2.5b Organize care based on mutual health goals. 2.5i Priorize risk migaon strategies to prevent

or reduce adverse outcomes.

2.5c Priorize care based on best evidence. 2.5j Develop evidence-based intervenons to

improve outcomes and safety.

2.5d Incorporate evidence-based intervenon to

improve outcomes and safety.

2.5k Incorporate innovaons into pracce when

evidence is not available.

2.5e Ancipate outcomes of care (expected,

unexpected, and potenally adverse).

2.5f Demonstrate raonale for plan.

2.5g Address individuals’ experiences and

perspecves in designing plans of care.

2.6 Demonstrate accountability for care delivery.

2.6a Implement individualized plan of care using

established protocols.

2.6e Model best care pracces to the team.

2.6b Communicate care delivery through mulple

modalies.

2.6f Monitor aggregate metrics to assure

accountability for care outcomes.

2.6c Delegate appropriately to team members. 2.6g Promote delivery of care that supports

pracce at the full scope of educaon.

2.6d Monitor the implementaon of the plan of

care.

2.6h Contribute to the development of policies

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 transions of

care across the health connuum.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

2.7 Evaluate outcomes of care.

2.7a Reassess the individual to evaluate health

outcomes/goals.

2.7d Analyze data to idenfy gaps and inequies in

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 modicaons to

standard pracce.

2.7f Synthesize outcome data to inform evidence-

based pracce, guidelines, and policies.

2.8 Promote self-care management.

2.8a Assist the individual to engage in self-care

management.

2.8f Develop strategies that promote self-care

management.

2.8b Employ individualized educaonal strategies

based on learning theories, methodologies, and

health literacy.

2.8g Incorporate the use of current and emerging

technologies to support self-care management.

2.8c Educate individuals and families regarding self-

care for health promoon, illness prevenon, and

illness management.

2.8h Employ counseling techniques, including

movaonal interviewing, to advance wellness and

self-care management.

2.8d Respect individuals and families’ self-

determinaon in their healthcare decisions.

2.8i Evaluate adequacy of resources available to

support self-care management.

2.8e Idenfy personal, system, and community

resources available to support self-care

management.

2.8j Foster partnerships with community

organizaons to support self-care management.

2.9 Provide care coordinaon.

2.9a Facilitate connuity of care based on

assessment of assets and needs.

2.9f Evaluate communicaon pathways among

providers and others across sengs, systems, and

communies.

2.9b Communicate with relevant stakeholders

across health systems.

2.9g Develop strategies to opmize care

coordinaon and transions of care.

2.9c Promote collaboraon by clarifying

responsibilies among individual, family, and team

members.

2.9h Guide the coordinaon of care across health

systems.

2.9d Recognize when addional experse and

knowledge is needed to manage the paent.

2.9i Analyze system-level and public policy

inuence on care coordinaon.

2.9e Provide coordinaon of care of individuals and

families in collaboraon with care team.

2.9j Parcipate in system-level change to improve

care coordinaon across sengs.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 3: Populaon Health

Descriptor: Populaon health spans the healthcare delivery connuum from public health

prevenon to disease management of populaons and describes collaborave acvies with

both tradional and non-tradional partnerships from aected communies, public health,

industry, academia, health care, local government enes, and others for the improvement

of equitable populaon health outcomes. (Kindig & Stoddart, 2003; Kindig, 2007; Swartout &

Bishop, 2017; CDC, 2020).

Contextual Statement: A populaon is a discrete group that the nurse and others care for

across sengs at local, regional, naonal, and global levels. Populaon health spans the

healthcare delivery connuum, including public health, acute care, ambulatory care, and long-

term care. Populaon health also encompasses collaborave acvies among stakeholders – all

relevant individuals and organizaons involved in care, including paents and communies

themselves - for the improvement of a populaon’s health status. The purpose of these

collaborave acvies, including development of intervenons 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 mulple factors that inuence the health of a dened group. Populaon health

includes populaon management through systems thinking, including health promoon and

illness prevenon, to achieve populaon health goals (Storell, Wehtle, Winslow, & Saunders,

2017). Nurses play a crical role in advocang for, developing, and implemenng policies that

impact populaon health globally and locally. In addion, nurses respond to crises and provide

care during emergencies, disasters, epidemics, or pandemics. They play an essenal role in

system preparedness and ethical response iniaves. Although each type of public health

emergency will likely require a unique set of competencies, preparedness for responding begins

with a populaon health perspecve and a parcular focus on surveillance, prevenon, and

containment of factors contribung to the emergency.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

3.1 Manage populaon health.

3.1a Dene a target populaon including its

funconal and problem-solving capabilies

(anywhere in the connuum of care).

3.1j Assess the ecacy of a system’s capability to

serve a target sub-populaon’s healthcare needs.

3.1b Assess populaon health data. 3.1k Analyze primary and secondary populaon

health data for mulple populaons against

relevant benchmarks.

3.1c Assess the priories of the community and/or

the aected clinical populaon.

3.1l Use established or evolving methods to

determine populaon-focused priories for care.

3.1d Compare and contrast local, regional, naonal,

and global benchmarks to idenfy health paerns

across populaons.

3.1m Develop a collaborave approach with

relevant stakeholders to address populaon

healthcare needs, including evaluaon methods.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

3.1e Apply an understanding of the public health

system and its interfaces with clinical health care in

addressing populaon health needs.

3.1n Collaborate with appropriate stakeholders

to implement a sociocultural and linguiscally

responsive intervenon plan.

3.1f Develop an acon plan to meet an idened

need(s), including evaluaon methods.

3.1g Parcipate in the implementaon of

sociocultural and linguiscally responsive

intervenons.

3.1h Describe general principles and pracces for

the clinical management of populaons across the

age connuum.

3.1i Idenfy ethical principles to protect the health

and safety of diverse populaons.

3.2 Engage in eecve partnerships.

3.2a Engage with other health professionals to

address populaon health issues.

3.2d Ascertain collaborave opportunies for

individuals and organizaons to improve populaon

health.

3.2b Demonstrate eecve collaboraon and

mutual accountability with relevant stakeholders.

3.2e Challenge biases and barriers that impact

populaon health outcomes.

3.2c Use culturally and linguiscally responsive

communicaon strategies.

3.2f Evaluate the eecveness of partnerships for

achieving health equity.

3.2g Lead partnerships to improve populaon

health outcomes.

3.2h Assess preparaon 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 implicaons of

proposed intervenon(s).

3.3c Analyze cost-benets of selected populaon-

based intervenons.

3.3b Priorize paent-focused and/or community

acon plans that are safe, eecve, and ecient in

the context of available resources.

3.3d Collaborate with partners to secure and

leverage resources necessary for eecve,

sustainable intervenons.

3.3e Advocate for intervenons that maximize cost-

eecve, accessible, and equitable resources for

populaons.

3.3f Incorporate ethical principles in resource

allocaon in achieving equitable health.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

3.4 Advance equitable populaon health policy.

3.4a Describe policy development processes. 3.4f Idenfy opportunies to inuence the policy

process.

3.4b Describe the impact of policies on populaon

outcomes, including social jusce and health

equity.

3.4g Design comprehensive advocacy strategies to

support the policy process.

3.4c Idenfy best evidence to support policy

development.

3.4h Engage in strategies to inuence policy

change.

3.4d Propose modicaons to or development of

policy based on populaon ndings.

3.4i Contribute to policy development at the

system, local, regional, or naonal levels.

3.4e Develop an awareness of the

interconnectedness of populaon health across

borders.

3.4j Assess the impact of policy changes.

3.4k Evaluate the ability of policy to address

disparies and inequies within segments of the

populaon.

3.4l Evaluate the risks to populaon health

associated with globalizaon.

3.5 Demonstrate advocacy strategies.

3.5a Arculate a need for change. 3.5f Appraise advocacy priories for a populaon.

3.5b Describe the intent of the proposed change. 3.5g Strategize with an interdisciplinary group and

others to develop eecve advocacy approaches.

3.5c Dene stakeholders, including members of the

community and/or clinical populaons, and their

level of inuence.

3.5h Engage in relaonship-building acvies with

stakeholders at any level of inuence, including

system, local, state, naonal, and/or global.

3.5d Implement messaging strategies appropriate

to audience and stakeholders.

3.5i Demonstrate leadership skills to promote

advocacy eorts that include principles of social

jusce, diversity, equity, and inclusion.

3.5e Evaluate the eecveness of advocacy acons.

3.6 Advance preparedness to protect populaon health during disasters and public health emergencies.

3.6a Idenfy changes in condions that might

indicate a disaster or public health emergency.

3.6f Collaboravely iniate rapid response acvies

to protect populaon health.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

3.6b Understand the impact of climate change on

environmental and populaon health.

3.6g Parcipate in ethical decision making that

includes diversity, equity, and inclusion in advanced

preparedness to protect populaons.

3.6c Describe the health and safety hazards of

disasters and public health emergencies.

3.6h Collaborate with interdisciplinary teams to

lead preparedness and migaon eorts to protect

populaon health with aenon to the most

vulnerable populaons.

3.6d Describe the overarching principles and

methods regarding personal safety measures,

including personal protecve equipment (PPE).

3.6i Coordinate the implementaon of evidence-

based infecon control measures and proper use of

personal protecve equipment.

3.6e Implement infecon control measures and

proper use of personal protecve equipment.

3.6j Contribute to system-level planning, decision

making, and evaluaon for disasters and public

health emergencies.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 4: Scholarship for the Nursing Discipline

Descriptor: The generaon, synthesis, translaon, applicaon, and disseminaon of nursing

knowledge to improve health and transform health care (AACN, 2018).

Contextual Statement: Nursing scholarship informs science, enhances clinical pracce,

inuences policy, and impacts best pracces for educang nurses as clinicians, scholars, and

leaders. Scholarship is inclusive of discovery, applicaon, integraon, 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 pracce 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 crique

research and determine its applicability to nursing’s body of knowledge, is crical. Ethical

comportment in the conduct and disseminaon of research and advocacy for human subjects

are essenal components of nursing’s role in the process of improving health and health care.

Whereas the research process is the generaon of new knowledge, evidence-based pracce

(EBP) is the process for the applicaon, translaon, and implementaon of best evidence into

clinical decision-making. While evidence may emerge from research, EBP extends beyond just

data to include paent preferences and values as well as clinical experse. Nurses, as innovators

and leaders within the interprofessional team, use the uniqueness of nursing in nurse-paent

relaonships to provide opmal care and address health inequies, structural racism, and

systemic inequity.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

4.1 Advance the scholarship of nursing.

4.1a Demonstrate an understanding of dierent

approaches to scholarly pracce.

4.1h Apply and crically evaluate advanced

knowledge in a dened area of nursing pracce.

4.1b Demonstrate applicaon of dierent levels of

evidence.

4.1i Engage in scholarship to advance health.

4.1c Apply theorecal framework(s)/models in

pracce.

4.1j Discern appropriate applicaons of

quality improvement, research, and evaluaon

methodologies.

4.1d Demonstrate an understanding of basic

elements of the research process.

4.1k Collaborate to advance one’s scholarship.

4.1e Parcipate in scholarly inquiry as a team

member.

4.1l Disseminate one’s scholarship to diverse

audiences using a variety of approaches or

modalies.

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

and with other stakeholders for the contribuons

of nursing scholarship.

4.1g Communicate scholarly ndings.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

4.2 Integrate best evidence into nursing pracce.

4.2a Evaluate clinical pracce to generate quesons

to improve nursing care.

4.2f Use diverse sources of evidence to inform

pracce.

4.2b Evaluate appropriateness and strength of the

evidence.

4.2g Lead the translaon of evidence into pracce.

4.2c Use best evidence in pracce. 4.2h Address opportunies for innovaon and

changes in pracce.

4.2d Parcipate in the implementaon of a pracce

change to improve nursing care.

4.2i Collaborate in the development of new/revised

policy or regulaon in the light of new evidence.

4.2e Parcipate in the evaluaon of outcomes and

their implicaons for pracce.

4.2j Arculate inconsistencies between pracce

policies and best evidence.

4.2k Evaluate outcomes and impact of new

pracces based on the evidence.

4.3 Promote the ethical conduct of scholarly acvies.

4.3a Explain the raonale for ethical research

guidelines, including Instuonal Review Board

(IRB) guidelines.

4.3e Idenfy and migate potenal risks and areas

of ethical concern in the conduct of scholarly

acvies.

4.3b Demonstrate ethical behaviors in scholarly

projects including quality improvement and EBP

iniaves.

4.3f Apply IRB guidelines throughout the

scholarship process.

4.3c Advocate for the protecon of parcipants in

the conduct of scholarly iniaves.

4.3g Ensure the protecon of parcipants in the

conduct of scholarship.

4.3d Recognize the impact of equity issues in

research.

4.3h Implement processes that support ethical

conduct in pracce and scholarship.

4.3i Apply ethical principles to the disseminaon of

nursing scholarship.

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 pracce, enhance quality and

minimize risk of harm to paents and providers through both system eecveness 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 recognion 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 acon 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 pracce guidelines and

evidence-based intervenons.

Safety is inclusive of aending to work environment hazards, such as violence, burnout,

ergonomics, and chemical and biological agents; there is a synergisc relaonship between

employee safety and paent 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 obligaon to

remain non-punive in detecng, reporng, and analyzing errors, possible exposures, and near

misses when they occur.

Quality and safety are interdependent, as safety is a necessary aribute of quality care. For

quality health care to exist, care must be safe, eecve, mely, ecient, equitable, and person-

centered. Quality care is the extent to which care services improve desired health outcomes

and are consistent with paent preferences and current professional knowledge (IOM, 2001).

Addionally, quality care includes collaborave engagement with the recipient of care in

assuming responsibility for health promoon 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.

Essenally, everyone in health care is responsible for quality care and paent safety. Nurses

are uniquely posioned 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 connued gaps in healthcare safety.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

5.1 Apply quality improvement principles in care delivery.

5.1a Recognize nursing’s essenal role in improving

healthcare quality and safety.

5.1i Establish and incorporate data driven

benchmarks to monitor system performance.

5.1b Idenfy sources and applicaons of naonal

safety and quality standards to guide nursing

pracce.

5.1j Use naonal safety resources to lead team-

based change iniaves.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

5.1c Implement standardized, evidence-based

processes for care delivery.

5.1k Integrate outcome metrics to inform change

and policy recommendaons.

5.1d Interpret benchmark and unit outcome data

to inform individual and microsystem pracce.

5.1l Collaborate in analyzing organizaonal process

improvement iniaves.

5.1e Compare quality improvement methods in the

delivery of paent care.

5.1m Lead the development of a business plan for

quality improvement iniaves.

5.1f Idenfy strategies to improve outcomes of

paent care in pracce.

5.1n Advocate for change related to nancial

policies that impact the relaonship between

economics and quality care delivery.

5.1g Parcipate in the implementaon of a pracce

change.

5.1o Advance quality improvement pracces

through disseminaon of outcomes.

5.1h Develop a plan for monitoring quality

improvement change.

5.2 Contribute to a culture of paent safety.

5.2a Describe the factors that create a culture of

safety.

5.2g Evaluate the alignment of system data and

comparave paent safety benchmarks.

5.2b Arculate the nurse’s role within an

interprofessional team in promong safety and

prevenng errors and near misses.

5.2h Lead analysis of actual errors, near misses,

and potenal situaons that would impact safety.

5.2c Examine basic safety design principles to

reduce risk of harm.

5.2i Design evidence-based intervenons to

migate risk.

5.2d Assume accountability for reporng unsafe

condions, near misses, and errors to reduce harm.

5.2j Evaluate emergency preparedness system-level

plans to protect safety.

5.2e Describe processes used in understanding

causes of error.

5.2f Use naonal paent safety resources,

iniaves, and regulaons at the point of care.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

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

5.3a Idenfy actual and potenal level of risks to

providers within the workplace.

5.3e Advocate for structures, policies, and

processes that promote a culture of safety and

prevent workplace risks and injury.

5.3b Recognize how to prevent workplace violence

and injury.

5.3f Foster a just culture reecng civility and

respect.

5.3c Promote policies for prevenon of violence

and risk migaon.

5.3g Create a safe and transparent culture for

reporng incidents.

5.3d Recognize one’s role in sustaining a just

culture reecng civility and respect.

5.3h Role model and lead well-being and resiliency

for self and team.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 6: Interprofessional Partnerships

Descriptor: Intenonal collaboraon across professions and with care team members, paents,

families, communies, and other stakeholders to opmize care, enhance the healthcare

experience, and strengthen outcomes.

Contextual Statement: Professional partnerships that include interprofessional,

intraprofessional, and paraprofessional partnerships, build on a consistent demonstraon of

core professional values (altruism, excellence, caring, ethics, respect, communicaon, and

shared accountability) in the provision of team-based, person-centered care. Nursing knowledge

and experse uniquely contributes to the intenonal work within teams and in concert with

paent, family, and community preferences and goals. Interprofessional partnerships require

a coordinated, integrated, and collaborave implementaon of the unique knowledge, beliefs,

and skills of the full team for the end purpose of opmized care delivery. Eecve collaboraon

requires an understanding of team dynamics and an ability to work eecvely in care-oriented

teams. Leadership of the team varies depending on needs of the individual, community,

populaon, and context of care.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

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

6.1a Communicate the nurse’s roles and

responsibilies clearly.

6.1g Evaluate eecveness of interprofessional

communicaon tools and techniques to support

and improve the ecacy of team-based

interacons.

6.1b Use various communicaon tools and

techniques eecvely.

6.1h Facilitate improvements in interprofessional

communicaons of individual informaon (e.g.

EHR).

6.1c Elicit the perspecves of team members to

inform person-centered care decision making.

6.1i Role model respect for diversity, equity, and

inclusion in team-based communicaons.

6.1d Arculate impact of diversity, equity, and

inclusion on team-based communicaons.

6.1j Communicate nursing’s unique disciplinary

knowledge to strengthen interprofessional

partnerships.

6.1e Communicate individual informaon in a

professional, accurate, and mely manner.

6.1k Provide expert consultaon for other members

of the healthcare team in one’s area of pracce.

6.1f Communicate as informed by legal, regulatory,

and policy guidelines.

6.1l Demonstrate capacity to resolve

interprofessional conict.

6.2 Perform eecvely in dierent team roles, using principles and values of team dynamics.

6.2a Apply principles of team dynamics, including

team roles, to facilitate eecve team funconing.

6.2g Integrate evidence-based strategies and

processes to improve team eecveness and

outcomes.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

6.2b Delegate work to team members based on

their roles and competency.

6.2h Evaluate the impact of team dynamics and

performance on desired outcomes.

6.2c Engage in the work of the team as appropriate

to one’s scope of pracce and competency.

6.2i Reect on how one’s role and experse

inuences team performance.

6.2d Recognize how one’s uniqueness (as a

person and a nurse) contributes to eecve

interprofessional working relaonships.

6.2j Foster posive team dynamics to strengthen

desired outcomes.

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 responsibilies of

healthcare professionals through interprofessional

collaborave pracce.

6.3d Direct interprofessional acvies and

iniaves.

6.3b Leverage roles and abilies of team members

to opmize care.

6.3c Communicate with team members to clarify

responsibilies in execung 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

and how they may aect mutual respect and

communicaon with team members.

6.4e Pracce self-assessment to migate conscious

and implicit biases toward other team members.

6.4b Demonstrate respect for the perspecves and

experiences of other professions.

6.4f Foster an environment that supports the

construcve sharing of mulple perspecves and

enhances interprofessional learning.

6.4c Engage in construcve communicaon to

facilitate conict management.

6.4g Integrate diversity, equity, and inclusion into

team pracces.

6.4d Collaborate with interprofessional team

members to establish mutual healthcare goals for

individuals, communies, or populaons.

6.4h Manage disagreements, conicts, and

challenging conversaons among team members.

6.4i Promote an environment that advances

interprofessional learning.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 7: Systems-Based Pracce

Descriptor: Responding to and leading within complex systems of health care. Nurses

eecvely and proacvely coordinate resources to provide safe, quality, and equitable care to

diverse populaons.

Contextual Statement: Using evidence-based methodologies, nurses lead innovave soluons

to address complex health problems and ensure opmal care. Understanding of systems-

based pracce is foundaonal to the delivery of quality care and incorporates key concepts of

organizaonal structure, including relaonships among macro-, meso-, and microsystems across

healthcare sengs. Knowledge of nancial and payment models relave to reimbursement

and healthcare costs is essenal. In addion, the impact of local, regional, naonal, and

global structures, systems, and regulaons on individuals and diverse populaons must be

considered when evaluang paent outcomes. As change agents and leaders, nurses possess

the intellectual capacity to be agile in response to connually evolving healthcare systems, to

address structural racism and other forms of discriminaon, and to advocate for the needs of

diverse populaons. Systems-based pracce is predicated on an ethical pracce environment

where professional and organizaonal values are aligned, and structures and processes enable

ethical pracce by all members of the instuon.

Integrated healthcare systems are highly complex, and gaps or failures in service and delivery

can cause ineecve, harmful outcomes. These outcomes also span individual through global

networks. Cognive shiing from focused to big picture is a crucial skill set. Similarly, the ability

for nurses to predict change, employ improvement strategies, and exercise scal prudence are

crical skills. System awareness, innovaon, and design also are needed to address such issues

as structural racism and systemic inequity.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

7.1 Apply knowledge of systems to work eecvely across the connuum of care.

7.1a Describe organizaonal structure, mission,

vision, philosophy, and values.

7.1e Parcipate in organizaonal strategic planning.

7.1b Explain the relaonships of macrosystems,

mesosystems, and microsystems.

7.1f Parcipate in system-wide iniaves that

improve care delivery and/or outcomes.

7.1c Dierenate between various healthcare

delivery environments across the connuum of

care.

7.1g Analyze system-wide processes to opmize

outcomes.

7.1d Recognize internal and external system

processes that impact care coordinaon and

transion of care.

7.1h Design policies to impact health equity and

structural racism within systems, communies, and

populaons.

7.2 Incorporate consideraon of cost-eecveness of care.

7.2a Describe the nancial and payment models of

health care.

7.2g Analyze relevant internal and external factors

that drive healthcare costs and reimbursement.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

7.2b Recognize the impact of health disparies and

social determinants of health on care outcomes.

7.2h Design pracces that enhance value, access,

quality, and cost-eecveness.

7.2c Describe the impact of healthcare cost and

payment models on the delivery, access, and

quality of care.

7.2i Advocate for healthcare economic policies and

regulaons to enhance value, quality, and cost-

eecveness.

7.2d Explain the relaonship of policy, regulatory

requirements, and economics on care outcomes.

7.2j Formulate, document, and disseminate the

return on investment for improvement iniaves

collaboravely with an interdisciplinary team.

7.2e Incorporate consideraons of eciency, value,

and cost in providing care.

7.2k Recommend system-wide strategies that

improve cost- eecveness considering structure,

leadership, and workforce needs.

7.2f Idenfy the impact of diering system

structures, leadership, and workforce needs on

care outcomes.

7.2l Evaluate health policies based on an ethical

framework considering cost-eecveness, health

equity, and care outcomes.

7.3 Opmize system eecveness through applicaon of innovaon and evidence-based pracce.

7.3a Demonstrate a systemac approach for

decision-making.

7.3e Apply innovave and evidence-based

strategies focusing on system preparedness and

capabilies.

7.3b Use reported performance metrics to

compare/monitor outcomes.

7.3f Design system improvement strategies based

on performance data and metrics.

7.3c Parcipate in evaluang system eecveness. 7.3g Manage change to sustain system

eecveness.

7.3d Recognize internal and external system

processes and structures that perpetuate racism

and other forms of discriminaon within health

care.

7.3h Design system improvement strategies that

address internal and external system processes

and structures that perpetuate structural racism

and other forms of discriminaon in healthcare

systems.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 8: Informacs and Healthcare Technologies

Descriptor: Informaon and communicaon technologies and informacs processes are used to

provide care, gather data, form informaon to drive decision making, and support professionals

as they expand knowledge and wisdom for pracce. Informacs processes and technologies are

used to manage and improve the delivery of safe, high-quality, and ecient healthcare services

in accordance with best pracce and professional and regulatory standards.

Contextual Statement: Healthcare professionals interact with paents, families, communies,

and populaons in technology-rich environments. Nurses, as essenal members of the

healthcare team, use informaon and communicaon technologies and informacs tools in

their direct and indirect care roles. The technologies, the locaons in which they are used,

the users interacng with the technology, the communicaon occurring, and the work being

done all impact the data collected, informaon formed, decisions made, and the knowledge

generated. Addionally, the ulizaon of informaon and communicaon technologies in

healthcare sengs 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,

eciency of communicaons, and connecons between team members, paents, and

consumers. It is essenal that nurses at all levels understand their role and the value of their

input in health informaon technology analysis, planning, implementaon, and evaluaon.

With the prevalence of paent-focused health informaon technologies, all nurses have a

responsibility to advocate for equitable access and assist paents and consumers to opmally

use these tools to engage in care, improve health, and manage health condions.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

8.1 Describe the various informaon and communicaon technology tools used in the care of paents,

communies, and populaons.

8.1a Idenfy the variety of informaon and

communicaon technologies used in care sengs.

8.1g Idenfy best evidence and pracces for the

applicaon of informaon and communicaon

technologies to support care.

8.1b Idenfy the basic concepts of electronic

health, mobile health, and telehealth systems for

enabling paent care.

8.1h Evaluate the unintended consequences of

informaon and communicaon technologies on

care processes, communicaons, and informaon

ow across care sengs.

8.1c Eecvely use electronic communicaon tools. 8.1i Propose a plan to inuence the selecon

and implementaon of new informaon and

communicaon technologies.

8.1d Describe the appropriate use of mulmedia

applicaons in health care.

8.1j Explore the scal impact of informaon and

communicaon technologies on health care.

8.1e Demonstrate best pracce use of social

networking applicaons.

8.1k Idenfy the impact of informaon and

communicaon technologies on workow

processes and healthcare outcomes.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

8.1f Explain the importance of nursing engagement

in the planning and selecon of healthcare

technologies.

8.2 Use informaon and communicaon technology to gather data, create informaon, and generate

knowledge.

8.2a Enter accurate data when chronicling care. 8.2f Generate informaon and knowledge from

health informaon technology databases.

8.2b Explain how data entered on one paent

impacts public and populaon health data.

8.2g Evaluate the use of communicaon technology

to improve consumer health informaon 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

informaon literacy assessments and improvement

strategies.

8.2i Clarify how the collecon of standardized data

advances the pracce, understanding, and value of

nursing and supports care.

8.2e Describe the importance of standardized

nursing data to reect the unique contribuon of

nursing pracce.

8.2j Interpret primary and secondary data and

other informaon to support care.

8.3 Use informaon and communicaon technologies and informacs processes to deliver

safe nursing care to diverse populaons in a variety of sengs.

8.3a Demonstrate appropriate use of informaon

and communicaon technologies.

8.3g Evaluate the use of informaon and

communicaon technology to address needs, gaps,

and ineciencies in care.

8.3b Evaluate how decision support tools impact

clinical judgment and safe paent care.

8.3h Formulate a plan to inuence decision-

making processes for selecng, implemenng, and

evaluang support tools.

8.3c Use informaon and communicaon

technology in a manner that supports the nurse-

paent relaonship.

8.3i Appraise the role of informaon and

communicaon technologies in engaging the

paent and supporng the nurse-paent

relaonship.

8.3d Examine how emerging technologies inuence

healthcare delivery and clinical decision making.

8.3j Evaluate the potenal uses and impact of

emerging technologies in health care.

8.3e Idenfy impact of informaon and

communicaon technology on quality and safety of

care.

8.3k Pose strategies to reduce inequies in digital

access to data and informaon.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

8.3f Idenfy the importance of reporng system

processes and funconal issues (error messages,

mis-direcons, device malfuncons, etc.) according

to organizaonal policies and procedures.

8.4 Use informaon and communicaon technology to support documentaon of care and

communicaon among providers, paents, and all system levels.

8.4a Explain the role of communicaon technology

in enhancing clinical informaon ows.

8.4e Assess best pracces for the use of advanced

informaon and communicaon technologies to

support paent and team communicaons.

8.4b Describe how informaon and communicaon

technology tools support paent and team

communicaons.

8.4f Employ electronic health, mobile health, and

telehealth systems to enable quality, ethical, and

ecient paent care.

8.4c Idenfy the basic concepts of electronic

health, mobile health, and telehealth systems in

enabling paent care.

8.4g Evaluate the impact of health informaon

exchange, interoperability, and integraon to

support paent-centered care.

8.4d Explain the impact of health informaon

exchange, interoperability, and integraon on

health care.

8.5 Use informaon and communicaon technologies in accordance with ethical, legal, professional,

and regulatory standards, and workplace policies in the delivery of care.

8.5a Idenfy common risks associated with using

informaon and communicaon technology.

8.5g Apply risk migaon and security strategies to

reduce misuse of informaon and communicaon

technology.

8.5b Demonstrate ethical use of social networking

applicaons.

8.5h Assess potenal ethical and legal issues

associated with the use of informaon and

communicaon technology.

8.5c Comply with legal and regulatory requirements

while using communicaon and informaon

technologies.

8.5i Recommend strategies to protect health

informaon when using communicaon and

informaon technology.

8.5d Educate paents on their rights to access,

review, and correct personal data and medical

records.

8.5j Promote paent engagement with their

personal health data.

8.5e Discuss how clinical judgment and crical

thinking must prevail in the presence of

informaon and communicaon technologies.

8.5k Advocate for policies and regulaons that

support the appropriate use of technologies

impacng health care.

8.5f Deliver care using remote technology. 8.5l Analyze the impact of federal and state policies

and regulaon on health data and technology in

care sengs.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 9: Professionalism

Descriptor: Formaon and culvaon of a sustainable professional identy, including

accountability, perspecve, collaborave disposion, and comportment, that reects nursing’s

characteriscs and values.

Contextual Statement: Professionalism encompasses the development of a nursing identy

embracing the values of integrity, altruism, inclusivity, compassion, courage, humility, advocacy,

caring, autonomy, humanity, and social jusce. Professional identy formaon necessitates the

development of emoonal intelligence to promote social good, engage in social jusce, and

demonstrate ethical comportment, moral courage, and asserveness in decision making and

acons. Nursing professionalism is a connuous process of socializaon that requires the nurse

to give back to the profession through the mentorship and development of others.

Professional identy, inuenced by one’s personal identy and unique background, is formed

throughout one’s educaon and career. Nursing identy ourishes through engagement and

reecon in mulple experiences that is dened by diering perspecves and voices. As a

result, nurses embrace the history, characteriscs, and values of the discipline and think, act,

and feel like a nurse. Professional identy formaon is not a linear process but rather one

that responds to challenges and matures through professional experiences as one develops

condence as a nurse.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

9.1 Demonstrate an ethical comportment in one’s pracce reecve of nursing’s mission to society.

9.1a Apply principles of professional nursing ethics

and human rights in paent care and professional

situaons.

9.1h Analyze current policies and pracces in the

context of an ethical framework.

9.1b Reect on one’s acons and their

consequences.

9.1i Model ethical behaviors in pracce and

leadership roles.

9.1c Demonstrate ethical behaviors in pracce. 9.1j Suggest soluons when unethical behaviors are

observed.

9.1d Change behavior based on self and situaonal

awareness.

9.1k Assume accountability for working to resolve

ethical dilemmas.

9.1e Report unethical behaviors when observed.

9.1f Safeguard privacy, condenality, and

autonomy in all interacons.

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

determinaon.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

9.2 Employ parcipatory approach to nursing care.

9.2a Employ the use of intenonal presence to

facilitate shared meaning of the experience between

nurse and recipient of care.

9.2h Foster opportunies for intenonal presence

in pracce.

9.2b Facilitate health and healing through

compassionate caring.

9.2i Idenfy innovave and evidence-based

pracces that promote person-centered care.

9.2c Demonstrate empathy to the individual’s life

experience.

9.2j Advocate for pracces that advance diversity,

equity, and inclusion.

9.2d Advocate for pracces that advance diversity,

equity, and inclusion.

9.2k Model professional expectaons for

therapeuc relaonships.

9.2e Demonstrate cultural sensivity and humility

in pracce.

9.2l Facilitate communicaon that promotes a

parcipatory approach.

9.2f Apply principles of therapeuc relaonships

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

best interest of the individual, community, and

profession.

9.3i Advocate for nursing’s professional

responsibility for ensuring opmal care outcomes

9.3b Demonstrate the moral courage to report

concerns related to actual or potenal hazards and/

or errors.

9.3j Demonstrate leadership skills when

parcipang in professional acvies and/or

organizaons.

9.3c Demonstrate professional and personal

honesty and integrity.

9.3k Address actual or potenal hazards and/or

errors.

9.3d Take responsibility for one’s roles, decisions,

obligaons, acons, and care outcomes.

9.3l Foster a pracce environment that promotes

accountability for care outcomes.

9.3e Engage in professional acvies and/or

organizaons.

9.3m Advocate for policies/pracces that promote

social jusce 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 sengs.

9.3g Advocate for social jusce and health equity,

including addressing the health of vulnerable

populaons.

9.3o Lead in the development of opportunies for

professional and interprofessional acvies.

9.3h Engage in peer evaluaon.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

9.4 Comply with relevant laws, policies, and regulaons.

9.4a Advocate for policies that promote health and

prevent harm.

9.4d Advocate for polices that enable nurses to

pracce to the full extent of their educaon.

9.4b Adhere to the registered nurse scope and

standards of pracce.

9.4e Assess the interacon between regulatory

agency requirements and quality, scal, and value-

based indicators.

9.4c Adhere to regulatory requirements and

workplace policies consistent with one’s

educaonal preparaon.

9.4f Evaluate the eect of legal and regulatory

policies on nursing pracce and healthcare

outcomes.

9.4g Analyze eorts to change legal and regulatory

policies that improve nursing pracce and health

outcomes.

9.4h Parcipate in the implementaon of policies

and regulaons to improve the professional

pracce environment and healthcare outcomes.

9.5 Demonstrate the professional identy of nursing.

9.5a Describe nursing’s professional identy and

contribuons to the healthcare team.

9.5f Arculate nursing’s unique professional

identy to other interprofessional team members

and the public.

9.5b Demonstrate the core values of professional

nursing identy.

9.5g Evaluate pracce environment to ensure that

nursing core values are demonstrated.

9.5c Demonstrate sensivity to the values of

others.

9.5h Idenfy opportunies to lead with moral

courage to inuence team decision-making.

9.5d Demonstrate ethical comportment and moral

courage in decision making and acons.

9.5i Engage in professional organizaons that

reect nursing’s values and identy.

9.5e Demonstrate emoonal intelligence.

9.6 Integrate diversity, equity, and inclusion as core to one’s professional identy.

9.6a Demonstrate respect for diverse individual

dierences and diverse communies and

populaons

9.6d Model respect for diversity, equity, and

inclusion for all team members.

9.6b Demonstrate awareness of personal and

professional values and conscious and unconscious

biases.

9.6e Crique one’s personal and professional

pracces in the context of nursing’s core values.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

9.6c Integrate core principles of social jusce and

human rights into pracce.

9.6f Analyze the impact of structural and cultural

inuences on nursing’s professional identy.

9.6g Ensure that care provided by self and others is

reecve of nursing’s core values.

9.6h Structure the pracce environment to

facilitate care that is culturally and linguiscally

appropriate.

9.6i Ensure self and others are accountable in

upholding moral, legal, and humanisc principles

related to health.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Domain 10: Personal, Professional, and Leadership Development

Descriptor: Parcipaon in acvies and self-reecon that foster personal health, resilience,

and well-being; contribute to lifelong learning; and support the acquision of nursing experse

and the asseron 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 adapng to ambiguity and change; 2) development of the nurse as a professional

responsible for lifelong learning and ongoing self-reecon; and 3) development of the nurse

as a leader procient in asserng control, inuence, and power in professional and personal

contexts, which includes advocacy for paents 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 experse, and determined

leadership pracce in a variety of contexts.

Graduates must develop aributes and skills crical to the viability of the profession and

pracce environments. The aim is to promote diversity and retenon in the profession, self-

awareness, avoidance of stress-induced emoonal and mental exhauson, and re-direcon of

energy from negave percepons to posive inuence through leadership opportunies.

Entry-Level Professional Nursing Educaon Advanced-Level Nursing Educaon

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

10.1a Demonstrate healthy, self-care behaviors that

promote wellness and resiliency.

10.1c Contribute to an environment that promotes

self-care, personal health, and well-being.

10.1b Manage conict between personal and

professional responsibilies.

10.1d Evaluate the workplace environment to

determine level of health and well-being.

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

10.2a Engage in guided and spontaneous reecon

of one’s pracce.

10.2g Demonstrate cognive exibility in managing

change within complex environments.

10.2b Integrate comprehensive feedback to

improve performance.

10.2h Mentor others in the development of their

professional growth and accountability.

10.2c Commit to personal and professional

development.

10.2i Foster acvies that support a culture of

lifelong learning.

10.2d Expand personal knowledge to inform clinical

judgment.

10.2j Expand leadership skills through professional

service.

10.2e Idenfy role models and mentors to support

professional growth.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

10.2f Parcipate in ongoing acvies that embrace

principles of diversity, equity, inclusion, and an-

discriminaon.

10.3 Develop capacity for leadership.

10.3a Compare and contrast leadership principles

and theories.

10.3j Provide leadership to advance the nursing

profession.

10.3b Formulate a personal leadership style. 10.3k Inuence intenonal change guided by

leadership principles and theories.

10.3c Demonstrate leadership behaviors in

professional situaons.

10.3l Evaluate the outcomes of intenonal change.

10.3d Demonstrate self-ecacy consistent with

one’s professional development.

10.3m Evaluate strategies/methods for peer review.

10.3e Use appropriate resources when dealing with

ambiguity.

10.3n Parcipate in the evaluaon of other

members of the care team.

10.3f Modify one’s own leadership behaviors based

on guided self-reecon.

10.3o Demonstrate leadership skills in mes of

uncertainty and crisis.

10.3g Demonstrate self-awareness of one’s own

implicit biases and their relaonship to one’s

culture and environment.

10.3p Advocate for the promoon of social jusce

and eradicaon of structural racism and systemac

inequity in nursing and society.

10.3h Communicate a consistent image of the

nurse as a leader.

10.3q Advocate for the nursing profession in a

manner that is consistent, posive, relevant,

accurate, and disncve.

10.3i Recognize the importance of nursing’s

contribuons as leaders in pracce and policy

issues.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Glossary

Accountability: Obligaon or willingness to accept responsibility or to account for one’s acons.

Advanced nursing pracce role: One of the four Advanced Pracce Registered Nurse (APRN)

roles – cered registered nurse anesthest, cered nurse-midwife, cered clinical nurse

specialist, and cered nurse praconer.

Advanced nursing pracce specialty: See Specialty.

Advanced Pracce Registered Nurse (APRN): Designaon given to one of four nursing roles:

cered registered nurse anesthests, cered nurse-midwives, cered clinical nurse

specialists, and cered nurse praconers. An APRN is a nurse who has 1.) completed an

accredited graduate-level educaon program preparing him/her for one of the four recognized

APRN roles; 2.) passed a naonal cercaon examinaon that measures APRN role and

populaon-focused competencies and who maintains connued competence as evidenced

by recercaon in the role and populaon through the naonal cercaon program; 3.)

acquired advanced clinical knowledge and skills preparing him/her to provide direct care to

paents, as well as a component of indirect care; 4.) built on the competencies of registered

nurses by demonstrang a greater depth and breadth of knowledge, a greater synthesis of

data, increased complexity of skills and intervenons, and greater role autonomy; 5.) been

educaonally prepared to assume responsibility and accountability for health promoon and/or

maintenance as well as the assessment, diagnosis, and management of paent problems, which

includes the use and prescripon of pharmacologic and non-pharmacologic intervenons;

6.) clinical experience of sucient depth and breadth to reect the intended license; and 7.)

obtained a license to pracce in one of the four APRN roles (APRN Consensus Work Group &

NCSBN APRN Advisory Commiee, 2008).

APRN Core: APRN educaon 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, pharmacokinecs and

pharmacotherapeucs of all broad categories of agents (APRN Consensus Work Group & NCSBN

APRN Advisory Commiee, 2008).

Advocacy: The act or process of supporng a cause or proposal: the act or process of

advocang. Advocacy is a pillar of nursing. Nurses insncvely advocate for their paents, in

their workplaces, and in their communies; but legislave and polical advocacy is equally

important to advancing paent care.

Analyc approach: Any method based on breaking down a complex process into its parts so as

to beer understand the whole.

Authenc or intenonal presence: Being fully present in the moment This extends to

possessing an awareness of when you dri and how to intenonally bring yourself back to the

interacon (Altman, 2014).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Care: A focused aenon on, and when possible, engagement with a paent to determine a

person’s parcular needs and the use of clinical judgment to meet those needs (Grace, 2018).

Care outcomes: Harris (1991) dened outcomes as the end points of care, substanal changes

in the health condion of a paent, and changes in paent behavior caused by medical

intervenons. Given these denions, outcomes related to clinical pracce are any change that

resulted from health care.

Caring relaonship: Caring constutes the essence of what it is to be human, having a profound

eect on well-being and recovery, being at ease, and being healed. When hospitality is received,

paents feel a connecon, they begin to trust, and their healing begins.

Clinical immersion: A brief, structured, intense nursing praccum where the enre focus is in a

parcular clinical seng without the distracon of other academic classes (Tratnack, et al., 2011).

Clinical judgment: The skill of recognizing cues regarding a clinical situaon, generang and

weighing hypotheses, taking acon, and evaluang outcomes for the purpose of arriving at a

sasfactory clinical outcome. Clinical judgment is the observed outcome of two unobserved

underlying mental processes, crical thinking and decision making (NCSBN, 2018).

Clinical reasoning: Thought processes that allow healthcare providers to arrive at a conclusion.

Cognive exibility: A crical execuve funcon involving the ability to adapt behaviors in

response to changes in the environment. Cognive exibility generally refers to the ability to

adapt exibly to a constantly changing environment.

Complex systems: Systems whose behavior is intrinsically dicult to model due to the

dependencies, compeons, relaonships, or other types of interacons between their parts

or between a given system and its environment. Complex systems have disnct properes that

arise from these relaonships, such as nonlinearity, emergence, spontaneous order, adaptaon,

and feedback loops, among others.

Competence: The array of abilies (knowledge, skills, and atudes) across mulple domains

or aspects of performance in a certain context. Competence is mul-dimensional and dynamic

(Frank, Snell, Cate, et al., 2010).

Competency: An observable ability of a health professional, integrang mulple components

such as knowledge, skills, values, and atudes. Since competencies are observable, they can be

measured and assessed to ensure their acquision (Frank, Snell, Cate, et al., 2010).

Competency framework: An organized and structured representaon of a set of interrelated

and purposeful competencies (Englander et al., 2013, p. 1089).

Competency list: The delineaon of the specic competencies within a competency framework

(Englander, et al., 2013, p.1089).

Concepts: A concept is an organizing idea or mental construct represented by common

aributes. Rodgers (1989, p. 332) describes concepts as “an abstracon that is expressed in

some form.”

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Core values: In nursing, core nursing values include human dignity, integrity, autonomy,

altruism, and social jusce.

Core disciplinary knowledge: The intellectual structures within which the discipline delineates

its unique focus of vision and social mandate. AACN has idened core disciplinary knowledge

as having three components: historic and philosophic foundaons to the development of

nursing knowledge; exisng and evolving substanve nursing knowledge; and methods and

processes of theory/knowledge development (AACN, 2002, p. 289).

Cost eecveness: A way to examine both the costs and health outcomes of one or more

intervenons; it compares one intervenon to another (or the status quo) by esmang how

much it costs to gain a unit of a health outcome, like a life year gained or a death prevented.

Crical thinking: The skill of using logic and reasoning to idenfy the strengths and weaknesses

of alternave healthcare soluons, conclusions, or approaches to clinical or pracce problems.

Cultural awareness: The deliberate self-examinaon and in-depth exploraon of one’s biases,

stereotypes, prejudices, assumpons, and “isms” that one holds regarding individuals and

groups who are dierent from them (Campinha-Bacote, 1998).

Cultural competence: The ability to eecvely work within the client’s cultural context.

Structural competence is recognion of the economic and polical condions that produce

health inequalies in the rst place. It is the ability to understand how instuons, markets,

or healthcare delivery systems shape symptom presentaons and to mobilize for correcon of

health and wealth inequalies in society (Drevdahl, 2018; Metzl et al., 2018; Metzl et al., 2020).

Cultural and linguisc competence: A set of congruent behaviors, atudes, and policies that

come together in a system, agency, or among professionals that enables eecve work in

cross-cultural situaons. ‘Culture’ refers to integrated paerns of human behavior that include

the language, thoughts, communicaons, acons, customs, beliefs, values, and instuons of

racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to funcon

eecvely as an individual and an organizaon within the context of the cultural beliefs,

behaviors, and needs presented by consumers and their communies (Cross et al., 1989).

Cultural competence is a developmental process that evolves over an extended period.

Culturally sensive: “The ability to be appropriately responsive to the atudes, feelings,

or circumstances of groups of people that share a common and disncve racial, naonal,

religious, linguisc, or cultural heritage” (DHHS, OMH, 2001, p. 131).

Cultural humility: A lifelong process of self-reecon and self-crique whereby the individual

not only learns about another’s culture, but also examines her/his own beliefs and cultural

idenes.

Determinants of health: The range of personal, social, economic, and environmental

factors that interrelate to determine individual and populaon health. These factors include

policymaking, social factors, health services, individual behaviors, and biology and genecs.

Determinants of health reach beyond the boundaries of tradional health care and public

health sectors. Sectors such as educaon, housing, transportaon, agriculture, and environment

can be important allies in improving populaon health (Healthy People 2020).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Diagnose: To idenfy the nature of an illness or other problem by examinaon of the symptoms.

Diversity: A broad range of individual, populaon, and social characteriscs, including but

not limited to age; sex; race; ethnicity; sexual orientaon; gender identy; family structures;

geographic locaons; naonal origin; immigrants and refugees; language; any impairment that

substanally limits a major life acvity; religious beliefs; and socioeconomic status. Inclusion

represents environmental and organizaonal cultures in which faculty, students, sta, and

administrators with diverse characteriscs thrive. Inclusive environments require intenonality

and embrace dierences, not merely tolerate them. Everyone works to ensure the perspecves

and experiences of others are invited, welcomed, acknowledged, and respected in inclusive

environments.

Domains of competence: Broad disnguishable areas of competence that in the aggregate

constute a general descripve framework for a profession (Englander et al., 2013, p. 1089).

Emoonal intelligence: The ability to perceive, appraise and express emoon, access and

process emoonal informaon, generate feelings, understand emoonal knowledge and

regulate emoons for emoonal and intellectual growth (Mayer, et al, 1997, p. 10). Emoonal

intelligence, like academic intelligence, can be learned, increases with age, and is predicve of

how emoonal processing contributes to success in life (Mayer et al., 2004).

Equity: The ability to recognize the dierences in the resources or knowledge needed to allow

individuals to fully parcipate in society, including access to higher educaon, with the goal

of overcoming obstacles to ensure fairness (Kranich, 2001). To have equitable systems, all

people should be treated fairly, unhampered by arcial barriers, stereotypes, or prejudices

(Cooper, 2016).

Ethical comportment: The way in which nurses embody the ability to relate to others respecully

and responsively (Benner, 2009. Ethical comportment consists of four crical aributes: 1)

embodiment, 2) skilled relaonal know-how, 3) caring, and 4) salience (Hardin, 2018).

Ethical competence: The ability to recognize an ethical situaon/issue (awareness/sensivity),

the ability to determine a jusable acon (reecon/decision-making), and have the

movaon, knowledge, and skills to implement a decision (comportment and acon) (ANA

Scope & Standards, 2021).

Evidence-based pracce: A conscienous, problem-solving approach to clinical pracce that

incorporates the best evidence from well-designed studies, paent values and preferences, and

a clinician’s experse in making decisions regarding a paent’s care. Being knowledgeable about

evidence-based pracce and levels of evidence is important for clinicians to be condent about

how much emphasis they should place on a study, report, pracce alert or pracce guideline

when making decisions about a paent’s care.

Explicit biases: Conscious posive or negave feelings and/or thoughts about groups or identy

characteriscs. Because these atudes are explicit in nature, they are espoused openly,

through overt and deliberate thoughts and acons (Harrison et al., 2019; Wilson et al., 2000)

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

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 uid ideology that is

constantly shiing and changing throughout society.

Health disparies: “A parcular type of health dierence that is closely linked with economic,

social, or environmental disadvantage. Health disparies adversely aect groups of people who

have systemacally experienced greater social or economic obstacles to health based on their

racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognive,

sensory, or physical disability; sexual orientaon or gender identy; geographic locaon; or

other characteriscs historically linked to discriminaon or exclusion” (US Department of Health

and Human Services (2010).

Health equity: When every person has an opportunity to aain his or her full health potenal”

and no one is “disadvantaged from achieving this potenal because of social posion or other

socially determined circumstances (Naonal Academies of Sciences, Engineering, and Medicine,

2017). Health inequies are reected in dierences in length of life; quality of life; rates of

disease, disability, and death; severity of disease; and access to treatment.

Health inequity: The distribuon and allocaon of power and resources dierenally, which

manifest in unequal social, economic, and environmental condions (Naonal Academies of

Sciences, Engineering, and Medicine, 2017).

Health Informaon Technology (HIT): The electronic systems healthcare professionals and

paents use to store, share, and analyze health informaon. HIT consists of many types of

applicaons such as Electronic Health Records, personal health records, electronic prescribing,

mobile applicaons, social networks, monitors, wearables, nanotechnology, genomics, and

robocs (Oce of the Naonal Coordinator for Health Informaon Technology [ONC], 2018).

Healthcare team: The collecve of individuals who contribute to the care and treatment of an

individual, family, group, or populaon.

Healthy lifestyle: A way of living that lowers the risk of being seriously ill or dying early.

Scienc studies have idened 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.

Holisc admissions review: An admissions strategy that assesses an applicant’s unique

experiences alongside tradional measures of academic achievement, such as grades and test

scores. This process is used to help schools consider a broad range of factors reecng the

applicant’s academic readiness, contribuon to the incoming class, and potenal for success

both in school and later as a professional.

Holisc nursing: “All nursing pracce that has healing the whole person as its goal” (American

Holisc Nurses’ Associaon, 1998).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Implicit and unconscious biases: The tendency to process informaon based on unconscious

associaons and feelings, even when these are contrary to one’s conscious or declared beliefs.

They are automacally acvated and may occur unconsciously (Metzl et al., 2018, 2020; Van

Ryn et al. 2011).

Inclusive environments: Environmental and organizaonal cultures in which faculty, students,

sta, and administrators with diverse characteriscs thrive. Inclusive environments require

intenonality and embrace dierences, not merely tolerate them. Everyone works to ensure the

perspecves and experiences of others are invited, welcomed, acknowledged, and respected.

Inequies: Characterized by a lack of equity, injusce, unfairness.

Informacs: The intersecon 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 informaon management and data analycs, informacs is the overarching eld of study

that pulls all these subdomains into one discipline focused on improving health and healthcare.

Emerging topics like arcial intelligence and machine learning are incorporang in the eld of

informacs (AMIA, 2021).

Informaon and Communicaons Technologies (ICT): Technologies that provide access to

informaon through telecommunicaons, including the internet, telephones, cell phones,

wireless signals, networks, satellite systems, telehealth/telenursing, and video conferencing.

Innovaon: 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 Innovaon Group, 2021).

Integraon: 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.

Intenonal change theory: The essenal components and processes of desirable, sustainable

change in one’s behavior, thoughts, feelings, and percepons. The “change” maybe in a person’s

acons, habits, competencies, or aspiraons as well as in the way one feels in certain situaons

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 relavely long me (Boyatzis, 2006).

Interdisciplinary: Refers to a group of healthcare providers with various areas of experse who

work together toward the goals of their clients.

Interoperability: The ability of dierent informaon systems, devices, and applicaons

(systems) to access, exchange, integrate, and cooperavely use data in a coordinated manner,

within and across organizaonal, regional, and naonal boundaries to provide mely and

seamless portability of informaon and opmize the health of individuals and populaons

globally. Health data exchange architectures, applicaon interfaces, and standards enable data

to be accessed and shared appropriately and securely across the complete spectrum of care,

within all applicable sengs and with relevant stakeholders, including the individual.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Interprofessional: Engagement involving two or more professions or professionals.

Interprofessional team: The cooperaon, coordinaon, and collaboraon expected among

members of dierent professions in delivering paent-centered care collecvely.

Just culture: Balances the need for an open and honest reporng 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 opportunies

throughout one’s life to foster the connuous development and improvement of the knowledge

and skills needed for employment and personal fulllment.

Macrosystem: The highest system level represents the whole of the organizaon and is led by

senior leaders such as the CEO, chief operaons ocer (COO), chief nursing ocer (CNO), and

chief informaon ocer (CIO) and is guided by a board of trustees (Nelson, et al., 2007).

Managing disease: To improve the health of persons with chronic condions and reduce

associated costs from avoidable complicaons by idenfying and treang chronic condions

more quickly and more eecvely, thus slowing the progression of diseases.

Mesosystem: The interrelated units and clinical leadership that provide care to certain

populaons (McKinley et al., 2008).

Microsystem: Small, funconal 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 subpopulaons of paents. These units have

clinical and business aims, linked processes, and a shared informaon environment, and focus

on producing performance outcomes. Microsystems are complex adapve systems, and as such

they must do the primary work associated with core aims, meet the needs of internal sta, and

maintain themselves over me as clinical units (Nelson, et al., 2002).

Migaon: The acon 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 objecves. The expanding use of mobile health is driven rapid advances

in mobile technologies and applicaons, a rise in new opportunies for the integraon of

mobile health into exisng eHealth services, and the connued growth in coverage of mobile

cellular networks.

Moral courage: The willingness of individuals to take hold of, and fully support, ethical

responsibilies essenal 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 dicult ethical dilemmas. Moral courage entails doing the

right thing, even when others choose less ethical behavior, which may include taking no acon

at all (Lachman, 2009; 2007a; 2007b; Sekerka & Bagozzi, 2007).

Moral ethical behaviors: Prevailing standards of behavior used to judge right and wrong.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Nurse sensive indicators: Reect three aspects of nursing care: structure, process, and

outcomes. Structural indicators include the supply of nursing sta, the skill level of nursing sta,

and the educaon and cercaon levels of nursing sta. Process indicators measure methods

of paent assessment and nursing intervenons. Nursing job sasfacon is also considered a

process indicator. Outcome indicators reect paent outcomes that depend on the quanty or

quality of nursing care (e.g., pressure ulcers and falls).

Nursing informacs: The specialty that integrates nursing science with mulple informaon and

analycal sciences to idenfy, dene, manage, and communicate data, informaon, knowledge,

and wisdom in nursing pracce (HIMSS, 2021).

Parcipatory approach: Calls for involving stakeholders, parcularly the parcipants in a

program or those aected by a given policy, in specic aspects of the evaluaon process. The

approach covers a wide range of dierent types of parcipaon, and stakeholders can be

involved at any stage of the impact evaluaon process, including its design, data collecon,

analysis, reporng, and managing a study.

Partnerships: Close cooperaon between pares having specified and joint rights and

responsibilities.

Paent: The recipient of a healthcare service or intervenon at the individual, family,

community, or aggregate level. Paents may funcon in independent, interdependent, or

dependent roles, and may seek or receive nursing intervenons related to disease prevenon,

health promoon, 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

paent views, input, and experiences can help improve overall health outcomes.

Point of Care: Where care is delivered, including in diverse sengs where individuals live, learn,

work, play, and worship.

Populaon: A collecon of individuals who have one or more personal or environmental

characteriscs in common.

Pracce: Any form of nursing intervenon that inuences healthcare outcomes for individuals

or populaons, including the direct care of individual paents, management of care for

individuals and populaons, administraon of nursing and healthcare organizaons, and the

development and implementaon of health policy (AACN, 2004). Pracce includes both direct

and indirect care experiences (dened 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 specic health goals

or achieve selected health outcomes. Direct care may be provided in a wide range of

sengs, including acute and crical care, long term care, home health, community-

based sengs, and telehealth. (AACN, 2004, 2006; Suby, 2009; Upenieks, Akhavan,

Kotlerman et al., 2007).

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

• Indirect care refers to nursing decisions, acons, or intervenons that are provided

through or on behalf of individuals, families, or groups. These decisions or

intervenons create the condions under which nursing care or selfcare may occur.

Nurses might use administrave decisions, populaon or aggregate health planning,

or policy development to aect health outcomes in this way. Nurses who funcon

in administrave capacies are responsible for direct care provided by other nurses.

Their administrave decisions create the condions under which direct care is

provided. Public health nurses organize care for populaons or aggregates to create

the condions under which improved health outcomes are more likely to occur. Health

policies create broad scale condions for delivery of nursing and health care (AACN,

2004, 2006; Suby, 2009; Upenieks et al., 2007).

Preparedness: The readiness of the naon’s medical and public health infrastructure to

respond to and recover from disasters and public health emergencies. Preparedness requires

collaboraon with hospitals, healthcare coalions, biotech rms, community members, state,

local, tribal, and territorial governments, and other partners across the country to improve

readiness and response capabilies.

Primary and secondary data: Primary data is collected by an invesgator for a specic purpose.

Secondary data is collected by someone else for another purpose (but being ulized by the

invesgator for another purpose).

Profession: An occupaon (e.g., nursing, medicine, law, teaching) that is not mechanical or

agricultural and requires special educaon.

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 acon to engage in structured acvies to advance

career development, educaon, leadership, program management, and/or compliance iniaves.

Professional identy: The representaon of self, achieved in stages over me during which

the characteriscs, values, and norms of a profession are internalized, resulng in an individual

thinking, acng, 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 connuously improve the quality

and safety of health care systems (Cronenwe 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 retenon and reduce burnout. Building posive

relaonships, maintaining posivity, developing emoonal insight, creang work-life balance,

and reecng on successes and challenges are eecve strategies for resilience building.

Response and recovery in an emergency/disaster: Idenfying resources and experse 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:

migaon, preparedness, response, and recovery.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

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 dierent investments. ROI seeks to

directly measure the amount of return on a parcular investment, relave to the investment’s

cost. To calculate ROI, the benet (or return) of an investment is divided by the cost of the

investment. The result is expressed as a percentage or a rao.

Risk assessment: A process to idenfy potenal hazards and analyze what could happen if a

hazard occurs. To assess risk, organizaons oen consider possible scenarios that could unfold

and what the potenal impacts may be.

Scholarship: The generaon, synthesis, translaon, applicaon, and disseminaon of knowledge

that aims to improve health and transform health care. Scholarship is the communicaon of

knowledge generated through mulple forms of inquiry that inform clinical pracce, nursing

educaon, policy, and healthcare delivery. Scholarship is inclusive of discovery, integraon,

applicaon, and teaching (Boyer, 1990). The hallmark aribute of scholarship is the cumulave

impact of the scholar’s work on the eld of nursing and health care.

Self-care: The act of aending to one’s physical or mental health, generally without medical or

other professional consultaon.

Self-management: The management of or by oneself; the taking of responsibility for one’s own

behavior and well-being.

Service: is the acon of helping or doing work for someone.

Simulaon: A technique that creates a situaon or environment to allow persons to experience

a representaon of a real event for the purpose of pracce, learning, evaluaon, tesng, or to

gain understanding of systems or human acons (AHRQ, 2020).

Social Determinants of Health: See Determinants of Health

Social Jusce: The expectaon that everyone deserves equal economic, polical,

and social rights and opportunies. Equity, access, parcipaon, and human rights are four

principles of social jusce including to ensure fair distribuon 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 parcipate in decisions that aect their lives, and to protect

individual liberes to informaon about circumstances and decisions aecng them and to

appeal decisions believed to be unfair (Morgaine, 2014; Nemetchek, 2019).

Social Responsibility: An ethical theory in which individuals are accountable for fullling their

civic duty, and the acons of an individual must benet the whole of society. This typically

involves a balance between economic growth and the welfare of society and the environment.

(Pachchamama Alliance, 2021)

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Specialty: The pursuit, area of study, or skill to which someone has devoted much me and eort

and in which they are expert. Nursing specializaon involves focusing on nursing pracce in an

idened specic area within the discipline of professional nursing. A dened specialty scope of

pracce statement and standards of professional pracce, with accompanying competencies,

are unique to each nursing specialty. These documents help assure connued understanding and

recognion of nursing’s diverse professional contribuons (Finnell, et al, 2015).

• Advanced nursing pracce speciales: Currently, advanced nursing pracce speciales

include informacs, administraon/pracce leadership, public health/populaon

health, and health policy. Speciales may evolve over me to address future

healthcare needs.

Spheres of Care: Encompass the healthcare needs of individuals, families, populaons, 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 prevenon/promoon of health

and well-being, which includes the promoon of physical and mental health in all paents as

well as management of minor acute and intermient care needs of generally healthy paents;

2) chronic disease care, which includes management of chronic diseases and prevenon of

negave sequelae; 3) regenerave or restorave care, which includes crical/trauma care,

complex acute care, acute exacerbaons of chronic condions, and treatment of physiologically

unstable paents that generally requires care in a mega-acute care instuon; and, 4) hospice/

palliave/supporve care which includes end-of-life care as well as palliave and supporve

care for individuals requiring extended care or those with complex, chronic disease states or

those requiring rehabilitave 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 stascs, standardized data is the process of pung dierent variables on

the same scale. This process allows one to compare scores between dierent types of variables.

Stress management: A range of strategies to help one beer deal with stress and diculty

(adversity). Managing stress can help an individual lead a more balanced, healthier life.

Stress is an automac physical, mental and emoonal response to a challenging event. Stress

management approaches include learning skills such as problem-solving, priorizing tasks, and

me management to enhance the ability to cope with adversity.

Structural racism: A complex system of conferring social benets in some groups and imposing

burdens on others resulng in segregaon, poverty, and denial of opportunity for people of

color. Structural racism comprises cultural beliefs, historical legacies, and instuons, policies

within and among public and private organizaons that interweave to create drasc racial

disparies in life outcomes (Wiecek, 2011).

Support care: Treatment given to prevent, control, or relieve complicaons and side eects and

to improve the paent’s comfort and quality of life.

System decision: A computerized program used to support determinaons, judgments, and

courses of acon in an organizaon or a business. A system decision sis through and analyzes

massive amounts of data, compiling comprehensive informaon that can be used to solve

problems and in decision-making.

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Systemic inequity: A condion where one category of people is aributed an unequal status

in relaon to other categories of people. This relaonship is perpetuated and reinforced by a

conuence of unequal relaons in roles, funcons, decisions, rights, and opportunies.

Systemic racism (also known as instuonalized racism): Terms similar to structural racism

which focuses more on the historical, cultural and social psychological aspects of the currently

racialized society. The term instuonal racism may be used to dierenate “access to the

goods, services, and opportunies of society by race. Instuonalized racism is normave,

somemes legalized, and oen manifests as inherited disadvantage. It is structural, having been

codied in our instuons of custom, pracce, and law, so there is no idenable perpetrator.

Instuonalized racism is oen evident as inacon in the face of need” (Jones, 2000).

Systems: A set of elements or components working together as parts of a mechanism or an

interconnecng network.

Systems-based pracce: An analyc tool and a way of viewing the world, which can

make caregiving and change eorts more successful. The focus is on understanding the

interdependencies of a system or series of systems and the changes idened 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

communies by at least two health providers who work collaboravely with paents and their

caregivers—to the extent preferred by each paent—to accomplish shared goals within and across

sengs to achieve coordinated, high-quality care (Naylor, 2010; NAM, 2012; AANP, 2020).

Telehealth systems: The use of a technology-based virtual plaorm to deliver various aspects of

health informaon, prevenon, monitoring, and medical care.

Translaon: The process of turning observaons in the laboratory, clinic, and community into

intervenons that improve the health of individuals and the public — from diagnoscs and

therapeucs to medical procedures and behavioral changes.

Translaonal science: The eld of invesgaon focused on understanding the scienc and

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THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Essenals Task Force

Essenals Leadership Team

Jean Giddens, PhD, RN, FAAN

Co-Chair of the Essenals Task Force

Virginia Commonwealth University

Cynthia McCurren, PhD, RN

Co-Chair of the Essenals Task Force

University of Michigan-Flint

John McFadden, PhD, CRNA

Co-Chair of the Essenals Task Force

Barry University

Lin Zhan, PhD, RN, FAAN

AACN Board Liaison

University of Memphis

Jean Bartels, PhD, RN

Consultant

Linda Caldwell, DNSc, ANP-BC

Consultant

Nancy DeBasio, PhD, RN, FAAN

Consultant

Essenals Task Force Members

Angela Amar, PhD, RN, ANEF, FAAN

University of Nevada Las Vegas

Jacklyn Barber, EdD, RN, CNL, CNS

Morningside College

Carol Buck-Rolland, EdD, APRN

University of Vermont

Jill Case-Wirth, MHA, BSN, RN

WellStar Health System (Pracce)

Lori Escallier, PhD, RN, CPNP-PC, FAAN

SUNY Downstate Health Sciences University

Eileen Fry-Bowers, PhD, JD, RN, CPNP, FAAN

University of San Diego

Vincent Hall, PhD, RN, CNE

Walden University

Beverly Foster, PhD, MN, MPH, RN

University of North Carolina – Chapel Hill

Jacqueline Hill, PhD, RN

Bowie State University

Erica Hooper-Arana, DNP, RN, PHN, CNS, CNL

University of San Francisco

Krisn Lee, PhD, MSN, RN, CNE

University of Missouri-Kansas City

Kim Litwack, PhD, RN, FAAN, APNP

University of Wisconsin-Milwaukee

Mary Morin, MSN, RN, NEA-BC

Sentara Healthcare (Pracce)

Connie Miller, DNP, RNC-OB, CNE

University of Arizona

Susan Mullaney, DNP, APRN, GNP-BC,

GS-C, FAANP

UnitedHealth Group (Pracce)

Susan Ruppert, PhD, RN, FNP-C,

ANP-BC, FCCM, FNAP, FAANP, FAAN

University of Texas Health Science Center

at Houston

Marcella Rutherford, PhD, MBA, MSN, RN

Nova Southeastern University

Martha Scheckel, PhD, MSN, RN

University of St Thomas

Jenny Schuessler, PhD, RN, CNE

University of West Georgia

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION

Casey Shillam, PhD, RN

University of Portland

Mary Stachowiak, DNP, RN, CNL

Rutgers School of Nursing

Rachel Start, MSN, RN, NEA-BC, FAAN

Rush University Medical Center (Pracce)

Allison Squires, PhD, RN, FAAN

New York University

Susan Swider, PhD, PHNA-BC, FAAN

Rush University

Marjorie Splaine Wiggins, DNP, MBA, RN,

NEA-BC, FAAN

Maine Health System (Pracce)

Marisa Wilson, DNSc, MHSc, RN, CPHIMS,

RN-BC, FAMIA, FAAN

University of Alabama-Birmingham

Danuta Wojnar, PhD, RN, MN, MED,

IBCLC, FAAN

Seale University

Geraldine Young, DNP, MSN, APRN, FNP-BC,

CDCES, FAANP

Froner Nursing University

AACN Sta Liaisons

Joan Stanley, PhD, NP, FAAN, FAANP

Chief Academic Ocer

Rick García, PhD, RN

Director of Nursing Educaon

Kathy McGuinn, MSN, RN

Director of Interprofessional Educaon and

Pracce Partnerships

Shirin Samimi-Farr

Project Manager

Krisi Yosifova

Nursing Educaon Coordinator

Approved by the AACN Membership on April 6, 2021.