Essentials Draft Document Dec2020

AACN DRAFT Essentials Document 11.5.
2020
DRAFT
The Essentials: Core Competencies for Professional
Nursing Education
Introduction
Since 1986, the American Association of Colleges of Nursing (AACN) has published the
Essentials series that provides the educational framework for the preparation of nurses
at four-year colleges and universities. In the past, three versions of Essentials were
published: The Essentials of Baccalaureate Education for Professional Nursing Practice,
last published in 2008; The Essentials of Master’s Education in Nursing, last published in
2011; and The Essentials of Doctoral Education for Advanced Nursing Practice, last
published in 2006. Each of these documents have provided specific guidance for the
development and revision of nursing curricula at each degree level. Given changes in
higher education, learner expectations, and the rapidly evolving healthcare system
outlined in AACN’s Vision for Academic Nursing (2019), new thinking and new
approaches to nursing education are needed to prepare the nursing workforce of the
future.
The Essentials: Core Competencies for Professional Nursing Education provides a

framework for preparing individuals as members of the discipline of nursing, reflecting
expectations across the trajectory of nursing education and applied experience.
Competencies for professional nursing practice and advanced nursing practice are made
explicit. This singular document introduces ten domains that represent the essence of
professional nursing practice and the expected competencies for each domain (see page
20). The domains and competencies exemplify the uniqueness of nursing as a
profession, reflect the diversity of practice settings, yet share common language that is
understandable across healthcare professions and by employers, learners, faculty, and
the public. The competencies accompanying each domain are designed to be applicable
across four spheres of care (prevention/promotion of health and wellbeing, chronic
illness care, critical/trauma care, and hospice/palliative care), throughout the lifespan,
and with diverse patient populations. While the domains and broad competencies are
identical for both entry and advanced levels of education, the sub-competencies build
from entry into professional nursing practice to advanced levels of knowledge and
practice. The intent is that any curricular model should lead to the ability of the learner
to achieve the competencies.
As a document shared with practice partners, and specifically with nursing colleagues,
the Essentials serve to bridge the gap between education and practice. The core
competencies are informed by the expanse of higher education, nursing education,
nursing as a discipline, and a breadth of knowledge. The core competencies are equally
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AACN DRAFT Essentials Document 11.5.2020
informed by the lived experiences of those deeply entrenched in various areas where
nurses practice, where the synthesis of knowledge and action intersect. The collective
understanding allows all nurses to have a shared vision; promotes open discourse and
exchange about nursing practice; and a unified voice that represents the nursing
profession.
This introduction provides an overview of the evolution of nursing as a discipline, critical

aspects of the profession that serve as a framework, and sufficient depth to serve as a
guide that informs nursing education across the educational trajectory (entry into
practice through advanced education). Specific citations throughout provide immediate
access to relevant references that substantiate relevancy.
Foundational Elements
The Essentials: Core Competencies for Professional Nursing Education has been built on
the strong foundation of nursing as a discipline, the foundation of a liberal education,
and principles of competency-based education.
Nursing as a Discipline
As the framework for preparing nursing’s future workforce, the Essentials intentionally
reflect and integrate nursing as a discipline. The emergence of nursing as a discipline
had its earliest roots in Florence Nightingale’s thoughts about the nature of nursing.
Believing nursing to be both a science and an art, she conceptualized the whole patient
(mind, body, and spirit) as the center of nursing’s focus. The influence of the
environment on an individual’s health and recovery was of utmost importance. The
concepts of health, healing, well-being, and the interconnectedness with the
multidimensional environment also were noted in her work. Although Nightingale did
not use the word “caring” explicitly, the concept of care and a commitment to others
were evident through her actions (Dunphy, 2015). Following Nightingale, the nursing
profession underwent a period of disorganization and confusion as it began to define
itself as a distinct scientific discipline. Early nursing leaders including Effie Taylor, Annie
Goodrich, Agatha Hodgins, and Esther Lucille Brown sought to define the functions of
the nurse (Gunn, 1991; Keeling, Hehman & Kirchgessner, 2017).
Nursing as a discipline began to take shape in the 1970s and 1980s. Leaders of that era
shared the belief that the discipline of nursing was the study of the well-being
patterning of human behavior and the constant interaction with the environment,
including relationships with others, health, and the nurse (Donaldson & Crowley 1978;
Fawcett 1984; Chinn & Kramer 1983, 2018; Roy & Jones 2007). The concept of caring
also was described as the defining attribute of the nursing discipline (Leininger, 1978;
Watson, 1985). Both Newman (1991, 2008) and Smith (2008) affirmed caring as the
focus of the discipline. Newman (2008) suggested that relationships were the unifying
construct. Smith (2010) later posited that relationships were built on partnership,
presence, and shared meaning. Meleis (1985, 2018) further defined the discipline as a
human science concerned with understanding the whole person, patterning, and human
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experience. As a practice discipline, she proposed that nursing is committed to enhance

the care of people through knowledge; that it embraces the spiritual, ethical, relational
and practical aspects of caring; and that it includes all human experiences.
To further the understanding of the discipline, Thorne proposed that “nursing’s angle of
vision” provides the framework for answering questions related to nursing practice,
health care, and the human condition, which is critical to defining nursing’s role in
interdisciplinary practice (Thorne, 2014). She further states that while early theorists
envisioned one theory as dominant over all others, nursing can now “find ways of
articulating core disciplinary knowledge that are as powerful but less constraining than
were those of earlier traditions” (p. 2).
While the work of early theorists was extensive, Green (2018) noted that none have
been accepted as completely defining the nature of nursing as a discipline. In today’s
complex healthcare environment with rapid advances in technology, the advent of big
data, population and global health, and precision health care, it is even more important
that the discipline of nursing has a clear understanding of what its focus is and what is
not (Green, 2018). Its distinct nature is differentiated from other healthcare professions
by the way the various aspects of nursing are seen in nurse-patient interactions
facilitating humanization, meaning, and healing in living and dying through nurse-
patient interactions. It is not that nursing activities in their individual expression are
different; what is different is the goal of nursing: to support, enhance, and achieve
optimal levels of wellness; to prevent illness, to restore health, and to alleviate suffering
which unifies the various aspects of nursing. Clinical intimacy, existential concern,
ethical mandate, patient advocacy, and care for the human person become the
coherent unity called nursing.
In a historical analysis of literature on the discipline of nursing, five concepts emerged as

defining the discipline: human wholeness; health; healing and well-being; human-
environment-health relationship; and caring (Smith, 2019). Smith purports that if
nursing is to retain its status as a discipline, the explicit disciplinary knowledge must be
an integral part of all levels of nursing. Nursing has its own science, and this body of
knowledge is foundational for the next generation. With a clear sense of our nursing
identity and the growing awareness of our mission to society, nursing can articulate
explicitly its value and the purpose of nursing practice.
Advancing the Discipline of Nursing in the Future
The continued development of nursing as a unique discipline requires an intentional
approach. Jairath, et. al (2018) stated that any further development of the discipline
should have the capacity to directly transform the patient’s health experience. A new
social order may be necessary in which scientists, theorists, and practitioners work
together to address questions related to the interplay of big data and nursing theory.
Nursing graduates, particularly at the advanced nursing practice level, must be well-
prepared to think conceptually and theoretically to better inform nursing care. Students
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must not only be introduced to the knowledge and values of the discipline, but they
must be guided to practice from a disciplinary perspective – by seeing patients through
the “lens” of wholeness and interconnected with family and community; appreciating
how the social, political, and economic environment influences health; attending to
what is most important to well-being; developing a caring-healing relationship; and
honoring personal dignity, choice, and meaning. Smith & McCarthy (2010) spoke to the
need to provide a foundation for practitioners in the knowledge of the discipline.
Without this knowledge, the persistent challenge of differentiating nursing and the
professional levels of practice will continue.
Knowledge of the discipline builds in graduate education, as students apply and

generate nursing knowledge in their advanced nursing roles or develop and test
theories as researchers. Nursing practice should be guided by a nursing perspective. In
order to appropriately educate the next generation of nurses, disciplinary knowledge
should be leveled to reflect the competencies or roles expected at each level.
The Value of a Liberal Education

In higher education, every academic discipline is grounded in a unique body of
knowledge that distinguishes that discipline. Through the study of the humanities, social
sciences, and natural sciences, students develop the capacity to engage in socially
valued work and civic leadership in society. Liberal education exposes students to a
broad worldview, multiple disciplines, and ways of knowing through specific
coursework; however, the richness of perspective and knowledge is woven throughout
the nursing curriculum as these are integral to the full scope of nursing practice
(Hermann, 2004). Successful integration of liberal and nursing education provides
graduates with knowledge of human cultures, including spiritual beliefs, as well as the
physical and natural worlds supporting an approach to practice. The study of history,
policy formation, fine arts, literature, languages, and the behavioral, biological, and
natural sciences are key to the understanding of one’s self and others and forms the
basis for clinical reasoning and subsequent clinical judgements.
A liberal education creates the foundation for intellectual and practical abilities within
the context of nursing practice as well as for engagement with the larger community,
locally and globally. A hallmark of liberal education is the development of a personal
values system that includes the ability to act ethically regardless of the situation and
where students are encouraged to define meaningful personal and professional goals
with a commitment to integrity, equity and social justice. Liberally educated graduates
are well prepared to integrate knowledge, skills, and values from the arts, sciences, and
humanities to provide safe, quality care; advocate for patients, families, communities
and populations; and promote health equity and social justice. Equally important,
nursing education must ensure an understanding of the intersection of bias, structural
racism, and social determinants with healthcare inequities and promote a call to action.
Competency-based Education
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Competency-based education is a process whereby students are held accountable to the

mastery of competencies deemed critical for an area of study. Competency-based
education is inherently anchored to the outputs of an educational experience versus the
inputs of the educational environment and system. Students are the center of the
learning experience, and performance expectations are clearly delineated along all
pathways of education and practice. Across the health professions, curriculum, course
work, and practice experiences are designed to promote responsible learning and
assure the development of competencies that are reliably demonstrated and
transferable across settings.
Advances in learning approaches and technologies, evolving student learning styles and
preferences, and the move to outcome driven education and assessment all point to a
transition to competency-based education. This learning approach is linked to explicitly
defined performance expectations, based on observable behavior, and requires
frequent assessment using diverse methodologies/formats. Designed in this fashion,
competency-based education produces learning and behavior that endures, since it
encourages conscious connections between knowledge and action. Learners who put
knowledge into action grasp the interrelatedness of their learning with both theoretical
perspectives and the world of their professional work. Achieving a specific competency
gives meaning to the theoretical and assists in understanding and taking on a
professional identity.
Further, today’s students are increasingly taking responsibility for their own learning
and, varied as they are in age and experience, respond to active learning strategies.
Active learning involves making an action out of knowledge—using knowledge to reflect,
analyze, judge, resolve, discover, interact, and create. Active learning requires clear
information regarding what is to be learned and planned, including guided practice in
using that information to achieve a competency. It also requires regular assessment of
progress towards mastery of the competency and frequent feedback on successes and
areas needing development.
Given the complexity of health care, employers, students, and the public are demanding
outcome accountability and expect all nursing graduates to exit their educational
programs with defined and observable skills and knowledge. Employers desire
assurance that graduates have expected competencies - the ability “to know” and also
“to do” based on current knowledge. Moving to a competency-based model fosters
intentionality of learning by defining domains, associated competencies, and
performance indicators for those competencies. Given the wide variability in how
nurses are prepared today, the need for a competency-based approach to nursing
education is clear.
A standard set of definitions frame competency-based education in the health

professions and was adopted for the re-envisioned Essentials. Adoption of common
definitions allows multiple stakeholders involved in health education and practice to
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share much of the same language. These definitions are included in the glossary (pp.
54).
Nursing Education for the 21st Century

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

Shifting U.S. population demographics, health workforce shortages, and persistent
health inequities necessitate the preparation of nurses able to address systemic racism
and pervasive inequities in health care. The existing inequitable distribution of the
nursing workforce across the United States, particularly in underserved urban and rural
areas, impacts access to healthcare services across the health continuum from health
promotion and disease prevention, chronic disease management, to restorative and
supportive care. Diversity, equity, and inclusion—as a value-- supports nursing
workforce development to prepare graduates who contribute to the improvement of
access and care quality for underrepresented and medically underserved populations
(AACN, 2019). Diversity, equity, and inclusion require intentionality, an institutional
structure of social justice, and individually concerted efforts. The integration of
diversity, equity, and inclusion in the new Essentials moves away from an isolated focus
on these critical concepts. Instead, these concepts, defined in competencies, are fully
represented and deeply integrated throughout the domains and expected in learning
experiences across curricula.
Making nursing education equitable and inclusive requires actively combating structural
racism, discrimination, systemic inequity, exclusion, and bias. Holistic admission reviews
must be used to enhance the admission of a more diverse student population to the
profession. Additionally, an equitable and inclusive learning environment will support
the recruitment, retention, and graduation of nursing students from disadvantaged and
diverse backgrounds. Diverse and inclusive environments allow examination of any
implicit or explicit biases which can undermine efforts to enhance diversity, equity, and
inclusion. When diversity is integrated within inclusive educational environments with
equitable systems in place, biases are examined, assumptions are challenged, critical
conversations are engaged, perspectives are broadened, civil readiness and engagement
are enhanced, and socialization occurs. These environments recognize the value of and
need for diversity, equity, and inclusion to achieve excellence in teaching, learning,
research, scholarship, service, and practice.
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Academic nursing must address structural racism, systemic inequity, and discrimination
in how nurses are prepared. Nurse educators are called to critically evaluate policies,
processes, curricula, and structures for homogeneity, classism, color-blindness, and non-
inclusive environments. Evidence-based, institution-wide approaches focused on equity
in student learning and catalyzing culture shifts in the academy are fundamental to
eliminating structural racism in higher education (Barber, et al, 2020). Only through
deconstructive processes can academic nursing prepare graduates who provide high
quality, equitable, and culturally competent health care.
Finally, all nurses must learn to engage in ongoing personal development towards
understanding their own conscious and unconscious biases. Then, acting as stewards of
the profession, they can fulfill their responsibility to influence both nursing and societal
attitudes and behaviors toward eradicating structural/systemic racism and
discrimination and promoting social justice.
Four Spheres of Care

Historically, nursing education has emphasized clinical education in acute care. Looking
at current and future needs, it is becoming increasingly evident that the future of
healthcare delivery will occur within four “spheres of care” 1) disease
prevention/promotion of health and well-being, which includes the promotion of
physical and mental health in all patients as well as management of minor acute and
intermittent care needs of generally healthy patients; 2) chronic disease care, which
includes management of chronic diseases and prevention of negative sequela; 3)
regenerative or restorative care, which includes critical/trauma care, complex acute
care, acute exacerbations of chronic conditions, and treatment of physiologically
unstable patients that generally requires care in a mega-acute care institution; and, 4)
hospice/palliative/supportive care which includes end-of-life care as well as palliative
and supportive care for individuals in long term care or those with disabling conditions,
complex chronic disease states, and those requiring rehabilitative care (AACN, 2019).
Thus, nursing education must ensure graduates have practice experiences and
competencies with patients across the lifespan and within each of these areas. The idea
of utilizing registered nurses in health promotion or in primary care is not a new one.
Nightingale said, “Money would be better spent in maintaining health in communities
rather than building hospitals to cure”. Macy Foundation President George Thibault
stated, “We simply can’t meet the primary care needs of the nation unless registered
nurses are part of the solution and we must prepare them appropriately and use them
for this role” (2016).
The workforce of the future must attract and retain registered nurses who choose to
practice in community settings in order to sustain the nation’s health. Expanding
primary care into communities will enable our healthcare delivery systems to achieve
the Triple Aim of improving patient experiences, lowering costs, and ensuring better
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health outcomes. Nursing education must refocus and move beyond some previously
held beliefs such as: primary care content is not important because it is not on the
NCLEX-RN examination; students only value those skills required in acute care settings;
and faculty preceptors only have limited community-based experiences. The summary
from the Macy Foundation Conference on expanding the use of registered nursing in
primary care (2016) provides a call to education and practice to place more value on
primary care as a career choice, effectively changing the culture of nursing and health
care. Academic and practice leaders must work collaboratively to ensure this culture
change and educate primary care practitioners about the value of the registered nurse
role.
Systems-Based Practice
Integrated healthcare systems that require coordination across settings as well as across
the lifespans of diverse individuals and populations are emerging. Healthcare systems
are revising strategic goals and reorganizing services to move more care from the most
expensive venues – inpatient facilities and emergency departments - to primary care
and community settings. Consequently, nurse employment settings are also shifting,
creating a change in workforce distribution and the requisite knowledge and skills
necessary to provide care in those settings. Knowledge differentiating equity and
equality in healthcare systems and systems-based practice is essential. Evolving and
integrated healthcare systems require nurses to lead the implementation of systems-
based practice. This requires innovative thinking and redesigning to address structural
racism, systemic inequity, and discrimination. Equitable healthcare better serves the
needs of all individuals, populations, and communities.
Nursing education, at both the undergraduate and graduate levels, must infuse the
curricula with knowledge and skills in change management, communication, team
building, inclusivity as well as the development of competencies in informatics, data
science, and design and systems thinking (Demeris, et al, 2020). These key competencies
provide students with the tools to understand and implement innovative approaches.
Importantly, an understanding of how local, national, and global structures, systems,
politics, and rules and regulations contribute to the health outcomes of individual
patients, populations, and communities will support students in developing agility and
advocacy skills. Factors such as structural racism, cost containment, resource allocation,
and interdisciplinary collaboration are considered and implemented to ensure the
delivery of high quality, equitable, and safe patient care (Plack, et al, 2018).
Informatics and Technology

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

The future consumers of health care are changing. They are transitioning from passive
participants in medically focused acute care environments to engaged participants of
healthcare services. They will actively participate in managing not only their chronic
illnesses but also acute care exacerbations with an increasing focus on prevention and
wellness. Thus, nurses need an understanding of consumer engagement and experience
across all settings as an essential component of person-centered, quality care.
In today’s society, many people seek information and use technology to help make
informed decisions about their health. Nurses seek to help individuals determine what
information to use and how to use it. Individuals want to know about their options
when it comes to healthcare services, which extends to using websites to provide
information on provider quality and performance, comparing prices for common
procedures, and reviewing the effectiveness of treatments and care approaches (Health
Affairs Blog, March 2019). Gaffney (2015) stated that as consumers shoulder more of
the financial responsibility for their health care, they became more educated about
available options. Studies have shown that patients who are engaged in decision-making
regarding their care have better outcomes and lower costs. Facilitation of meaningful
practice experiences in health care must start with the individual who is actively
engaged in the journey throughout the continuum of care.
Each interaction between a patient and nurse or healthcare provider creates an

experience. An individual’s experience is defined as “the sum of all interactions, shaped
by an organization’s culture that influence patient perceptions across the continuum of
care.” (Wolf, Niederhauser, Marshburn & LeVela, 2014). Within that interactive
experience, the attitudes and the behaviors of the nurse matter a great deal. Nurses are
identified as one of the most trusted professions in the United States. Trust between
the nurse and the individual is foundational to an interactive and iterative relationship
that will enhance a positive experience of care. Individuals with positive experiences of
care often have better outcomes.
Patient engagement has been described as “the blockbuster drug of the 21st century”
(Sherman, 2014). Who better to engage patients in their care than nurses? Nursing
practice has consistently focused on patient care and ongoing communication with
family members and care providers. Sherman points to the fact that effective
patient/family involvement leads to safer and higher quality care. In addition, patient
engagement can be directly correlated with increased reimbursement to hospitals
based on achieving health outcomes. Nurses in all settings and across the continuum of
care must assume leadership roles in creating a culture that supports full engagement of
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patients in their care and in the development of policies which will provide guidance to
the improvement of patient engagement (Sherman, 2014).
Academic-Practice Partnerships
Partnerships and collaborative team-based care are the cornerstones of safe, effective
care whether it be for individuals, families, communities, or populations. Academic-
practice partnerships serve to recruit and retain nurses and to support the practice and
academic enterprise in relation to mutual research, leadership development, and a
shared commitment to redesign practice environments. Such partnerships also have the
potential to facilitate the ability of nurses to achieve educational and career
advancement, prepare nurses of the future to practice and lead, provide mechanisms
for career-long learning, and provide a structure for transition to practice programs.
Successful academic-practice partnerships are predicated on respect, relationship,
reciprocity and co-design.
The 2016 report Advancing Healthcare Transformation: A New Era for Academic Nursing
identified a path for achieving enhanced partnerships between academic nursing and
academic health centers with the goals of achieving improved healthcare outcomes,
fostering new models for innovation, and advancing integrated systems of health care.
While focused primarily on academic health centers, the recommendations apply to
partnerships between non-academic health centers and academic nursing as well. The
recommendations include enhancing the clinical practice of academic nursing;
partnering in the preparation of the nurses of the future; collaborating to develop
workforce plans in partnership with the health system; integrating academic nursing
into population health initiatives; partnering in the implementation of Accountable
Care; and partnering for optimal patient care and healthcare delivery (AACN, 2016).
Career-Long Learning
Current trends in higher education focus on supplemental methods of awarding credit
and recognition for additional learning which has implications for career-long learning.
Emerging educational methods should be considered as possible additions in the
development of curriculum pathways in contemporary nursing education. For example,
the use of ePortfolios, which may be used to record competency achievement and
educational milestones; and continued throughout one’s career, can be used to
document personal development plans, badges, certifications, employment appraisals,
and reflections on clinical events to establish meaning from various encounters.
Awarding of micro-credentials or badges by academic institutions is also becoming
popular. Badges recognize incremental learning in visible ways and can support career
development (Educause, 2018). Stackable credentials can be accumulated over time and
facilitate one’s professional development along a career trajectory (Department of
Labor, 2015). Open access courses represent another way to learn a variety of skills or
subject matter. All of these are important considerations in basic and advanced nursing
education.
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Domains and Concepts
Domains for Nursing

Domains are broad distinguishable areas of competence that, when considered in the
aggregate, constitute a descriptive framework for the practice of nursing. The re-
envisioned Essentials include ten domains that were adapted from the interprofessional
work initiated by Englander (2013) and tailored to reflect the discipline of nursing.
There is a need for a clear understanding of domains that are essential to practice,
including how these are defined, what competencies should be expected for each
domain at each level of nursing, and how those domains and competencies both
distinguish nursing and relate to other health professions. Each domain has a descriptor
(or working definition) and a contextual statement. The contextual statement for each
domain (presented in the Domain, Competency, Sub-Competency Table found
beginning on page 20) provides a framing for what the domain represents in the context
of nursing practice – thus providing an explanation for how the competencies within the
domain should be interpreted. The domain designations, descriptors, and contextual
statements may evolve over time to reflect future changes in healthcare and nursing
practice. Although the domains are presented as discrete entities, the expert practice of
nursing requires integration of most of the domains in every practice situation or
patient encounter, thus they provide a robust framework for competency-based
education. The domains and descriptors used in the Essentials are listed below.
• Domain 1: Knowledge for Nursing Practice

Descriptor: Integration, translation, and application of established and evolving
disciplinary nursing knowledge and ways of knowing, as well as knowledge
from other disciplines, including a foundation in liberal arts and sciences. This
distinguishes the practice of professional nursing and forms the basis for clinical
judgement and innovation in nursing practice.
• Domain 2: Person-Centered Care

Descriptor: Person-centered care focuses on the individual within multiple
complicated contexts, including family and/or important others. Person-
centered care is holistic, just, respectful, compassionate, coordinated, evidence-
based and developmentally appropriate.
• Domain 3: Population Health

Descriptor: Population health spans the healthcare delivery continuum and
describes collaborative activities among stakeholders for the improvement of an
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equitable population health outcomes.
• Domain 4: Scholarship for Nursing Practice

Descriptor: The generation, synthesis, translation, application, and dissemination
of nursing knowledge to improve health and transform health care.
• Domain 5: Quality and Safety

Descriptor: Employment of established and emerging principles of safety
and improvement science. Quality and safety, as core values of nursing
practice, enhance quality and minimize risk of harm to patients and
providers through both system effectiveness and individual performance.
• Domain 6: Interprofessional Partnerships

Descriptor: Intentional collaboration across professions and with care team
members, patients, families, and communities to optimize care, enhance the
healthcare experience, and strengthen outcomes.
• Domain 7: Systems-Based Practice

Descriptor: Responding to and leading within complex systems of health
care. Nurses effectively and proactively coordinate resources to provide safe,
quality, equitable care to diverse populations.
• Domain 8: Information and Healthcare Technologies

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

Descriptor: Participation in activities and self-reflection that foster personal
health, resilience, and well-being, and career-long learning, and support the
acquisition of nursing expertise and assertion of leadership.
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Concepts for Nursing Practice

In addition to domains, there are several featured concepts associated with professional
nursing practice that are integrated within the Essentials. A concept is an organizing
idea or a mental abstraction that represents important areas of knowledge. A common
understanding of each concept is achieved through characteristics and attributes. All
disciplines (including nursing) have an endless number of concepts. The featured
concepts are well-represented in the nursing literature and thus are also found
throughout the Essentials and verified through a crosswalk analysis. Specifically, the
featured concepts are found in the introduction, across the domains (within domain
descriptors and contextual statements), and within the competencies and sub-
competencies. Although not every concept is found within every domain, each concept
is represented in most domains – and all of the domains have multiple concepts
represented.
The featured concepts found within the Essentials are not of “lesser importance” than a
domain. Each of these concepts serves as a core component of knowledge, facts and
skills across multiple situations, and contexts within nursing practice. Each concept
functions as a hub for transferable knowledge, thus enhancing learning when learners
make cognitive links to other information through mental constructs. The integration of
concepts within the competencies and sub-competencies is essential to ensure an
application throughout the educational experience. As an example, can you imagine
talking about person-centered care without also talking about diversity, equity, and
inclusion? Can you imagine having a conversation about population health without
considering ethics, policy, and advocacy? These concepts truly are interrelated and
interwoven within the domains and competencies, serving as a foundation to students’
learning.
The featured concepts are:
• Clinical Judgement
As one of the key attributes of professional nursing, clinical judgement refers to
the process by which nurses make decisions based on knowledge, evidence,
intuition, critical thinking and clinical reasoning (Manetti, 2019). These skills are
used to process and interpret information in the delivery of care. Clinical
decision making as a result of clinical judgement, is directly related to patient
care outcomes.
• Communication
Communication is a central component in all areas of nursing practice.
Communication is defined as an exchange of information, thoughts and feelings
through a variety of mechanisms. This concept encompasses all the various ways
people interact with each other including verbal, written, behavior, body
language, touch, and emotion. Effective communication between nurses and
patients and between nurses and other health professionals is necessary for the
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delivery of high quality, individualized nursing care. Communication also is a core

component of team-based, interprofessional care and closely interrelated with
the concept Determinants of Health (described below).
• Compassionate Care
As an essential principal of person-centered care, compassionate care refers to
the way nurses relate to others as human beings, and involves “noticing another
person’s vulnerability, experiencing an emotional reaction to this, and acting in
some way with them in a way that is meaningful for people” (Murray & Tuqiri,
2020). Compassionate care is interrelated with other concepts such as caring,
empathy, and respect; compassionate care is also closely associated with patient
satisfaction.
• Determinants of Health
Determinants of health refers to the range of personal, social, economic, and
environmental factors that influence health status (Healthy People, 2020).
Determinants of health also is closely interrelated with health disparities.
Nursing practices such as assessment, health promotion, access to care, and
patient teaching support improvements in health outcomes. The determinants
of health concept is closely interrelated with the concepts diversity, equity,
inclusion, health policy (described below), and communication.
• Diversity, Equity, and Inclusion

Collectively, diversity, equity, and inclusion (DEI) form a very broad and
important concept for the Essentials. DEI refers to a broad range of individual,
population, and social constructs and is adapted in the Essentials as one of the
most visible concepts. Although these are collectively considered a concept,
differentiation of each conceptual element leads to enhanced understanding.
Diversity references individual and personal characteristics, including but not

limited to age; sex; race; ethnicity; sexual orientation; gender identity; family
structures; geographic locations; national origin; immigrants and refugees;
language; physical, functional, and learning abilities; religious beliefs; and
socioeconomic status. Inclusion represents environmental and organizational
cultures in which faculty, students, staff, and administrators with diverse
characteristics thrive. Inclusive environments require intentionality and
embrace differences, not merely tolerate them. Everyone works to ensure the
perspectives and experiences of others are invited, welcomed, acknowledged,
and respected in inclusive environments. Equity is the ability to recognize the
differences in the resources or knowledge needed to allow individuals to fully
participate in society, including access to higher education, with the goal of
overcoming obstacles to ensure fairness (Kranich, 2001). To have equitable
systems, all people should be treated fairly, unhampered by artificial barriers,
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stereotypes or prejudices (Cooper, 2016). Two other concepts that fit within DEI
include structural racism and social justice.
• Ethics
Core to professional nursing practice, ethics refers to principles that guide a
person’s behavior. Ethics is closely tied to moral philosophy involving the study
of or examination of morality through a variety of different approaches (Tubbs,
2009). Four commonly accepted principles in biomedical and nursing ethics
include respect for autonomy, beneficence, non-maleficence, and justice (ICN,
2006 and ANA, 2001). Moral distress occurs when nurses experience an ethical
issue they are unable to address and/or care situations that go against their
moral compass.
• Evidence-based Practice
The delivery of optimal health care requires the integration of current evidence
and clinical expertise with individual and family preferences. Evidence-based
practice is a problem-solving approach to the delivery of health care that
integrates best evidence from studies and patient care data with clinician
expertise and patient preferences and values (Melnyk, Fineout-Overhold,
Stillwell, & Williamson, 2010).
• 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). It represents an important aspect of advocacy for patients and for the
profession by speaking with a united voice on policy issues that affect nursing
practice and health outcomes. Nurses can have a profound influence on health
policy by becoming engaged in the policy process on multiple levels; nurses must
be prepared to interpret, evaluate, and lead policy change.
Competencies and Sub-Competencies
The competencies identified in this Essentials document provide a bridge between the
current and future needs of practice and the requisite education to prepare a
competent practitioner. Competence develops over time, is progressive, and reflects
the impact of internal and external factors and experiences of the student. Internal
factors include education, experience, knowledge, and professional orientation, among
others. External forces include the complexity of the learning experience and
professional autonomy. While knowledge is essential to the development of
competence, it does not in and of itself validate competence (Currier, 2019). Rather,
learners progress to successive levels of competence by demonstrating achievement of
expectations across the span of their education and practice experience. Students are
15
successful when they meet and sustain measurable competence at each level of
performance expectation and are able to transfer their competence across different
practice experiences and settings (Macy Foundation, 2017).
All competencies are organized within each of the ten domains; they are broad in scope
and cross all levels and areas of nursing practice. The competency is intentionally
written as a short statement; therefore, it is necessary to gain an understanding of the
contextual statement within the parent domain. In other words, the competency is
interpreted as a component within the domain.
For each competency, sub-competencies have been identified for both entry-level and
advanced nursing education. These sub-competencies are designed to ‘paint a picture’
of how the competency is achieved at each level. The sub-competencies are designed to
be understandable, observable, and measurable by learner, faculty, and future
employers. Since competence matures over time and is continual, the novice nurse may
integrate few of the domains at any one time into his/her practice or while providing
care while the expert nurse may continually incorporate most, if not all, of the domains
and competencies into his/her practice. It also should be noted that there is overlap or
crossing of competencies in several domains; the duplication is intentional as the
competency or sub-competency may have a different context in different domains.
A New Model for Nursing Education
The re-envisioned Essentials represents a new direction for nursing education,

influenced by the AACN Vision for Nursing Education (AACN 2018). In this new model,
competency-based education provides the structure for nursing across degree
programs. The model is applicable today and provides a mechanism to easily adapt to
future changes in nursing education programs.
Our current education model – with multiple degrees and degree paths that prepare
nurses for similar roles – is confusing to our stakeholders. As an example, there are
several types of programs and degrees that prepare students to become a registered
nurse; even within AACN member programs there are three recognized options.
Another example (and as confusing) are the multiple education programs and paths to
prepare a nurse practitioner (NP) and multiple types of NP certification. As a result, the
current nursing education system is confusing to our stakeholders. In some cases, it also
has led to confusion regarding the difference between an academic degree and a role
within the profession – as if the academic degree signifies a specific nursing role.
This new model is an intentional departure from the previous versions of Essentials that
were aligned to an academic degree. The two levels of sub-competencies essentially
reflect the educational stages of nurses now and in the future – as they enter practice,
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and as they return to school to advance their education – regardless of the degree they
are completing (See Figure 1).
The first level sub-competencies set the foundation for nurses entering professional
practice (Bachelor of Nursing degrees and master’s entry nursing degrees). These entry-
level competencies are used within curricula for prelicensure preparation and degree
completion pathways for professional nursing practice for nurses with initial preparation
at the associate degree. Experiences may vary across individual programs, but whatever
the learning experiences, will ensure the ability to demonstrate true mastery of
competencies in multiple and authentic contexts and over time (not a ‘one and
done’/checklist approach).
The second level sub-competencies build and expand the competence of the nurse
seeking advanced education in nursing. Advanced nursing education generally affords
the student the opportunity to focus on an emphasis area or practice role. Graduate
nursing education is the opportunity to acquire specialty knowledge. But regardless of
the specialty emphasis, the advanced level sub-competencies across all the Domains of
competence must be the foundation for specialty practice. Any program of study that a
student pursues in advanced nursing education will include the advanced sub-
competencies, that will complement any additional competencies defined for achieving
a specialty area of practice. Advanced education in nursing broadens the breadth of
experiences in context and complexity (thus competency achievement), consistent with
expectations of graduate education.
Figure 1: Model for Nursing Education
Transitioning from entry-level nursing to advanced nursing education requires the nurse
to complete the level 2 nursing sub-competencies (having already attained the level 1
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nursing sub-competencies.) Level 2 sub-competencies form the basis for all advanced
education, and as conceptualized apply to any advanced nursing practice role as core
content. Referencing Thorne’s use of “nursing’s angle of vision” reinforces the
importance of nurses using the unique knowledge and insight of the profession to
inform any practice role and to impact the challenges in healthcare. Competencies
designed for specialization in a specific role (e.g., nurse practitioner, midwife,
informatician, administrator) build on and are complemented by the Essentials core
competencies.
The re-envisioned Essentials represents an opportunity for a future characterized by

greater clarity as it relates to expectations of graduates and a more disciplined approach
to nursing education. Competencies are used within the academic program as core
expectations, thus setting a common standard. Additional elements within a degree
plan will allow schools to distinguish themselves in alignment with various institutional
missions. This model adapts to the current state of nursing education, and perhaps
more importantly, provides a path for an evolving trajectory for nursing education. As
an example, the AACN’s Vision for Academic Nursing (2019) noted a trend in second-
degree master’s entry nursing programs and postulated that in the future this could be a
preferred path for entry into the profession. As another example, the AACN has long
proposed that advanced nursing practice education be at the doctoral level (AACN,
2004); this perspective has not changed, and in fact was reaffirmed in 2015 (AACN,
2015). Additionally, the RAND Corporation found “near universal agreement” on the
value of a DNP degree to prepare nurses to meet future healthcare needs (Auerback,
2015). However, a large number of nursing programs continue to offer master’s degree
education, thus the new Essentials model accommodates for this reality. Over time,
higher education, stakeholder demands, nursing regulatory standards, and economics
are among the many forces that will drive the direction and pace of change for nursing
education in the future. This model has been designed to adapt to such future changes,
not only for the degrees offered, but also for recognized areas of emphasis offered at
the advanced education level by coupling with specialty competencies and or
certification standards.
The Essentials do not apply directly to the preparation of nurse researchers in a PhD
program. However, the second-level sub-competencies could be used by PhD programs
to guide core courses for doctoral nursing, particularly for programs offering bachelor-
to-PhD degrees. Additionally, for nursing programs offering both DNP and PhD degrees
and/or PhD to DNP or DNP to PhD options, the second-level core sub-competencies
could form the basis for shared core courses between the two doctoral degree
programs – representing efficiencies in program delivery.
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Implementing the Essentials in Curricula

(This section to be further developed)
Incorporating the Competencies in the Curriculum (to be further developed)

Figure 2 shows how the competencies are used or integrated across and in the
curriculum. Competencies are not the curriculum itself but rather serve as a central
foundation for the curricula and the program assessment plan.
Practice Expectations (To be developed further)

Entry-Level Expectations
Entry-level professional nurses need knowledge and proficiencies to practice across a
variety of venues. Consequently, all entry-level professional nurses must be prepared
for generalist practice across the lifespan with emphasis in four spheres of care: disease
prevention/promotion of health and well-being; chronic disease care; regenerative or
restorative care; and hospice/palliative/supportive care (AACN, 2019), see Figure 3.
Didactic, simulated, and clinical learning experiences will be needed to prepare nurses
to practice in these diverse settings. Mastery of the entry-level competencies will enable
the new nurse to practice as a generalist in any setting with diverse populations.
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Figure 3: Four Spheres of Care
Practice Expectations for Advanced-Level Education (To be developed)
Final Scholarly Product (To be developed)
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Domains, Competencies and Sub-Competencies for Entry-level Professional Nursing Education

and Advanced-level Nursing Education
Domain 1: Knowledge for Nursing Practice

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

1.1 Demonstrate an understanding of the discipline of nursing’s distinctive perspective and where shared perspectives exist
with other disciplines
1.1a Identify concepts, derived from theories from nursing and 1.1e Translate evidence from nursing science and other
other disciplines, which distinguish the practice of nursing. sciences into practice.
1.1b Apply knowledge of nursing science that develops a 1.1f Advance the contributions of nursing science to practice.
foundation for nursing practice.
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1.1c Understand the historical foundation of nursing as the 1.1g Optimize an understanding of nursing history to advance
relationship developed between the individual and nurse. nursing’s influence in health care.
1.1d Articulate nursing’s distinct perspective to practice
1.2 Apply theory and research-based knowledge from nursing, the arts, humanities, and other sciences.
1.2a Apply or employ knowledge from nursing science as well 1.2f Synthesize knowledge from nursing and other disciplines
as the natural, physical and social sciences, and the humanities to inform education, practice and research.
to build an understanding of the human experience and
nursing practice.
1.2b Develop intellectual curiosity. 1.2g Apply an analytic approach to nursing practice.
1.2c Demonstrate social responsibility as a global citizen who 1.2h Employ ethical decision making to assess, intervene, and
fosters the attainment of health equity for all. evaluate nursing care.
1.2d Examine influence of personal values in decision making 1.2i Demonstrate socially responsible leadership.
for nursing practice.
1.2e Demonstrate ethical decision making. 1.2j Translate theories from nursing and other disciplines to
practice.
1.3 Demonstrate clinical judgement founded on a broad knowledge base.
1.3a Demonstrate clinical reasoning 1.3d Integrate foundational and advanced specialty knowledge
into clinical reasoning.
1.3b Integrate multiple ways of knowing and inquiry to inform 1.3e Demonstrate clinical judgment based on synthesis of
clinical judgement. current and emerging evidence
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1.3c Incorporate knowledge from nursing and other disciplines 1.3f Analyze decision models from nursing and other
to support clinical judgement. knowledge domains to improve clinical judgement.
Domain 2: Person-Centered Care

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

2.1 Engage with the individual in establishing a caring relationship.
2.1a Demonstrate qualities of empathy. 2.1d Promote caring relationship to optimize outcomes.
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2.1b Demonstrate compassionate care. 2.1e Foster caring relationships to mitigate the impact of
health inequities.
2.1c Establish mutual respect with the patient and family.
2.2 Communicate effectively with individuals.
2.2a Demonstrate relationship-centered communication. 2.2f Demonstrate advanced communication skills and
techniques using a variety of modalities with diverse
audiences.
2.2b Consider individual values in communications. 2.2g Demonstrate emotional intelligence in all
communications.
2.2c Use a variety of communication modes appropriate for 2.2h Employ motivational interviewing.
the context.
2.2d Demonstrate the ability to conduct sensitive or difficult 2.2i Design evidence-based person-centered engagement
conversations. materials.
2.2e Use evidence-based patient teaching materials, 2.2j Apply personalized information, including
considering health literacy, vision, hearing, cultural sensitivity. genetic/genomics, to health care.
2.2k Facilitate difficult conversations and disclosure of

sensitive information.
2.3 Perform an assessment.
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2.3a Obtain a complete and accurate history in a systematic 2.3e Apply knowledge and skills of comprehensive assessment
manner. performance to area of advanced nursing practice.
2.3b Perform a clinically relevant holistic, health assessment. 2.3f Employ appropriate screening and diagnostic protocols
based on assessment findings and determinants of health.
2.3c Perform point of care diagnostic testing (e.g. blood 2.3g Communicate a comprehensive assessment.
glucose, PO2, EKG).
2.3d Distinguish between normal and abnormal health

findings.
2.4 Diagnose actual or potential health problems and needs.
2.4a Synthesize assessment data in the context of the patient’s 2.4e Employ advanced clinical reasoning to the diagnostic
current preferences, situation and experience. process.
2.4b Create problem list. 2.4f Integrate knowledge of physiology, pathophysiology, and
pharmacology into decision making in advanced nursing
practice.
2.4c Prioritize problems.
2.4d Understand the results of laboratory data, imaging studies
and other diagnostic tests.
2.4e Contribute as a team member to the formation and

improvement of diagnoses.
2.5 Develop a plan of care.
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2.5a Engage the patient and the interprofessional team in plan 2.5g Lead an interprofessional team to collaboratively develop
development. a comprehensive plan of care.
2.5b Organize care based on mutual health goals. 2.5h Prioritize risk mitigation strategies to prevent or reduce
adverse outcomes.
2.5c Prioritize care based on best evidence 2.5i Develop evidence-based interventions to improve
outcomes and safety.
2.5d Incorporate evidence-based intervention to improve 2.5j Incorporate innovations into practice when evidence is not
outcomes and safety. available.
2.5d Anticipate outcomes of care (expected, unexpected, and

potentially adverse).
2.5e Demonstrate rationale for plan.
2.5f Address patients’ experiences and perspectives in

designing plans of care.
2.6 Demonstrate accountability for care delivery.
2.6a Implement plan of care using established protocols. 2.6e Model best care practices to the healthcare team.
2.6b Communicate care delivery through multiple modalities. 2.6f Monitor metrics to assure accountability for care
outcomes.
2.6c Delegate appropriately to healthcare team members. 2.6g Promote delivery of care that supports practice at the full
scope of education.
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2.6d Monitor the execution 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 protocols.
2.6j Ensure accountability throughout transitions of care across
the health continuum.
2.7 Evaluate outcomes of care.
2.7a Reassess the individual to evaluate health 2.7d Analyze data to identify gaps and inequities in care and
outcomes/goals. monitor trends in outcomes.
2.7b Modify plan of care as needed. 2.7e Monitor system-level aggregate data to determine
healthcare outcomes and trends.
2.7c Recognize the need for modifications to standard practice. 2.7f Synthesize outcome data to inform evidence-based
practice, guidelines, and policies.
2.8 Promote self-care management for individuals.
2.8a Assist the individual to engage in self-care management. 2.8f Develop strategies that promote self-care management.
2.8b Employ individualized educational strategies based on 2.8g Incorporate the use of current and emerging technologies
learning theories, methodologies, and health literacy. to support self-care management.
2.8c Educate patients regarding self-care for health promotion, 2.8h Use counseling techniques to advance wellness and self-
illness prevention, and illness management. care management among colleagues, staff, and recipients of
health care.
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2.8d Respect patients’ self-determination in their health care 2.8i Evaluate adequacy of community resources available to
decisions. support self-care management
2.8e Identify community resources available to support self- 2.8j Foster partnerships with community organizations to
care management. support self-care management.
2.8k Educate individuals to enhance their participation in
shared care decision making.
2.9 Provide care coordination.
2.9a Facilitate continuity of care based on assessment of 2.9e Evaluate communication pathways among providers and
needs. others across settings, systems and communities.
2.9b Communicate with relevant stakeholders across health 2.9f Develop strategies to optimize care coordination and
systems. transitions of care.
2.9c Promote collaboration by clarifying responsibilities among 2.9g Lead the coordination of care across health systems.
patient, family, and team members.
2.9d Recognize when additional expertise and knowledge is 2.9h Analyze system-level and public policies influence on care
needed to manage the patient. coordination.
2.9i Participate in system level change to improve care

coordination across settings.
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Domain 3: Population Health

Descriptor: Population health spans the healthcare delivery continuum and describes collaborative activities among stakeholders for
the improvement of an equitable population health outcomes.
Contextual Statement: A population is a discrete group that the nurse and others care for across settings at local, regional, national,
and global levels. Population health spans the health care delivery continuum and describes collaborative activities among
stakeholders for the improvement of a population’s health status. The purpose of these collaborative activities, including
interventions and policies, is to strive towards health equity. Diversity, equity, inclusivity, and ethics must be emphasized and
valued. Accountability for outcomes is shared by all, since outcomes arise from multiple factors that influence the health of a
defined group. Population health includes population management through systems thinking, including health promotion and illness
prevention, to achieve population health goals (Storfjell, 2017). In addition, nurses respond to crises and provide care during
emergencies, disasters, epidemics or pandemics. They play an essential role in system preparedness and ethical response initiatives.
Although each type of public health emergency will likely require a unique set of competencies, preparedness for responding begins
with a population health perspective and a particular focus on surveillance, prevention and containment of factors contributing to
the emergency.

3.1 Manage population health.
3.1a Define a target population including its functional and 3.1g Assess the efficacy of a system’s capability to serve a target
problem-solving capabilities (anywhere in the continuum of sub-population’s healthcare needs.
care).
3.1b Assess health status data, including health determinants, 3.1h Analyze primary and secondary health status data for
assets, barriers, and inequities. multiple populations against relevant benchmarks.
3.1c Assess the priorities of the community/population. 3.1i Use established or evolving methods to determine
population-focused priorities for care.
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3.1d Compare and contrast local, regional, national, and global 3.1j Develop a collaborative approach with relevant
benchmarks to identify health patterns across populations. stakeholders to address population healthcare needs, including
evaluation methods.
3.1e Develop an action plan to meet an identified need(s), 3.1k Collaborate with appropriate stakeholders to implement a
including evaluation methods. sociocultural and linguistically responsive intervention plan.
3.1f Participate in the implementation of sociocultural and

linguistically responsive interventions.
3.2 Engage in effective partnerships.
3.2a Engage with other health professionals to address 3.2d Create collaborative opportunities for individuals and
population health issues organizations to improve population health.
3.2b Demonstrate effective collaboration and mutual 3.2e Challenge biases and barriers that impact population
accountability with relevant stakeholders. health outcomes.
3.2c Use culturally and linguistically responsive communication 3.2f Evaluate the effectiveness of partnerships for achieving
strategies. health equity.
3.2g Lead partnerships to improve population health outcomes.
3.2h Assess preparation and readiness of partners to organize

during natural and manmade disasters.
3.3 Consider the economic impact of the delivery of health care.
3.3a Describe access and equity resource implications of 3.3c Analyze cost-benefits of selected population-based
proposed intervention(s). interventions.
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3.3b Prioritize action plans that are safe, effective, and 3.3d Collaborate with partners to secure resources necessary
efficient in the context of available resources. for effective, sustainable interventions.
3.3e Advocate for interventions that maximize cost-effective,
accessible, and equitable resources for populations.
3.3f Incorporate ethical principles in resource allocation in

achieving equitable health.
3.4 Advance equitable population health policy.
3.4a Describe the policy process. 3.4f Identify opportunities to influence the policy process.
3.4b Describe the impact of policies on population outcomes, 3.4g Design comprehensive advocacy strategies to support the
including social justice and health equity. policy process.
3.4c Identify best evidence to support policy development. 3.4h Engage in strategies to influence policy change.
3.4d Propose modifications to or development of policy based 3.4i Contribute to policy development at the system, local,
on population findings. regional or national levels.
3.4e Develop an awareness of the interconnectedness of 3.4j Assess the impact of policy changes
population health across borders.
3.4k Evaluate the ability of policy to address disparities and
inequities within segments of the population.
3.4L Evaluate the risks to population health associated with

globalization.
3.5 Demonstrate advocacy strategies.
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3.5a Articulate a need for change. 3.5f Appraise advocacy priorities for a population.
3.5b Describe the intent of the proposed change. 3.5g Strategize with others to develop effective advocacy
approaches.
3.5c Define stakeholders and their level of influence. 3.5h Engage in relationship-building activities with stakeholders
at any level of influence, including system, local, state, national,
and/or global.
3.5d Implement messaging strategies appropriate to audience 3.5i Demonstrate leadership skills to promote advocacy efforts
and stakeholders. that include principles of social justice, diversity, equity, and
inclusion.
3.5e Evaluate the effectiveness of advocacy actions.
3.6 Advance preparedness to protect population health during disasters and public health emergencies.
3.6a Identify changes in conditions that might indicate a disaster 3.6g Initiate rapid response activities to protect population
or public health emergency. health.
3.6b Describe the health and safety hazards of disasters and 3.6h Participate in ethical decision making that includes
public health emergencies. diversity, equity and inclusion in advanced preparedness to
protect populations.
3.6c Describe the overarching principles and methods regarding 3.6i Collaborate to lead preparedness and mitigation efforts to
personal safety measures, including PPE. protect population health with attention to the most vulnerable
populations.
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3.6d Implement infection control measures and proper use of 3.6j Coordinate the implementation of evidence-based infection
personal protective equipment. control measures and proper use of personal protective
equipment.
3.6e Describe general principles and practices for the clinical 3.6k Contribute to system-level planning, decision making, and
management of populations across the age continuum. evaluation for disasters and public health emergencies.
3.6f Identify ethical principles to protect the health and safety

of diverse populations.
Domain 4: Scholarship for the Nursing Discipline

Descriptor: The generation, synthesis, translation, application, and dissemination of nursing knowledge to improve health and
transform health care.
Contextual Statement: Nursing scholarship informs science, enhances clinical practice, influences policy, and impacts best practices
for educating nurses as clinicians, scholars, and leaders. Scholarship is inclusive of discovery, application, integration, and teaching.
While not all inclusive the scholarship of discovery includes primary empirical research, analysis of large data sets, theory
development, and methodological studies. The scholarship of practice interprets, draws together, applies and brings new insight to
original research. The scholarship of teaching focuses on the transmission, transformation, and extension of knowledge (Boyer,
1999).
Knowledge of the basic principles of the research process, including the ability to critique research and determine its applicability to
nursing’s body of knowledge is critical. Ethical comportment in the conduct and dissemination of research and advocacy for human
subjects are essential components of nursing’s role in the process of improving health and healthcare. Whereas the research process
is the generation of new knowledge, evidence-based practice (EBP) is the process for the application, translation, and
implementation of best evidence into clinical decision-making. While evidence may emerge from research, EBP extends beyond just
data to include patient preferences and values as well as clinical expertise. Nurses, as innovators and leaders, within the
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interprofessional team use the uniqueness of nursing in nurse-patient relationships to provide optimal care; and address health
inequities, structural racism, and systemic inequity.

4.1 Advance the scholarship of nursing.
4.1a Demonstrate an understanding of different approaches to 4.1h Apply advanced knowledge in a defined area of nursing
scholarly practice. practice.
4.1b Demonstrate application of different levels of evidence. 4.1i Engage in scholarship to advance health.
4.1c Apply theoretical framework(s)/models in practice. 4.1j Discern appropriate applications of quality improvement,
research, and evaluation methodologies.
4.1d Demonstrate an understanding of basic elements of the 4.1k Collaborate to advance one’s scholarship.
research process.
4.1e Participate in scholarly inquiry as a team member. 4.1L Disseminate one’s scholarship to diverse audiences using
a variety of approaches or modalities.
4.1f Critique research. 4.1m Advocate within the interprofessional team for the
contributions of nursing scholarship.
4.1g Communicate scholarly findings.
4.2 Integrate best evidence into nursing practice.
4.2a Evaluate clinical practice to generate questions to improve 4.2f Use diverse sources of evidence to inform practice.
nursing care.
4.2b Evaluate appropriateness and strength of the evidence. 4.2g Lead the translation of evidence into practice.
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4.2c Apply best evidence in practice. 4.2h Address opportunities for innovation and changes in
practice.
4.2d Participate in the implementation of a practice change to 4.2i Evaluate potential impacts of policy and regulation in the
improve nursing care. face of new evidence.
4.2e Participate in the evaluation of outcomes and their 4.2j Evaluate outcomes and impact of new practices based on
implications for practice. the evidence.
4.3 Promote the ethical conduct of scholarly activities.

4.3a Explain the rationale for ethical research guidelines 4.3d Identify and mitigate potential risks and areas of ethical
including the Institutional Review Board (IRB) guidelines. concern in the conduct of all scholarly activities.
4.3b Demonstrate ethical behaviors in scholarly projects 4.3e Apply the Institutional Review Board (IRB) guidelines
including quality improvement and EBP initiatives. throughout the scholarship process.
4.3c Advocate for the protection of participants in the conduct 4.3f Ensure the protection of participants and associated
of all scholarly initiatives. others in the conduct of scholarship.
4.3g Implement processes that support ethical conduct in

practice and scholarship.
4.3h Apply ethical principles to the dissemination of nursing

scholarship.
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Domain 5: Quality and Safety

Descriptor: Employment of established and emerging principles of safety and improvement science. Quality and safety, as core
values of nursing practice, enhance quality and minimize risk of harm to patients and providers through both system
effectiveness and individual performance.
Contextual Statement: Provision of safe, quality care necessitates knowing and using established and emerging principles of
safety science in care delivery. Quality and safety encompass provider and recipient safety and recognition of the 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, care givers are empowered and encouraged to promote safety and
take appropriate action to prevent and report adverse events and ‘near misses’. Fundamental to the provision of safe quality
care, caregivers adopt, integrate, and disseminate current practice guidelines and evidence-based interventions.
Safety is inclusive of attending to work environment violence, burnout, and ergonomics; there is a synergistic relationship between
employee safety and patient safety. A safe environment minimizes risk to both recipients and providers of care. It requires a shared
commitment to create a physically, psychologically, secure, and just environment. Safety demands an obligation to remain non-
punitive in detecting, reporting, and analyzing errors and near misses when they occur.
For quality health care to exist, care must be safe, effective, timely, efficient, equitable, and person-centered. Quality care is the
extent to which care services improve desired health outcomes and are consistent with patient preferences and current
professional knowledge (IOM, 2001). Additionally, quality care includes collaborative engagement with the recipient of care in
assuming responsibility for health promotion and illness treatment behaviors.

5.1 Apply quality improvement principles in care delivery.
5.1a Recognize nursing’s essential role in quality improvement. 5.1i Establish and incorporate data driven benchmarks to
monitor system performance.
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5.1b Identify sources and applications of national safety and 5.1j Lead team-based change initiatives based on quality and
quality standards. process improvement methods.
5.1c Articulate nurse sensitive outcomes applicable to one’s 5.1k Integrate outcome metrics to inform change and policy
patients and practice environments. recommendations.
5.1d Interpret benchmark and unit outcome data to inform 5.1L Collaborate in analyzing organizational process
individual and microsystem practice. improvement initiatives.
5.1e Compare quality improvement methods in the delivery of 5.1m Lead the development of a business plan for quality
patient care. improvement initiatives.
5.1f Identify strategies to improve outcomes of patient care in 5.1n Advocate for change related to financial policies that
practice. impact the relationship between economics and quality care
delivery.
5.1g Participate in the implementation of a practice change. 5.1o Advance quality improvement practices through
dissemination of outcomes.
5.1h Develop a plan for monitoring the quality improvement

change.
5.2 Contribute to a culture of patient safety.
5.2a Describe the factors that create a culture of safety. 5.2g Evaluate the alignment of system data and comparative
patient safety benchmarks.
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5.2b Articulate the nurse’s role within an interprofessional 5.2h Lead analysis of actual errors, near misses, and potential
team in promoting safety and preventing errors and near situations that would impact safety.
misses.
5.2c Examine basic safety design principles to reduce risk of 5.2i Design evidence-based interventions to mitigate risk.
harm.
5.2d Recognize the importance of reporting errors. 5.2j Evaluate emergency preparedness system-level plans to
protect safety.
5.2e Describe processes used in understanding causes of error.
5.2f Use national patient safety resources, initiatives, and

regulations at the point of care.
5.3 Contribute to a culture of provider and work environment safety.
5.3a Identify actual and potential level of risks to providers 5.3f Advocate for initiatives that support a culture of work
within the workplace. environment safety (people, process and technology),
including risks and strengths.
5.3b Recognize how to prevent workplace violence and injury. 5.3g Create a just culture reflecting civility and respect.
5.3c Promote policies for prevention of violence and risk 5.3h Create a safe and transparent culture for reporting
mitigation. incidents.
5.3e Manage own personal well-being and resiliency. 5.3i Role model and lead well-being and resiliency for self and
team.
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Domain 6: Interprofessional Partnerships

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

6.1 Communicate in a manner that facilitates a partnership approach to quality care delivery.
6.1a Communicate the nurse’s roles and responsibilities 6.1g Evaluate effectiveness of interprofessional communication
clearly. tools and techniques to support and improve the efficacy of
team-based interactions.
6.1b Use various communication tools and techniques 6.1h Facilitate improvements in interprofessional
effectively. communications of patient information (e.g. EHR).
6.1c Elicit the perspectives of team members to inform person- 6.1i Role model respect for diversity, equity, and inclusion in
care decision making. team-based communications.
6.1d Articulate impact of diversity, equity, and inclusion on 6.1j Communicate nursing’s unique disciplinary knowledge to
team-based communications. strengthen interprofessional partnerships
6.1e Communicate patient information in a professional, 6.1k Provide expert consultation for other members of the
accurate, and timely manner. healthcare team in one’s area of practice.
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6.1f Communicate as informed by legal, regulatory, and policy 6.1L Lead resolution of interprofessional conflict.
guidelines.
6.2 Perform effectively in different team roles, using principles and values of team dynamics.
6.2a Apply principles of team dynamics, including team roles, 6.2g Integrate evidence-based strategies and processes to
to facilitate effective team functioning. improve team effectiveness and outcomes.
6.2b Delegate work to team members based on their roles and 6.2h Evaluate the impact of team dynamics and performance on
competency. desired outcomes.
6.2c Engage in the work of the team as appropriate to one’s 6.2i Reflect on how one’s role and expertise influences team
scope of practice and competency. performance.
6.2d Recognize how one’s uniqueness (as a person and a 6.2j Foster positive team dynamics to strengthen desired
nurse) contributes to effective interprofessional working outcomes.
relationships.
6.2e Apply principles of team leadership and management.

performance to improve quality and assure safety.
6.2f Evaluate performance of individual and team to improve

quality and promote safety.
6.3 Use knowledge of nursing and other professions to address healthcare needs.
6.3a Integrate the roles and responsibilities of healthcare 6.3d Lead interprofessional activities and initiatives.
professionals through interprofessional collaborative practice.
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6.3b Leverage abilities of team members to optimize care.
6.3c Communicate with team members to clarify

responsibilities in executing plan of care.
6.4 Work with other professions to maintain a climate of mutual learning, respect, and shared values.
6.4a Demonstrate an awareness of one’s biases and how they 6.4d Practice self-regulation to mitigate conscious and implicit
may affect mutual respect and communication with team biases toward other team members.
members.
6.4b Demonstrate respect for the perspectives and 6.4e Foster an environment that supports the constructive
experiences of other health professions. sharing of multiple perspectives and enhances interprofessional
learning.
6.4c Engage in constructive communication to facilitate 6.4g Integrate diversity, equity and inclusion into team practices.
conflict management.
6.4d Collaborate with interprofessional team members to 6.4h Manage disagreements, conflicts, and challenging
establish mutual healthcare goals for individuals or conversations among team members.
populations.
6.4i Promote an environment that advances interprofessional

learning.
Domain 7: Systems-Based Practice

Descriptor: Responding to and leading within complex systems of health care. Nurses effectively and proactively coordinate
resources to provide safe, quality, equitable care to diverse populations.
Contextual Statement: Using evidence-based methodologies, nurses lead innovative solutions to address complex health problems
and ensure safe, quality, equitable care. Understanding of systems-based practice is foundational to the delivery of quality care and
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incorporates key concepts of organizational structure including relationships among macro, meso, and microsystems across
healthcare settings. Knowledge of financial and payment models relative to reimbursement and healthcare costs is essential. In
addition, the impact of local, regional national and global structures, systems, and regulations on individuals and diverse populations
must be considered when evaluating patient outcomes. As change agents and leaders, nurses possess the intellectual capacity to be
agile in response to continually evolving healthcare systems, to address structural racism, other forms of discrimination, and to
advocate for the needs of diverse populations.

7.1 Apply knowledge of systems to work effectively across the continuum of care.
7.1a Describe organizational structure, mission, vision, 7.1e Participate in organizational strategic planning.
philosophy, and values.
7.1b Explain the relationships of macrosystems, mesosystems, 7.1f Participate in system-wide initiatives that improve care
and microsystems. delivery and/or outcomes.
7.1c Differentiate between various healthcare delivery 7.1g Analyze system-wide processes to optimize outcomes.
environments across the continuum of care.
7.1d Recognize internal and external system’s processes that 7.1h Design policies to impact health equity and structural
impact care coordination and transition of care. racism within systems, communities, and populations.
7.2 Incorporate consideration of cost-effectiveness of care.
7.2a Describe the financial and payment models of health care. 7.2g Analyze relevant internal and external factors that drive
healthcare costs and reimbursement.
7.2b Recognize the impact of health disparities and social 7.2h Design practices that enhance value, access, quality, and
determinants of health on care outcomes. cost-effectiveness.
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7.2c Describe the impact of healthcare cost and payment 7.2i Advocate for healthcare economic policies and regulations
models on the delivery, access, and quality of care. to enhance value, quality, and cost-effectiveness.
7.2d Explain the relationship of policy, regulatory requirements 7.2j Formulate, document and disseminate the return on
and economics on care outcomes. investment for improvement initiatives.
7.2e Incorporate considerations of efficiency, value, and cost in 7.2k Recommend system-wide strategies that improve cost-
providing care. effectiveness considering structure, leadership, and workforce
needs.
7.2f Identify the impact of differing system structures, 7.2L Evaluate health policies based on an ethical framework
leadership and workforce needs on care outcomes. considering cost-effectiveness, health equity, and care
outcomes.
7.3 Optimize system effectiveness through application of innovation and evidence-based practice.
7.3a Demonstrate a systematic approach for decision-making. 7.3e Apply innovative and evidence-based strategies focusing
on system preparedness and capabilities.
7.3b Use reported performance metrics to evaluate outcomes. 7.3f Design system improvement strategies based on
performance data and metrics.
7.3c Participate in evaluating system effectiveness. 7.3g Manage change to sustain system effectiveness.
7.3d Recognize internal and external system processes and 7.3h Design system improvement strategies that address
structures that perpetuate racism and other forms of internal and external system processes ad structures that
discrimination within healthcare. perpetuate structural racism and other forms of discrimination
in healthcare systems.
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Domain 8: Informatics and Healthcare Technologies

Descriptor: Information and communication technologies and informatics processes are used to provide care, gather data, form
information to drive decision making, and support professionals as they expand knowledge and wisdom for practice. Informatics
processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in
accordance with best practice and professional and regulatory standards.
Contextual Statement: Healthcare professionals interact with patients, families, communities, and populations in technology rich
environments. Nurses, as essential members of the healthcare team, use information and communication technologies and
informatics tools in their direct and indirect care roles. The technologies, the locations in which they are used, the users interacting
with the technology, the communication occurring, and the work being done all impact the data collected, information formed,
decisions made, and the knowledge generated. Additionally, the utilization of information and communication technologies in
healthcare settings changes how people, processes, and policies interact. Using these tools in the provision of care has both short-
and long-term consequences for the quality of the care, efficiency of communications, and connections between team members,
patients, and consumers. It is essential that nurses at all levels understand their role and the value of their input in health
information technology analysis, planning, implementation, and evaluation. With the prevalence of patient-focused health
information technologies, all nurses have a responsibility to advocate for equitable access, and assist patients and consumers to
optimally use these tools to engage in care, improve health, and manage health conditions.
8.1 Describe the various information and communication technology tools used in the care of patients, communities, and
populations.
8.1a Identify the variety of information and communication 8.1g Identify best evidence and practices for the application
technologies used in care settings. of information and communication technologies to support
care.
8.1b Identify the basic concepts of electronic health, mobile 8.1h Evaluate the unintended consequences of information
health, and telehealth systems for enabling patient care. and communication technologies on care processes,
communications, and information flow across care settings.
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8.1c Effectively use electronic communication tools. 8.1i Propose a plan to influence the selection and
implementation of new information and communication
technologies
8.1d Describe the appropriate use of multimedia applications in 8.1j Summarize the fiscal impact of information and
healthcare. communication technologies on health care.
8.1e Demonstrate best practice use of social networking 8.1k Appraise the impact of information and communication
applications. technologies on workflow processes and healthcare
outcomes.
8.1f Explain the importance of nursing engagement in the

planning and selection of healthcare technologies.
8.2 Use information and communication technology to gather data, create information, and generate knowledge.
8.2a Enter accurate data when chronicling care. 8.2f Generate information and knowledge from health
information technology databases.
8.2b Explain how data entered on one patient impacts public and 8.2g Evaluate the use of communication technology to
population health data. improve consumer health information literacy.
8.2c Use appropriate data when planning care. 8.2h Use standardized data to evaluate decision-making and
outcomes across all systems levels.
8.2d Demonstrate the appropriate use of health information 8.2i Clarify how the collection of standardized data advances
literacy assessments and improvement strategies. the practice, understanding, and value of nursing and
supports care.
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8.2e Describe the importance of standardized nursing data to 8.2j Interpret primary and secondary data and other
reflect the unique contribution of nursing practice. information to support care.
8.3 Use information and communication technologies and informatics processes to deliver safe nursing care to diverse
populations in a variety of settings.
8.3a Demonstrate appropriate use of information and 8.3g Evaluate the use of information and communication
communication technologies. technology to address needs, gaps, and inefficiencies in care.
8.3b Evaluate how decision support tools impact clinical 8.3h Formulate a plan to influence decision making processes
judgment and safe patient care. for selecting, implementing, and evaluating support tools.
8.3c Use information and communication technology in a 8.3i Appraise the role of information and communication
manner that supports the nurse-patient relationship. technologies in engaging the patient and supporting the
nurse-patient relationship.
8.3d Examine how emerging technologies influence healthcare 8.3j Evaluate the potential uses and impact of emerging
delivery and clinical decision making. technologies in healthcare.
8.3e Identify impact of information and communication 8.3k Apply strategies to reduce inequities in digital access to
technology on quality and safety of care. data and information.
8.3f Identify the importance of reporting system processes and

functional issues (e.g. error messages, mis-directions, device
malfunctions, etc.) according to organizational policies and
procedures.
8.4 Use information and communication technology to support documentation of care and communication among providers,
patients, and all system levels.
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8.4a Explain the role of communication technology in enhancing 8.4e Assess best practices for the use of advanced
clinical information flows. information and communication technologies to support
patient and team communications.
8.4b Describe how information and communication technology 8.4f Employ electronic health, mobile health, and telehealth
tools support patient and team communications. systems to enable quality and efficient patient care.
8.4c Identify the basic concepts of electronic health, mobile 8.4g Evaluate the impact of health information exchange,
health, and telehealth systems in enabling patient care. interoperability, and integration to support patient centered
care.
8.4d Explain the impact of health information exchange,

interoperability, and integration on health care.
8.5 Use information and communication technologies in accordance with ethical, legal, professional and regulatory standards,
and workplace policies in the delivery of care.
8.5a Identify common risks associated with using information 8.5g Apply risk mitigation and security strategies to reduce
and communication technology. misuse of information and communication technology.
8.5b Demonstrate ethical use of social networking applications. 8.5h Assess potential ethical and legal issues associated with
the use of information and communication technology.
8.5c Comply with legal and regulatory requirements while using 8.5i Recommend strategies to protect health information
communication and information technologies. when using communication and information technology.
8.5d Educate patients on their rights to access, review, and 8.5j Promote patient engagement with their personal health
correct personal data and medical records. data.
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8.5e Discuss how clinical judgement and critical thinking must 8.5k Advocate for policies and regulations that support the
prevail in the presence of information and communication appropriate use of technologies impacting health care.
technologies.
8.5f Deliver care using remote technology. 8.5L Analyze the impact of federal policy and regulation on
health data and technology in care settings.
Domain 9: Professionalism
Descriptor: Formation and cultivation of a sustainable professional nursing identity, accountability, perspective, collaborative
disposition and comportment that reflects nursing’s characteristics, and values.
Contextual Statement: Professionalism encompasses the development of a nursing identity embracing the values of integrity,
altruism, inclusivity, compassion, courage, humility, advocacy, and caring. Professional identity formation necessitates the
development of emotional intelligence to promote social good, engage in social justice, and demonstrate ethical comportment and
moral courage in decision making and actions. Nursing professionalism is a continuous process of socialization that requires the
nurse to give back to the profession through the mentorship and development of others.
Professional identity is formed throughout one’s education and career. Nursing identity flourishes through engagement and
reflection in multiple experiences. As a result, nurses embrace the history, characteristics, norms and values of the discipline and
think, act and feel like a nurse. Professional identity formation is not a linear process but rather one that responds to challenges and
matures through experiences of the professional nurse.

9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society.
9.1a Apply principles of professional nursing ethics and human 9.1h Analyze current policies and practices in the context of an
rights in patient care and professional situations. ethical framework.
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9.1b Reflect on one’s actions and their consequences. 9.1i Model ethical behaviors in practice and leadership roles
9.1c Demonstrate ethical behaviors in practice. 9.1j Intervene when unethical behaviors are observed.
9.1d Change behavior based on self- and situational 9.1k Assume accountability in working to resolve ethical
awareness. dilemmas.
9.1e Report unethical behaviors when observed.
9.1f Safeguard privacy, confidentiality, and autonomy in all

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

9.2 Employ participatory approach to nursing care.
9.2a Employ the use of intentional presence to facilitate shared 9.2h Foster opportunities for intentional presence in practice.
meaning.
9.2b Facilitate health and healing through compassionate 9.2i Design innovative and evidence-based practices that
caring. promote person-centered care.
9.2c Demonstrate empathy to the patient’s life experience. 9.2j Advocate for practices that advance diversity, equity and
inclusion.
9.2d Advocate for practices that advance diversity, equity and 9.2k Model principles of therapeutic relationships.
inclusion.
9.2e Demonstrate cultural sensitivity and humility in practice. 9.2L Facilitate communication that promotes a participatory
approach.
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9.2f Apply principles of therapeutic relationships and

professional boundaries.
9.2g Communicate in a professional manner.
9.3 Demonstrate accountability to the individual, society, and the profession.
9.3a Engage in advocacy that promotes the best interest of the 9.3i Advocate for nursing’s professional responsibility for
individual, community, and profession. ensuring optimal care outcomes
9.3b Demonstrate the moral courage to report concerns 9.3j Demonstrate leadership skills when participating in
related to actual or potential hazards and/or errors. professional activities and/or organizations.
9.3c Demonstrate professional and personal honesty and 9.3k Address actual or potential hazards and/or errors.
integrity.
9.3d Take responsibility for one’s roles, decisions, obligations, 9.3L Foster a practice environment that promotes
actions and care outcomes. accountability for care outcomes.
9.3e Engage in professional activities and/or organizations. 9.3m Advocate for policies/practices that promote social
justice and health equity.
9.3f Demonstrate adherence to a culture of civility. 9.3n Foster strategies that promote a culture of civility across a
variety of settings.
9.3g Advocate for social justice and health equity, including 9.3o Lead in the development of opportunities for professional
addressing the health of vulnerable populations. and interprofessional activities.
9.3h Engage in peer evaluation.
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9.4 Comply with relevant laws, policies, and regulations.
9.4a Advocate for policies that promote health and prevent 9.4d Advocate for polices that enable nurses to practice to the
harm. full extent of their education.
9.4b Adhere to the registered nurse scope and standards of 9.4e Assess the interaction between regulatory agency
practice. requirements and quality, fiscal, and value-based indicators.
9.4c Adhere to regulatory requirements and workplace policies 9.4f Evaluate the effect of legal and regulatory policies on
consistent with one’s educational preparation. nursing practice and healthcare outcomes.
9.4g Lead efforts to change legal and regulatory policies that

improve nursing practice and health outcomes.
9.4h Facilitate the implementation of policies and regulations

to improve the professional practice environment and
healthcare outcomes.
9.5 Demonstrate the professional identity of nursing.
9.5a Describe nursing’s professional identity and contributions 9.5f Articulate nursing’s unique professional identity to other
to the healthcare team. interprofessional team members, and the public.
9.5b Demonstrate the core values of professional nursing 9.5g Evaluate practice environment to ensure that nursing core
identity. values are demonstrated.
9.5c Demonstrate sensitivity to the values of others. 9.5h Lead with moral courage to influence team decision-
making.
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9.5d Demonstrate ethical comportment and moral courage in 9.5i Engage in professional organizations that reflect nursing’s
decision making and actions. values and identity.
9.5e Demonstrate emotional intelligence.
9.6 Integrate diversity, equity, and inclusion as core to one’s professional identity.
9.6a Demonstrate respect for diverse individual differences. 9.6d Model respect for diversity, equity and inclusion for all
team members.
9.6b Demonstrate awareness of personal and professional 9.6e Critique one’s personal and professional practices in the
values and conscious and unconscious biases. context of nursing’ core values.
9.6c Integrate core principles of social justice into practice. 9.6f Analyze the impact of structural and cultural influences on
nursing’s professional identity.
9.6g Ensure that care provided by self and others is reflective

of nursing’s core values.
9.6h Structure the practice environment to facilitate care that
is culturally and linguistically appropriate.
9.6i Ensure self and others are accountable in
upholding moral, legal, and humanistic principles related to
health.
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Domain 10: Personal, Professional, and Leadership Development

Descriptor: Participation in activities and self-reflection that foster personal health, resilience, and well-being, lifelong learning, and
support the acquisition of nursing expertise and assertion of leadership.
Contextual Statement: Competency in Personal, Professional, and Leadership Development encompasses three areas: 1)
development of the nurse as an individual, resilient, agile, and capable of adapting to ambiguity and change; 2) development of the
nurse as a professional, responsible, and accountable for lifelong learning and ongoing self-reflection; and 3) development of the
nurse as a leader, proficient in asserting control, influence, and power in professional and personal contexts. Development of these
dimensions requires a commitment to personal growth, sustained expansion of professional knowledge and expertise, and
determined leadership practice in a variety of contexts is required.
Graduates must develop attributes and skills critical to the viability of the profession and practice environments. The aim is to
promote diversity and retention in the profession, self-awareness, avoidance of stress-induced emotional and mental exhaustion,
and re-direction of energy from negative perceptions to positive influence through leadership opportunities.
10.1 Demonstrate a commitment to personal health and wellbeing.
10.1a Incorporate principles of health and wellness into daily 10.1d Role model personal health and well-being practices to
life. foster resilience.
10.1b Demonstrate healthy, self-care behaviors that promote 10.1e Contribute to an environment that promotes self-care,
wellness and resiliency. personal health and well-being.
10.1c Manage conflict between personal and professional 10.1f Evaluate the workplace environment to determine level
responsibilities. of health and wellbeing.
10.2 Demonstrate a spirit of inquiry that fosters flexibility and professional maturity.
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10.2a Engage in guided and spontaneous reflection of one’s 10.2g Demonstrate cognitive flexibility in managing change
practice. within complex environments.
10.2b Integrate comprehensive feedback to improve 10.2h Demonstrate professional agility by incorporating
performance. feedback to improve performance.
10.2c Commit to personal and professional development. 10.2i Mentor others in the development of their professional
growth and accountability.
10.2d Expand personal knowledge to inform clinical 10.2j Foster activities that support a culture of lifelong
judgement. learning.
10.2e Identify role models and mentors to support 10.2k Expand leadership through professional service.
professional growth.
10.2f Participate in lifelong learning activities that embrace
principles of diversity, equity, inclusion, and anti-
discrimination.
10.3 Develop capacity for leadership.

10.3a Compare and contrast leadership principles and 10.3h Provide leadership to advance the nursing profession.
theories.
10.3b Formulate a personal leadership style. 10.3i Influence intentional change guided by leadership
principles and theories.
10.3c Demonstrate leadership behaviors in professional 10.3j Evaluate the outcomes of intentional change.
situations.
10.3d Demonstrate self-efficacy consistent with one’s 10.3k Evaluate strategies/methods for peer review.
professional development.
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10.3e Use appropriate resources when dealing with ambiguity. 10.3L Participate in the evaluation of other members of the
care team.
10.3f Modify one’s own leadership behaviors based on guided 10.3m Demonstrate leadership skills in times of uncertainty
self-reflection. and crisis.
10.3g Demonstrate self-awareness of one’s own implicit biases 10.3n Lead in promoting social justice and eradicating
and the relationship to one’s culture and environment. structural racism and systematic inequity in nursing and
society.
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Glossary
Proposed Glossary Terms (Work in Progress)
• Accountability: According to Krautscheid (2014), professional nursing

accountability underpins safe nursing practice (Shultz, 2009) and is an essential
behavior supporting congruence between nursing actions and standards that are
associated with quality and safety in patient care. Nurse educators should not
assume that nursing students inherently possess behaviors consistent with
professional accountability. The lack of such professional accountability could
result in less than optimal patient care. Nursing curricula should explicitly
incorporate within the legitimate curriculum theory-guided teaching strategies
and learning activities that address the knowledge, skills, and attitudes
associated with professional accountability (American Association of Colleges of
Nursing, 2008, Baxter and Boblin, 2007, Crigger and Godfrey, 2011).
• Advanced nursing practice: any form of nursing intervention that influences
health care outcomes for individuals or populations, including the direct care of
individual patients, management of care for individuals and populations,
administration of nursing and health care organizations, and the development
and implementation of health policy. (AACN, 2006,p. 2)
• Advanced practice registered nursing: APRNs include certified registered nurse
anesthetists, certified nurse-midwives, clinical nurse specialists and certified
nurse practitioners. The definition of an Advanced Practice Registered Nurse
(APRN) is a nurse: 1. who has completed an accredited graduate-level education
program preparing him/her for one of the four recognized APRN roles; 2. who
has passed a national certification examination that measures APRN, role and
population-focused competencies and who maintains continued competence as
evidenced by recertification in the role and population through the national
certification program; 3. who has acquired advanced clinical knowledge and skills
preparing him/her to provide direct care to patients, as well as a component of
indirect care; however, the defining factor for all APRNs is that a significant
component of the education and practice focuses on direct care of individuals; 4.
whose practice builds on the competencies of registered nurses (RNs) by
demonstrating a greater depth and breadth of knowledge, a greater synthesis of
data, increased complexity of skills and interventions, and greater role
autonomy; 5. who is educationally prepared to assume responsibility and
accountability for health promotion and/or maintenance as well as the
assessment, diagnosis, and management of patient problems, which includes the
use and prescription of pharmacologic and non-pharmacologic interventions; 6.
who has clinical experience of sufficient depth and breadth to reflect the
intended license; and 7. who has obtained a license to practice as an APRN in
one of the four APRN roles: certified registered nurse anesthetist (CRNA),
certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse
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practitioner (CNP). (APRN Joint Dialogue Group, 2008, Consensus Model for
APRN Regulation)
• Advocacy: the act or process of supporting a cause or proposal: the act or
process of advocating. Advocacy is a pillar of nursing. Nurses instinctively
advocate for their patients, in their workplaces, and in their communities; but
legislative and political advocacy is no less important to advancing the caring
and patient care.
• Authentic or intentional presence: Authentic presence is about being fully
present in the moment. And when you do drift off (and you will because you're
human) you have the awareness to recognize it and bring yourself back to the
interaction (Joyce, J.).
• Care outcomes: Harris (1991) defined outcomes as the end points of care,
substantial changes in the health condition of a patient, and changes
in patient behavior caused by medical interventions [15]. Given
these definitions, outcomes related to clinical practice could be defined as any
change that resulted from health care.
• Caring relationship: Caring constitutes the essence of what it is to be human,
having a profound effect on well‐being and recovery and being at ease and being
healed. When hospitality is received, patients feel a connection; they begin to
trust and their healing begins.
• Clinical judgement: Clinical judgement refers to the thought process (clinical
reasoning) that allows healthcare providers to arrive at a conclusion
(clinical decision-making) based on objective and subjective information about a
patient. Clinical judgment can involve both automatic, intuitive reasoning and
analytic, reflective reasoning. These types of reasoning are not mutually
exclusive; healthcare providers might switch their judgment strategy based on
the circumstances they encounter. OR Clinical judgement is defined by the skill
of recognizing cues about a clinical situation, generating and weighing
hypotheses, taking action and evaluating outcomes for the purpose of arriving at
a satisfactory clinical outcome.
• Clinical reasoning: are the thought processes that allow healthcare providers to
arrive at a conclusion.
• Cognitive flexibility: is a critical executive function that can be broadly defined
as the ability to adapt behaviors in response to changes in the environment.
Cognitive flexibility is a broad term generally referring to our ability to adapt
flexibly to our constantly changing environment. It is something that human
animals are uniquely good at.
• Complex systems: are systems whose behavior is intrinsically difficult to model
due to the dependencies, competitions, relationships, or other types of
interactions between their parts or between a given system and its environment.
Systems that are "complex" have distinct properties that arise from these
relationships, such as nonlinearity, emergence, spontaneous order, adaptation,
and feedback loops, among others.
57
• Competence: The array of abilities [knowledge, skills, and attitudes] across

multiple domains or aspects of performance in a certain context. Statements
about competence require descriptive qualifiers to define the relevant abilities,
context, and state of training. Competence is multi-dimensional and dynamic.
(Frank, J.R., Snell, L.S., Cate, O.T., et al., 2010)
• Competency: An observable ability of a health professional, integrating multiple
components such as knowledge, skills, values, and attitudes. Since competencies
are observable, they can be measured and assessed to ensure their acquisition.
(Frank, J.R., Snell, L.S., Cate, O.T., et al., 2010)
• Competency framework: An organized and structured representation of a set of
interrelated and purposeful competencies (MedBiqitous Performance
Framework Working Group, 2012)
• Competency list: The delineation of the specific competencies within a
competency framework. (Englander, R., et al., 2013, p.1089)
• Concepts: A concept is an organizing idea or mental construct represented by
common attributes. Rodgers describes concepts as “an abstraction that is
expressed in some form” (1989, p. 332).
• Core values: Core nursing values essential to baccalaureate education include
human dignity, integrity, autonomy, altruism, and social justice. Strategies for
integrating and teaching core values are outlined, and outcomes of value-based
nursing education are described. Carefully integrated values education ensures
that the legacy of caring behavior embodied by nurses is strengthened for the
future nursing workforce.
• Core disciplinary knowledge: Expressed simply, when we think of core
disciplinary knowledge, we are most typically referring to the intellectual
structures within which the discipline delineates its unique focus of vision and
social mandate. In early reflections on this question with respect to the future of
doctoral education in nursing, Meleis (1988) reminded us that it orients us as to
the critical questions around which graduate training ought to be concerned as
well as to the unique knowledge it collectively has to offer. Over the years,
various academic nursing leadership entities have tried to articulate a
meaningful vision of what core disciplinary knowledge might entail. The
American Association of Colleges of Nursing (2002, 289) framed it as having
three components: historic and philosophic foundations to the development of
nursing knowledge; existing and evolving substantive nursing knowledge; and
methods and processes of theory/knowledge development.
• Cost effectiveness: Cost-effectiveness analysis is a way to examine both the
costs and health outcomes of one or more interventions. It compares an
intervention to another intervention (or the status quo) by estimating how much
it costs to gain a unit of a health outcome, like a life year gained or a death
prevented.
58
• Critical thinking: involves the skill of using logic and reasoning to identify the
strengths and weaknesses of alternative health care solutions, conclusions or
approaches to clinical or practice problems.
• Cultural awareness: The deliberate self-examination and in-depth exploration of
one’s biases, stereotypes, prejudices, assumptions, and “isms” that one holds
about individuals and groups who are different from them (Campinha-Bacote, J.
{1998}).
• Cultural competence: Cultural and linguistic competence is a set of congruent
behaviors, attitudes, and policies that come together in a system, agency, or
among professionals that enables effective work in cross-cultural situations.
'Culture' refers to integrated patterns of human behavior that include the
language, thoughts, communications, actions, customs, beliefs, values, and
institutions of racial, ethnic, religious, or social groups. 'Competence' implies
having the capacity to function effectively as an individual and an organization
within the context of the cultural beliefs, behaviors, and needs presented by
consumers and their communities. (Adapted from Cross, 1989).(1) Cultural
competence requires that organizations:
o have a defined set of values and principles, and demonstrate behaviors,
attitudes, policies, and structures that enable them to work effectively
cross-culturally
o have the capacity to (1) value diversity, (2) conduct self-assessment, (3)
manage the dynamics of difference, (4) acquire and institutionalize
cultural knowledge and (5) adapt to diversity and the cultural contexts of
the communities they serve.
o incorporate the above in all aspects of policy making, administration,
practice, service delivery, and involve systematically consumers, key
stakeholders, and communities.
Cultural competence is a developmental process that evolves over an extended
period. Both individuals and organizations are at various levels of awareness,
knowledge, and skills along the cultural competence continuum
• Culturally sensitive health care has been described as care that reflects “the
ability to be appropriately responsive to the attitudes, feelings, or circumstances
of groups of people that share a common and distinctive racial, national,
religious, linguistic, or cultural heritage” (DHHS, OMH, 2001, p. 131)
• Decision making – see clinical judgment - Clinical judgment or decision-making,
includes conclusions about a patient's status and needs with a determination of
a method to implement to best meet patient needs including an assessment of
the patient response (Tanner, 2006). Analytic and intuitive processes have been
described in nursing literature.
• Determinants of health: The range of personal, social, economic, and
environmental factors that influence health status are known as determinants of
health. OR Social determinants of health are conditions in the environments in
which people are born, live, learn, work, play, worship, and age that affect a
59
wide range of health, functioning, and quality-of-life outcomes and risks.

Conditions (e.g., social, economic, and physical) in these various environments
and settings (e.g., school, church, workplace, and neighborhood) have been
referred to as “place.” In addition to the more material attributes of “place,” the
patterns of social engagement and sense of security and well-being are also
affected by where people live. Resources that enhance quality of life can have a
significant influence on population health outcomes. Examples of these
resources include safe and affordable housing, access to education, public safety,
availability of healthy foods, local emergency/health services, and environments
free of life-threatening toxins.
o Understanding the relationship between how population groups
experience “place” and the impact of “place” on health is fundamental to
the social determinants of health—including both social and physical
determinants.
• Diagnose: identify the nature of (an illness or other problem) by examination of
the symptoms (Dictionary.com)
• Discipline
• Diversity: references a broad range of individual, population, and social
characteristics, including but not limited to age; sex; race; ethnicity; sexual
orientation; gender identity; family structures; geographic locations; national
origin; immigrants and refugees; language; physical, functional, and learning
abilities; religious beliefs; and socioeconomic status. Inclusion represents
environmental and organizational cultures in which faculty, students, staff, and
administrators with diverse characteristics thrive. Inclusive environments require
intentionality and embrace differences, not merely tolerate them. Everyone
works to ensure the perspectives and experiences of others are invited,
welcomed, acknowledged, and respected in inclusive environments.
• Domains of competence: Broad distinguishable areas of competence that in the
aggregate constitute a general descriptive framework for a profession.
(Englander, R.et al., 2013, p.1089)
• Emotional intelligence: the capacity to be aware of, control, and express one's
emotions, and to handle interpersonal relationships judiciously and
empathetically (Oxford Languages).
• Equity: More broadly, equity is interrelated with diversity and inclusion. Equity is
the ability to recognize the differences in the resources or knowledge needed to
allow individuals to fully participate in society, including access to higher
education, with the goal of overcoming obstacles to ensure fairness (Kranich,
2001). To have equitable systems, all people should be treated fairly,
unhampered by artificial barriers, stereotypes or prejudices (Cooper, 2016).
• Ethical comportment: goes beyond legality but figures prominently in making
quality clinical judgments about patient care (Benner et al., 2009). Benner et al.
(2009) define it as the way in which nurses embody the ability to relate to others
respectfully and responsively. Ethical comportment consists of four critical
60
attributes of everyday ethical comportment 1) embodiment, 2) skilled relational

know-how, 3) caring, and 4) salience (Hardin, 2018).
• Evidence-based practice: is a conscientious, problem-solving approach to clinical
practice that incorporates the best evidence from well-designed studies, patient
values and preferences, and a clinician's expertise in making decisions about a
patient's care. Unfortunately, no standard formula exists for how much these
factors should be weighed in the clinical decision-making process. However,
there are a variety of rating systems and hierarchies of evidence that grade the
strength or quality of evidence generated from a research study or report. Being
knowledgeable about evidence-based practice and levels of evidence is
important to every clinician as clinicians need to be confident about how much
emphasis they should place on a study, report, practice alert or clinical practice
guideline when making decisions about a patient's care.
• Health disparities: refers to a higher burden of illness, injury, disability, or
mortality experienced by one group relative to another. A “health care disparity”
typically refers to differences between groups in health insurance coverage,
access to and use of care, and quality of care. Health and health care disparities
often refer to differences that are not explained by variations in health needs,
patient preferences, or treatment recommendations and are closely linked with
social, economic, and/or environmental disadvantage. The terms “health
inequality” and “inequity” also are used to refer to disparities. Disparities occur
across many dimensions, including race/ethnicity, socioeconomic status, age,
location, gender, disability status, and sexual orientation.
• Health equity: Health equity is achieved when every person has the opportunity
to “attain his or her full health potential” and no one is “disadvantaged from
achieving this potential because of social position or other socially determined
circumstances.” Health inequities are reflected in differences in length of life;
quality of life; rates of disease, disability, and death; severity of disease; and
access to treatment.
• Health Information Technology (HIT) refers to the electronic systems health care
professionals and patients use to store, share, and analyze health information.
HIT consists of many types of applications such as Electronic Health Records,
Personal Health Records, Electronic prescribing, mobile applications, social
networks, monitors, wearables, nanotechnology, genomics, and robotics (Office
of the National Coordinator for Health Information Technology [ONC], 2018,
https://www.healthit.gov/sites/default/files/pdf/health-information-technology-
fact-sheet.pdf)
• Healthcare team: The healthcare team, regardless of where care is provided,
whether at a large academic institution or a small, rural private practice, is
the group of professionals who contribute to the care and treatment of an
individual, family, group or population.
• Healthy lifestyle: A healthy lifestyle is a way of living that lowers the risk of being
seriously ill or dying early. Not all diseases are preventable, but a large
61
proportion of deaths, particularly those from coronary heart disease and lung
cancer, can be avoided. Scientific studies have identified certain types of
behavior that contribute to the development of noncommunicable diseases and
early death. Health is not only just about avoiding disease. It is also about
physical, mental and social wellbeing. There are five areas that can impact
health and impact the risk of premature death. These five areas include healthy
diet, healthy physical activity level, healthy body weight, smoking, and moderate
alcohol intake.
• Holistic admissions
• Holistic review
• Implicit, explicit, and unconscious biases are biases that results from the
tendency to process information based on unconscious associations and feelings,
even when these are contrary to one’s conscious or declared beliefs:
• Inclusion: represents environmental and organizational cultures in which faculty,
students, staff, and administrators with diverse characteristics thrive. Inclusive
environments require intentionality and embrace differences, not merely
tolerate them. Everyone works to ensure the perspectives and experiences of
others are invited, welcomed, acknowledged, and respected in inclusive
environments.
• Inequities: lack of equity; injustice; unfairness, an unjust or unfair act, sentence,
etc.
• Informatics is the science of how to use data, information, and knowledge to
improve human health and the delivery of health care services. (American
Medical Informatics Association [AMIA], 2020 https://www.amia.org/fact-
sheets/what-informatics)
• Information and Communications Technologies (ICT) refers to technologies that
provide access to information through telecommunications. ICT includes the
internet, telephones, cell phones, wireless signals, networks, satellite systems,
telehealth/telenursing, and video conferencing, (TechTerms, 2020,
https://techterms.com/definition/ict )
• Innovation: is a great idea, executed brilliantly, and communicated in a way that
is both intuitive and fully celebrates the magic of the initial concept. Innovative
ideas can be big or small, but breakthrough or disruptive innovation is something
that either creates a new category, or changes an existing one dramatically, and
obsoletes the existing market leader.….But it needs to either create a new
market, or radically change an existing one (Foley).
• Integration: in nursing is the immersion experience designed to provide the
student with an opportunity to synthesize the knowledge and skills acquired
during previous coursework and learning experiences.
• Intentional change: theory (ICT) is a complex system. At the individual level, ICT
describes the essential components and processes of desirable, sustainable
change in one’s behavior, thoughts, feelings, and perceptions. The “change”
maybe in a person’s actions, habits or competencies. It may be in their dreams
62
or aspirations. It may be in the way they feel in certain situations or around

certain people. It may change in how they look at events at work or in life. It is
“desired” in that person wishes it so or would like to occur. It is a “sustainable”
in that it indoors – lasts a relatively long time (Boyatzis, 2006).
• Interoperability: is the ability of different information systems, devices and
applications (systems) to access, exchange, integrate and cooperatively use data
in a coordinated manner, within and across organizational, regional and national
boundaries, to provide timely and seamless portability of information and
optimize the health of individuals and populations globally. Health data
exchange architectures, application interfaces and standards enable data to be
accessed and shared appropriately and securely across the complete spectrum
of care, within all applicable settings and with relevant stakeholders, including
the individual.
• Interprofessional: occurring between or involving two or more professions or
professionals an interprofessional committee interprofessional collaboration.
• Interprofessional team: refers to the cooperation, coordination, and
collaboration expected among members of different professions in delivering
patient-centered care collectively
• Just culture: balances the need for an open and honest reporting environment
with the end of a quality learning environment and culture. While the
organization has a duty and responsibility to employees (and ultimately to
patients), all employees 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
• Levels of influence
• Lifelong learning
• Managing disease
• Mitigation
• Mobile health
• Moral courage
• Moral ethical behaviors
• Nurse sensitive outcomes
• Nursing informatics is the specialty that integrates nursing science with multiple
information and analytical sciences to identify, define, manage and
communicate data, information, knowledge, and wisdom in nursing practice.
(American Nurses Association [ANA], 2020 from the Health Information
Management and Systems Society [HIMSS],
https://www.himss.org/resources/what-nursing-informatics)
• Participatory approach
• Partnerships
• Patient: The term refers to the recipient of a healthcare service or intervention
at the individual, family, community, aggregate level. Patients may function in
independent, interdependent, or dependent roles, and may seek or receive
63
nursing interventions related to disease prevention, health promotion, or health

maintenance, as well as illness and end-of-life care. needs to be defined –
individual, group, population. (AACN, 1998, p.2)
• Preparedness
• Primary and secondary data
• Profession
• Professional agility
• Professional development
• Professional receptivity
• Relationship-centered care
• Response and recovery in an emergency/disaster
• Responsibility
• Return on investment (ROI)
• Risk assessment tools
• Scholarship
• Self-care
• Self-management
• Service
• Social determinants of health
• Specialty
• Sphere of care
• Standardized data
• Stress management
• Structural and cultural influences
• Structural racism
• Support care
• System decision
• System levels
• Systemic inequity
• Systems
• Systems-based practice
• Telehealth systems
• Translational science
• Wellness and well being
Reference List
(This section to be further developed)
American Association of Colleges of Nursing. (2019). AACN’s Vision for Academic
Nursing. Accessed at https://www.aacnnursing.org/Portals/42/News/White-
Papers/Vision-Academic-Nursing.pdf
64
Dunphy, L. (2015). Primary Care: Art and Science of Advanced Practice Nursing. F.A.
Davis Co.
Gunn, 1991
Keeling, A., Hehman, M., Kirschgessner, J. (2017). History of Professional Nursing in the
United States. Springer Publishing.
Donaldson, S., Crowley, D. (1978). The discipline of nursing. Nursing Outlook.

Feb;26(2):113-20.
Fawcett, J. (1984)
Chinn, P., Kramer, M. (1983). Theory and Nursing: A Systematic Approach. Research in
Nursing & Health. Vol. 7, Issue 1, Mar 1984 Wiley Periodicals:73-74.
Chinn, P., Kramer, M. (2018). Knowledge Development in Nursing. Mosby Title.
Roy, C., Jones, D.A. (2007). Nursing Knowledge Development and Clinical Practice.
Nursing Philosophy. 9(4):279-80
Leininger, M. (1978). Changing foci in American nursing education: primary and

transcultural nursing care. JAN. Vol 3, Issue 2, Mar 1978:155-166.
Watson, J. (1985).
Newman, M. (1991). The focus of the discipline of nursing. Advances in Nursing Science.
Vol 14, Issue 1, Sept 1991:1-6.
Newman, M. (2008)
Smith (2008)
Smith, M., Parker, M. (2010). Nursing Theories and Nursing Practice. 3rd ed.
Philadelphia: F.A. Davis Co.
Meleis, A. (2018). Theoretical nursing: Development and progress. 6th ed. Philadelphia:
Wolters Kluwer.
Thorne, S. (2014). What constitutes core disciplinary knowledge? Nursing Inquiry. Vol
21, Issue 1, Mar 2014:1-2.
Green (2018)
65
Smith, M. (2019). Regenerating Nursing’s Disciplinary Perspective. Advances in Nursing

Science: Vol. 42, No. 1, pp 3-16. Wolters Kluwer Health, Inc.
Jairath, N. N., Peden-McAlpine, C. J., Sullivan, M. C., Vessey, J. A., & Henly, S. J. (2018).
Theory and Theorizing in Nursing Science: Commentary from the Nursing Research
Special Issue Editorial Team. Nursing research, 67(2), 188–195.
Smith, M., McCarthy, M. P. (2010). Disciplinary knowledge in nursing education: Going

beyond the blueprints. Nursing Outlook, 58, 44-51.
Hermann, M. (2004). Linking Liberal & Professional Learning in Nursing Education.

Liberal Education, v90 n4 p42-47 Fall 2004.
American Association of Colleges of Nursing. (2017). Common Advanced Practice

Registered Nurse Doctoral-Level Competencies. Accessed at
https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Common-APRN-
Doctoral-Competencies.pdf
Macy Foundation (2016). Conference Summary: Registered Nurses: Partners in

Transforming Primary Care. Accessed at
https://macyfoundation.org/publications/conference-summary-registered-nurses-
partners-in-transforming-primary-care
Plack, M., Goldman, E., Scott, A., Pintz, C., Herrmann, D., Kline, K., Thompson, T.,
Brundage, S. (2018). Systems Thinking and Systems-Based Practice Across the Health
Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment, Teaching
and Learning in Medicine, 30:3, 242-254, DOI: 10.1080/10401334.2017.1398654
Demeris, G, et al. (2020)
Health Affairs Blog, March 2019
Gaffney (2015)
Wolf, Jason A. PhD, CPXP; Niederhauser, Victoria DrPH, RN; Marshburn, Dianne PhD, RN,
NE-BC; and LaVela, Sherri L. PhD, MPH, MBA (2014) "Defining Patient Experience,"
Patient Experience Journal: Vol. 1 : Iss. 1 , Article 3. DOI: 10.35680/2372-0247.1004
Available at: https://pxjournal.org/journal/vol1/iss1/3
Sand-Jecklin, K., Sherman, J. (2014). A quantitative assessment of patient and nurse

outcomes of bedside nursing report implementation. Journal of Clinical Nursing. Vol 23,
Issue 19-20, pgs. 2854-2863.
66
American Association of Colleges of Nursing (2016). Advancing Healthcare

Transformation: A New Era for Academic Nursing. Accessed at:
https://www.aacnnursing.org/portals/42/publications/aacn-new-era-report.pdf
Educause (2018). Badging. Retrieved from https://www.educause.edu/badging
Department of Labor, (2015)
Currier, (2019)
Macy Foundation Conference. Achieving Competency-Based Time-Variable Health

Professions Education. Recommendations from the Macy Foundation Conference,
Atlanta, GA. June 14-17, 2017
Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P.,
Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo,
R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010).
Competency-based medical education: theory to practice. Medical teacher, 32(8), 638–
645.
MedBiquitous Performance Framework Working Group--Definitiions.

http://groups.medbiq.org/medbiq/display/CWG/Performance+Framework+-+.Accessed
December 05,2012.
Englander, R., Cameron, T., Ballard, A., Dodge, J., Bull, J., & Aschenbrener, C. (2013).
Toward a common taxonomy of competency domains for the health professions and
competencies for physicians. Academic Medicine, 8(8), 1088-1094.
https://www.aacnnursing.org/Portals/42/Downloads/Essentials/Englander-2013.pdf
Murray, S. and Tuqiri, KA. 2020. The heart of caring - understanding compassionate care
through storyteling. International practice development journal. 10(1):4. doi
https://doi.org/10.19043/ipdj.101.004
Manetti, W. 2019. Sound clinical judgment in nursing: A concept analysis. Nursing

Forum, 54(1):102-110.
Healthy People, 2020 https://www.healthypeople.gov/2020/about/foundation-health-

measures/Determinants-of-Health
Kranich (2001)
Cooper (2016)
67
Tubbs, JB (2009). A handbook of bioethics terms. Washington DC: Georgetown

University Press.
Melnyk, Fineout-Overhold, Stillwell, & Williamson, 2010. Evidence-Based Practice: Step

by Step: Igniting a spirit of inquiry. American Journal of Nursing, 109 (11):49-52.
Keller T & Ridenour, N (2021). Ethics. In Giddens, J. (ed). Concepts for Nursing Practice,
St. Louis: Elsevier.
Auerbach, D., Martsolf, G., Pearson, M., Taylor, E., Zaydman, M., Muchow, A., Spetz, J.,
Lee, Y. 2015. The DNP by 2015: A Study of the Institutional, Political, and Professional
Issues that Facilitate or Impede Establishing a Post-Baccalaureate Doctor of Nursing
Practice Program. Rand Health Q, . 2015 Jul 15;5(1):3.
Barber PH., Hayes, TB., Johnson, TL, Marquez-Magana L. & 10,234 signatories (2020).
Systemic racism in higher education. Science 369 (6510), 1440-1441.
Tobbell, D. (2018) Nursing's Boundary Work: Theory Development and the Making of
Nursing Science, ca. 1950-1980. Nursing Research, Mar/Apr 2018;67(2):63-73.
Storfjell, J., Wehtje Winslow, B., Saunders, J. (2017). Catalysts for Change: Harnessing
the Power of Nurses to Build Population Health in the 21st Century. Robert Wood
Johnson Foundation. Accessed at
https://www.rwjf.org/en/library/research/2017/09/catalysts-for-change--harnessing-
the-power-of-nurses-to-build-population-health.html
Boyer, (1999)
Institute of Medicine (IOM). (2001). Crossing the Quality Chasm: A New Health System
for the 21st Century. Washington, D.C: National Academy Press; 2001.
International Council of Nurses (2006). The ICN Code of Ethics for Nurses. Available
from: http://www.icn.ch/images/stories/documents/about/icncode_english.pdf.
American Nurses Association. (2001). Code of Ethics for Nurses with Interpretive
Statements. Available
from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Tools-You-
Need/Code-of-Ethics.pdf.
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What is the purpose of The Essentials document?

What is the purpose of The Essentials document?

What are the foundational elements of The Essentials?

What are the foundational elements of The Essentials?

AACN DRAFT Essentials Document 11.5.

The Essentials: Core Competencies for Professional Nursing Education provides a

This introduction provides an overview of the evolution of nursing as a discipline, critical

experience. As a practice discipline, she proposed that nursing is committed to enhance

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

Knowledge of the discipline builds in graduate education, as students apply and

The Value of a Liberal Education

Competency-based education is a process whereby students are held accountable to the

A standard set of definitions frame competency-based education in the health

Nursing Education for the 21st Century

Diversity, Equity, and Inclusion

Four Spheres of Care

Informatics and Technology

Engagement and Experience

Each interaction between a patient and nurse or healthcare provider creates an

Domains and Concepts

Domains for Nursing

• Domain 1: Knowledge for Nursing Practice

• Domain 2: Person-Centered Care

• Domain 3: Population Health

equitable population health outcomes.

• Domain 4: Scholarship for Nursing Practice

• Domain 5: Quality and Safety

• Domain 6: Interprofessional Partnerships

• Domain 7: Systems-Based Practice

• Domain 8: Information and Healthcare Technologies

• Domain 10: Personal, Professional, and Leadership Development

Concepts for Nursing Practice

The featured concepts are:

delivery of high quality, individualized nursing care. Communication also is a core

• Diversity, Equity, and Inclusion

Diversity references individual and personal characteristics, including but not

Competencies and Sub-Competencies

A New Model for Nursing Education

The re-envisioned Essentials represents a new direction for nursing education,

Figure 1: Model for Nursing Education

The re-envisioned Essentials represents an opportunity for a future characterized by

Implementing the Essentials in Curricula

Incorporating the Competencies in the Curriculum (to be further developed)

Practice Expectations (To be developed further)

Figure 3: Four Spheres of Care

Practice Expectations for Advanced-Level Education (To be developed)

Final Scholarly Product (To be developed)

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

Domain 1: Knowledge for Nursing Practice

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

1.1d Articulate nursing’s distinct perspective to practice

Domain 2: Person-Centered Care

Entry-Level Professional Nursing Education Advanced-Level Nursing Education

2.1c Establish mutual respect with the patient and family.

2.2 Communicate effectively with individuals.

2.2k Facilitate difficult conversations and disclosure of

2.3 Perform an assessment.

2.3d Distinguish between normal and abnormal health

2.4e Contribute as a team member to the formation and