The Essentials: Core Competencies for Professional Nursing Education Overview

The nursing profession is constantly evolving to meet the ever-changing demands of the healthcare landscape. As healthcare grows more complex, nursing education must equip future nurses with the clinical skills, communication skills, clinical reasoning, and clinical judgment, as well as the critical thinking and adaptability needed to meet the demands of modern health care. The American Association of Colleges of Nursing (AACN) has been at the forefront of advancing nursing education, providing an academic framework informed by higher education, nursing practice, and insights from diverse healthcare environments. The most recent update, The Essentials: Core Competencies for Professional Nursing Education, released in 2021, marks a transformative move toward competency-based education (CBE).

A Shift in Nursing Education

The American Association of Colleges of Nursing (AACN), representing over 875 schools of nursing nationwide, has long been at the forefront of advancing nursing education. Since 1986, AACN’s The Essentials series has provided an academic framework informed by higher education, nursing practice, and insights from diverse health care environments. The most recent update, The Essentials: Core Competencies for Professional Nursing Education, released in 2021, marks a transformative move toward competency-based education (CBE). Rather than focusing solely on classroom content, CBE emphasizes outcomes-what students can demonstrate and apply in real-world health care settings. This approach addresses gaps in traditional nursing education, ensuring students are prepared for clinical practice, leadership, research, and system-level challenges.

Competency-Based Education (CBE)

Competency-based education develops the skills and knowledge a student must master prior to graduation. It shifts the focus from completing credit hours and taking exams to demonstrating clinical practice readiness. In competency-based programs, students have the opportunity to showcase their knowledge by applying it in clinical simulations, projects, and faculty observations. Competency-based education has been associated with higher levels of student satisfaction and program completion, as well as skills mastery and greater faculty development.

Strengthening Education Through Core Competencies

At the heart of The Essentials framework are eight core concepts that guide nursing education from baccalaureate, master’s, and Doctor of Nursing Practice programs:

Clinical Judgment
Communication
Compassionate Care
Diversity, Equity, and Inclusion
Ethics
Evidence-Based Practice
Health Policy
Social Determinants of Health

These concepts represent the knowledge, skills, and attitudes nurses need to succeed in today’s health care environment. It is important for nurses to understand how social determinants of health (SDOH) such as education access and quality, economic stability, transportation, access to healthy food, and housing affect patient outcomes. Integrating SDOH into nursing curricula empowers future nurses to deliver more holistic, patient-centered care.

Another significant goal of The Essentials standardize the knowledge, skills, and attitudes of graduates earning the same degree, regardless of the college or university they attended. By establishing clear, standardized outcomes, The Essentials ensures that health care employers can confidently understand the skills and knowledge nursing graduates bring to the workforce.

The 2021 AACN Essentials: A Transformative Framework

In 2021, the American Association of Colleges of Nursing (AACN) created new guidance for prospective nursing students to employ a more competency-based education approach. The need for new Essentials guidance came in light of results from studies showing that nurses were increasingly less prepared for the rigors of the job from a competency standpoint despite being more than academically able. The new nursing Essentials guidance also places a much larger emphasis on aspects of social injustice, diversity, equity, and inclusion (DEI), and structural racism as part of the consideration of nursing practice and policy.

Within the comprehensive 82-page Essentials document, the AACN developed 10 core domains which are distinguished areas of competence that create a descriptive framework for the practice of nursing.

Ten Core Domains of Nursing Practice

The AACN Essentials are structured around 10 domains of nursing practice and Level 1 and Level 2 subcompetencies. Level 1 subcompetencies are developed in prelicensure undergraduate nursing programs. Level 2 subcompetencies build on foundational (Level 1) knowledge and skills to achieve the knowledge skill required in advanced nursing practice. AACN identifies the following 10 domains as progression indicators - descriptive, observable behaviors that illustrate competency development:

Knowledge for nursing practice: This domain emphasizes the importance of a strong foundation of knowledge for nurses to provide safe and effective care.
Person-centered care: For nurses, this means engaging with the patient at a human level early to create a caring relationship. Heavy DEI emphasis exists within this domain.
Population health: Population Health refers to a subset of the global and local population that the nurse and others care for across settings.
Scholarship for the nursing discipline: Scholarship creates a distinction for nurses between actual research and the evidence-based practice of said research. Research gives evidence to apply. Evidence-based practice extends the research beyond data to include patient preferences and values combined with the nurse’s own clinical expertise.
Quality and safety: Contextually speaking, nurses must provide safe, quality care that necessitates knowing and using established and emerging principles of safety science in care delivery. Both quality and safety are considered interdependent of one another as defined by this Essential. Safety is a necessary component of quality care. And for there to be quality care, the care must be safe. Providing quality care to patients is a complex practice in everyday nursing life.
Interprofessional partnerships: This domain highlights the importance of collaboration and teamwork among healthcare professionals to provide comprehensive patient care.
Systems-based practice: The domain of systems-based practice demands that nursing education provide students with evidence-based methodologies and that nurses lead innovative solutions to address complex health problems.
Informatics and healthcare technologies: Informatics processes are used to manage and improve the delivery of care. Nurses are expected to be able to understand how to use informatic technologies and utilize the data provided in them. They should understand the way these tools work and their long and short-term consequences for quality of care. And lastly, nurses should know the importance of their role and the value of their inputs into the health information technology analysis, planning, implementation, and evaluation.
Professionalism: Professionalism is formed throughout a nurse’s career. The nursing profession is one of continuous socialization. These skills must be developed as they are considered critical to the viability of the profession and practice environments.
Personal, professional and leadership development: This domain emphasizes the importance of nurses continuously developing their personal and professional skills, as well as their leadership abilities, to advance in their careers and contribute to the nursing profession.

Eight Core Competencies

AACN also has identified 8 competencies that represent core areas of nursing knowledge:

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Clinical judgment
Communication
Compassionate care
Diversity, equity, and inclusion
Ethics
Evidence based-practice
Health policy
Social determinants of health

Subcompetencies follow and are further divided into entry level and advanced level nursing practice. These subcompetencies guide the development of the respective competencies. Although these subcompetencies are not formally required, they are an expectation of all nursing programs. Demonstrating that your students have attained these competencies offers critical evidence required for program reaccreditation.

A Meaningful Approach to Curriculum Design

To meet the requirements of the Essentials, programs must revise and reshape multiple courses throughout a program of study. This widespread implementation provides students with repeated exposure to key concepts across a variety of content and complexity levels, while still maintaining individual program flexibility. The Essentials do not set an expectation that each course individually incorporates all domains and subcompetencies - nor do they require a standardized curriculum. However, many APRN programs are requiring faculty to map their curriculum to the Essentials competencies to prove to accrediting bodies that their education is competency based.

Progression Indicators (PIs)

Progression Indicators (PIs) are used at the Essentials sub-competency level to provide clear descriptions of what a learner should be able to do at specific points in their education, helping faculty assess student success on the road to competency. PIs translate sub-competencies into clear, observable behaviors that faculty, preceptors, and students can use as a shared roadmap for learning. AACN has developed resources to help faculty use the PIs to strengthen experiential learning opportunities and promote readiness for practice. By making competence visible, PIs help educators foster transparency, strengthen experiential learning opportunities, and promote equitable readiness for professional nursing practice.

The Hottest Topic? Clinical Hours

Perhaps no topic related to the Essentials has generated as much discussion as clinical hours for NP students. All graduate nursing programs must meet specific clinical practice hour requirements to ensure competency at advanced levels, and multiple organizations have set clinical hour benchmarks. The Essentials require a minimum of 500 clinical hours for all graduate-level nurses. This includes specialties such as nursing education, leadership, and informatics. These hours can be comprised of direct and indirect care. The 2022 standards published by the National Task Force for Quality Nurse Practitioner Education call for 750 direct care hours within the student’s specialty area of study. As a result, many NP programs have changed their clinical requirement to 750 hours. The Commission on Collegiate Nursing Education (CCNE) requires the programs it accredits to provide a minimum of 1,000 post-baccalaureate practice hours (specifically for DNP programs). These hours must be completed within a supervised academic setting, ensuring that students gain the hands-on experience needed to achieve advanced nursing competencies. While a discrepancy exists between the recommendations by NONPF and AACN, most NP programs require 750 supervised clinical hours in accordance with the NONPF guidelines for entry into advanced practice. In accordance with recommendations from CCNE, most post-master’s DNP programs require 1,000 post-baccalaureate hours, 500 of which must be in a supervised academic setting. Students can transfer these hours from their master's program and fulfill the remaining hours through the implementation of their DNP project and their work as a certified nurse practitioner.

Resources and Support for Implementation

AACN offers a quick start guide for schools moving to implement the 2021 Essentials and transition to competency-based education. Designed for institutions in the early stages of their journey, this resource includes an overview video outlining how to begin the process of aligning nursing programs to meet contemporary standards. In addition, a webpage was created identifying four steps to curriculum redesign: Familiarize Yourself with the Essentials; Review AACN Guides and Talking Points; Strategizing Ways to Approach Implementation; and Engaging with Peers and Practice Partners.

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AACN is interested in hearing from schools about their efforts to adapt nursing programs to meet the 2021 Essentials and transition to competency-based education. They are compiling School Spotlights to share lessons learned and success strategies. AACN has created an online tool to help you record and submit videos about your program’s Essentials journey.

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