A quick guide to the new AACN Essentials

In 2021, the American Association of Colleges of Nursing (AACN) created a new guidance for prospective nursing students to employ a more competency-based education approach. Its goal is to bridge the gap between education and practice, to help future generations of nurses be as well-prepared for the practical rigors of nursing as possible while completing their formal education.

In this guide, we walk you through the key components of The Essentials: Core Competencies for Professional Nursing Education.

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. In one study from 2017, “23% of new nursing graduates are competent with basic clinical judgment skills despite passing the National Council Licensure Exam for Registered Nurses (NCLEX-RN).”

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. It’s meant to be an additional lens by which nurses conduct their profession to create the best patient outcomes possible.

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. These domains include:

1. Knowledge for Nursing Practice
2. Person-Centered Care
3. Population Health
4. Scholarship for Nursing Discipline
5. Quality and Safety
6. Interprofessional Partnerships
7. Systems-based Practice
8. Informatics and Healthcare Technologies
9. Professionalism
10. Personal, Professional, and Leadership Development

Each domain comes with a descriptor, a contextual explanation that further defines them, and a sub-competency table that distinguishes an entry-level versus advanced-level application within the context of a nurse’s preparedness.

The domains covered provide details for stakeholders wanting to understand what new nursing students will be expected to demonstrate competence in and how these domains are expected to be applied between entry and advanced-level education.

The 10 domains detailed in the new AACN Essentials revolve around four areas of care:  1) disease prevention/promotion of health and wellbeing, 2) chronic disease care, 3) regenerative or restorative care, and 4) hospice/palliative/supportive care. 

Domain #1: Knowledge for Nursing Practice

The AACN defines this as the “integration, translation, and application of established and evolving disciplinary nursing knowledge and ways of knowing, as well as knowledge in other disciplines including a foundation in liberal arts and natural and social sciences.”

In short, this part of the Essentials requires that nurses understand enough coursework and theory to approach the nursing profession in an intellectually curious manner and apply those foundational skills practically.

Within the first domain, there are sub-domains, some of which are made to distinguish between entry-level and advanced-level nursing education. 

For the Knowledge for Nursing Practice, these sub-domains include:

• Demonstrate an understanding of the discipline of nursing’s distinct perspective and where shared perspectives exist with other disciplines.
• Apply theory and research-based knowledge from nursing, the arts, humanities, and other sciences.
• Demonstrate clinical judgment founded a broad knowledge base.

Domain #2: Person-centered Care

One of the ways the nursing profession stands apart from others in the medical field is it approaches patient care from a relational lens to foster mutuality, active participation, and individual empowerment. 

For nurses, this means engaging with the patient at a human level early to create a caring relationship. It also means practicing people-based care with respect for diversity, differences, preferences, values, needs, resources, and the determinants of health unique to the individual. 

Heavy DEI emphasis exists within this domain. Nurses should use the best evidence and clinical judgment in planning and delivering this care across time, spheres of care, and developmental levels.

The sub-domains associated with the Person-centered Care nursing domain include:

• Engage the individual in establishing a caring relationship.
• Communicate effectively with individuals.
• Integrate assessment skills in practice.
• Diagnose actual or potential health problems and needs.
• Develop a plan of care.
• Demonstrate accountability for care delivery.
• Evaluate outcomes of care.
• Promote self-care management.
• Provide care coordination.

Advanced-level education will teach nurses to demonstrate a higher level of strategic care, more advanced techniques and technologies, and an ownership mentality in coordinating the care of the patient with the nurse taking the lead in the accountability of the outcome.

Domain #3: Population Health

Population Health refers to a subset of the global and local population that the nurse and others care for across settings. This spans a continuum across the healthcare population and can include public health, acute care, ambulatory care, and long-term care. 

This demands collaboration among each individual involved in care (including patients and communities) for the betterment of the population’s health status.

Population Health mandates nurses play a large role in advocating for, developing, and implementing policies that impact population health globally and locally while also responding to crises and providing care during emergencies, disasters, epidemics, or pandemics. 

Sub-domains of Population Health include:

• Manage population health
• Engage in effective partnerships
• Consider the socioeconomic impact of the delivery of healthcare
• Advance an equitable population health policy
• Demonstrate advocacy strategies
• Advanced preparedness to protect population health during disasters and public health emergencies

Domain #4: Scholarship for Nursing Discipline

Scholarship involves knowing the basic principles of the research process and being able to critically review research to determine how applicable it is to the nursing body of knowledge. 

This is considered to be the critical component of the Scholarship domain. 

Scholarship creates a distinction for nurses between actual research and the evidence-based practice of said research. Nurses, after all, are the ones mandated with translating, applying, and implementing evidence from scholarly research into everyday decision-making. 

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. Nurses should use their unique patient-caregiver relationship to provide optimal care and address health inequities.

Sub-domains of the Scholarship domain include:

• Advance the scholarship of nursing
• Integrate the best evidence into nursing practices 
• Promote the ethical conduct of scholarly activities

Domain #5: Quality and Safety

This domain requires nursing education to apply emerging principles of safety and improvement science. 

Contextually speaking, nurses must provide safe, quality care that necessitates knowing and using established and emerging principles of safety science in care delivery. Nursing education is supposed to look at quality and safety through the perspective of a system failure rather than an error of the individual in this context.

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. Both of these together improve a desired health outcome. 

Nurses are seen in their competency-based education as uniquely positioned to be the tip of the spear in addressing quality and safety thanks to their knowledge and ethical code and because of the increased complexity of care contributing to the gaps in healthcare safety. 

Nurses have a ground-level perspective and are an important voice and perspective in keeping quality and safety at the top of the mind.

Sub-domains of the Quality and Safety domain include:

• Apply quality improvement principles in care delivery
• Contribute to a culture of patient safety
• Contribute to a culture of provider and environmental safety

Domain #6: Interprofessional Partnerships

The domain of interprofessional partnerships requires team-based, person-centered care that works in unison within professional teams and in concert with the patient, family, and community. 

The competency-based domain strives for nursing students to intentionally collaborate across professions and communities to create optimal conditions for care and better patient outcomes.

Sub-domains of the Interprofessional Partnership domain include:

• Communicate in a manner that facilitates a partnership approach to quality care delivery
• Perform effectively in different team roles, using principles and values of team dynamics
• Use knowledge of nursing and other professions to address healthcare needs
• Work with other professions to maintain a climate of mutual learning, respect, and shared values

Domain #7: Systems-based Practice

Providing quality care to patients is a complex practice in everyday nursing life. 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. Knowledge of financial and payment models is part of this domain, as well.

Systems-based practice is founded on creating an ethical environment where professional and organizational values align, while structures and processes allow for ethical practice to occur from all stakeholders within the institution.

Much like the domain of person-centered care and population health, this domain demands nurses consider DEI in their everyday practice and identify a system awareness to address issues of inequity. 

Sud-domains of systems-based practice include:

• Apply knowledge of systems to work effectively across the continuum of care
• Incorporate consideration of cost-effectiveness of care
• Optimize system effectiveness through the application of innovation and evidence-based practice

Domain #8: Informatics and Healthcare Technologies

Informatics processes are used to manage and improve the delivery of care. These are supposed to make healthcare a more efficient process. 

Nurses are expected to be able to understand how to use informatic technologies and utilize the data provided in them. They should be able to understand how this information works with and against processes and policies within a healthcare environment. 

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. Nurses are often asked to provide patient data that aggregates to a larger policy decision.

Sub-domains of the informatics and health technologies domain include:

• Describe the various information and communication technology tools used in the care of patients, communities, and populations
• Use information and communication technology to gather data, create information, and generate knowledge
• Use information and communication technologies and informatics processes to deliver safe nursing care to diverse populations in a variety of settings
• Use information and communication technologies in accordance with ethical, legal, professional, and regulatory standards and workplace policies in the delivery of care

Domain #9: Professionalism

Professionalism is formed throughout a nurse’s career. This requires nursing education to prepare the student to embrace integrity, altruism, inclusivity, compassion, courage, humility, advocacy, caring, autonomy, humanity, and social justice.  

The nursing profession is one of continuous socialization. Nurses are required to give back to their profession by mentoring and developing others.

Sub-domains the professionalism against the domain include:

• Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society
• Employ a participatory approach to nursing care
• Demonstrate accountability to the individual, society, and the profession
• Comply with relevant laws, policies, and regulations
• Demonstrate the professional identity of nursing
• Integrate diversity, equity, and inclusion as core to one’s professional identity

Domain #10: Personal, Professional, and Leadership Development

Competency in this nursing essential means having developed three areas of professional development:

1. Development of the nurse as an individual who is resilient, agile, and capable of adapting to ambiguity and change
2. Development of the nurse as a professional responsible for lifelong learning and ongoing self-reflection
3. Development of the nurse as a leader proficient in asserting control, influence, and power in professional and personal contexts, including advocacy for patients 

These skills must be developed as they are considered critical to the viability of the profession and practice environments. These skills help nurses develop resiliency, promote diversity, and drive retention while protecting the nurse from stress-induced emotional and mental exhaustion.

The key sub-domains of this domain include:

• Demonstrate a commitment to personal health and well-being.
• Demonstrate a spirit of inquiry that fosters flexibility and professional maturity.
• Develop capacity for leadership.

How technology fits into the latest Essentials guidance

With the new mandate of competency-based education in the nursing student experience, a comprehensive experiential learning management system is more essential than ever.

So much of a nursing student's education will come from the externship and real-life experience and showcasing of competency within that environment. 

Implement an experiential learning management system to manage your externship programs.

From scheduling to evaluations, compliance to hours tracking, a comprehensive experiential learning management system manages every aspect of your externship/clinical process.