Sub-competencies for advanced-level professional nursing education:

Domain 1: Knowledge for Nursing Practice

1.2 Apply theory and research-based knowledge from nursing, the arts, humanities, and other sciences. 
1.2f Synthesize knowledge from nursing and other disciplines to inform education, practice, and research. 
1.2g Apply a systematic and defendable approach to nursing practice decisions. 
1.2h Employ ethical decision making to assess, intervene, and evaluate nursing care. 
1.2i Demonstrate socially responsible leadership.

1.3 Demonstrate clinical judgment founded on a broad knowledge base. 
1.3d Integrate foundational and advanced specialty knowledge into clinical reasoning. 
1.3e Synthesize current and emerging evidence to influence practice.

Domain 2: Person-Centered Care

2.2 Communicate effectively with individuals.

2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.

2.2i Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.  

2.4 Diagnose actual or potential health problems and needs. 
2.4f Employ context driven, advanced reasoning to the diagnostic and decision-making process. 
2.4g Integrate advanced scientific knowledge to guide decision making.

2.5 Develop a plan of care. 
2.5i Prioritize risk mitigation strategies to prevent or reduce adverse outcomes. 
2.5j Develop evidence-based interventions to improve outcomes and safety. 
2.5k Incorporate innovations into practice when evidence is not available. 

2.6 Demonstrate accountability for care delivery. 
2.6g Promote delivery of care that supports practice at the full scope of education. 
2.6h Contribute to the development of policies and processes that promote transparency and accountability. 
2.6i Apply current and emerging evidence to the development of care guidelines/tools.

2.7 Evaluate outcomes of care.

2.7d Analyze data to identify gaps and inequities in care and monitor trends in outcomes. 
2.7e Monitor epidemiological and system-level aggregate data to determine healthcare outcomes and trends. 
2.7f Synthesize outcome data to inform evidence-based practice, guidelines, and policies.

2.9 Provide care coordination. 
2.9f Evaluate communication pathways among providers and others across settings, systems, and communities. 
2.9i Analyze system-level and public policy influence on care coordination.  

Domain 3: Population Health  

3.1 Manage population health.
3.1j Assess the efficacy of a system’s capability to serve a target sub-population’s healthcare needs. 
3.1k Analyze primary and secondary population health data for multiple populations against relevant benchmarks. 
3.1l Use established or evolving methods to determine population-focused priorities for care. 
3.1m Develop a collaborative approach with relevant stakeholders to address population healthcare needs, including evaluation methods.  

3.2 Engage in effective partnerships. 
3.2d Ascertain collaborative opportunities for individuals and organizations to improve population health. 
3.2e Challenge biases and barriers that impact population health outcomes. 
3.2f Evaluate the effectiveness of partnerships for achieving health equity. 
3.2g Lead partnerships to improve population health outcomes.

3.3 Consider the socioeconomic impact of the delivery of health care. 
3.3d Collaborate with partners to secure and leverage resources necessary 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. 
3.4f Identify opportunities to influence the policy process. 
3.4g Design comprehensive advocacy strategies to support the policy process. 
3.4h Engage in strategies to influence policy change. 
3.4i Contribute to policy development at the system, local, regional, or national levels. 
3.4k Evaluate the ability of policy to address disparities and inequities within segments of the population.

3.5 Demonstrate advocacy strategies. 
3.5f Appraise advocacy priorities for a population. 
3.5g Strategize with an interdisciplinary group and others to develop effective advocacy approaches. 
3.5h Engage in relationship-building activities with stakeholders at any level of influence, including system, local, state, national, and/or global. 
3.5i Demonstrate leadership skills to promote advocacy efforts that include principles of social justice, diversity, equity, and inclusion

3.6 Advance preparedness to protect population health during disasters and public health emergencies. 
3.6f Collaboratively initiate rapid response activities to protect population health. 
3.6g Participate in ethical decision making that includes diversity, equity, and inclusion in advanced preparedness to protect populations.  
3.6h Collaborate with interdisciplinary teams to lead preparedness and mitigation efforts to protect population health with attention to the most vulnerable populations.

Domain 4: Scholarship for the Nursing Discipline

4.1 Advance the scholarship of nursing 
4.1h Apply and critically evaluate advanced knowledge in a defined area of nursing practice. 
4.1i Engage in scholarship to advance health. 
4.1l Disseminate one’s scholarship to diverse audiences using a variety of approaches or modalities.

4.2 Integrate best evidence into nursing practice. 
4.2f Use diverse sources of evidence to inform practice. 
4.2g Lead the translation of evidence into practice. 
4.2h Address opportunities for innovation and changes in practice. 
4.2i Collaborate in the development of new/revised policy or regulation in the light of new evidence. 
4.2j Articulate inconsistencies between practice policies and best evidence.

Domain 5: Quality and Safety

5.1 Apply quality improvement principles in care delivery. 
5.1i Establish and incorporate data driven benchmarks to monitor system performance. 
5.1j Use national safety resources to lead teambased change initiatives. 
5.1k Integrate outcome metrics to inform change and policy recommendations. 
5.1m Lead the development of a business plan for quality improvement initiatives. 
5.1n Advocate for change related to financial policies that impact the relationship between economics and quality care delivery.

5.2 Contribute to a culture of patient safety. 
5.2g Evaluate the alignment of system data and comparative patient safety benchmarks.

Domain 6: Interprofessional Partnerships

6.1 Communicate in a manner that facilitates a partnership approach to quality care delivery. 
6.1g Evaluate effectiveness of interprofessional communication tools and techniques to support and improve the efficacy of team-based interactions. 
6.1i Role model respect for diversity, equity, and inclusion in team-based communications. 
6.1j Communicate nursing’s unique disciplinary knowledge to strengthen interprofessional partnerships 
6.1k Provide expert consultation for other members of the healthcare team in one’s area of practice.

6.3 Use knowledge of nursing and other professions to address healthcare needs. 
6.3d Direct interprofessional activities and initiatives.

6.4 Work with other professions to maintain a climate of mutual learning, respect, and shared values. 
6.4f Foster an environment that supports the constructive sharing of multiple perspectives and enhances interprofessional learning. 
6.4g Integrate diversity, equity, and inclusion into team practices. 
6.4h Manage disagreements, conflicts, and challenging conversations among team members. 
6.4i Promote an environment that advances interprofessional learning.

Domain 7: Systems Based Practice

7.1 Apply knowledge of systems to work effectively across the continuum of care. 
7.1f Participate in system-wide initiatives that improve care delivery and/or outcomes. 
7.1g Analyze system-wide processes to optimize outcomes. 
7.1h Design policies to impact health equity and structural racism within systems, communities, and populations.

7.2 Incorporate consideration of cost-effectiveness of care.

7.2g Analyze relevant internal and external factors that drive healthcare costs and reimbursement. 
7.2h Design practices that enhance value, access, quality, and cost-effectiveness. 
7.2i Advocate for healthcare economic policies and regulations to enhance value, quality, and cost effectiveness. 
7.2l Evaluate health policies based on an ethical framework considering cost-effectiveness, health equity, and care outcomes. 

7.3 Optimize system effectiveness through application of innovation and evidence-based practice. 
7.3e Apply innovative and evidence-based strategies focusing on system preparedness and capabilities. 
7.3f Design system improvement strategies based on performance data and metrics. 
7.3h Design system improvement strategies that address internal and external system processes and structures that perpetuate structural racism and other forms of discrimination in healthcare systems. 

Domain 8: Informatics and Healthcare Technologies 

8.1 Describe the various information and communication technology tools used in the care of patients, communities, and populations. 
8.1g Identify best evidence and practices for the application of information and communication technologies to support care. 
8.1i Propose a plan to influence the selection and implementation of new information and communication technologies. 
8.1k Identify the impact of information and communication technologies on workflow processes and healthcare outcomes.  

8.2 Use information and communication technology to gather data, create information, and generate knowledge. 
8.2f Generate information and knowledge from health information technology databases. 
8.2g Evaluate the use of communication technology to improve consumer health information literacy. 
8.2h Use standardized data to evaluate decision making and outcomes across all systems levels. 
8.2i Clarify how the collection of standardized data advances the practice, understanding, and value of nursing and supports care. 
8.2j Interpret primary and secondary data and other 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. 
8.3g Evaluate the use of information and communication technology to address needs, gaps, and inefficiencies in care. 
8.3h Formulate a plan to influence decision making processes for selecting, implementing, and evaluating support tools. 
8.3k Pose strategies to reduce inequities in digital access to data and information.

8.4 Use information and communication technology to support documentation of care and communication among providers, patients, and all system levels. 
8.4e Assess best practices for the use of advanced information and communication technologies to support patient and team communications. 
8.4g Evaluate the impact of health information exchange, interoperability, and integration to support patient-centered 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. 
8.5j Promote patient engagement with their personal health data. 
8.5k Advocate for policies and regulations that support the appropriate use of technologies impacting health care. 
8.5l Analyze the impact of federal and state policies and regulation on health data and technology in care settings.

Domain 9: Professionalism

9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society. 
9.1h Analyze current policies and practices in the context of an ethical framework. 
9.1i Model ethical behaviors in practice and leadership roles.

9.2 Employ participatory approach to nursing care. 
9.2h Foster opportunities for intentional presence in practice. 
9.2i Identify innovative and evidence-based practices that promote person-centered care. 
9.2j Advocate for practices that advance diversity, equity, and inclusion. 
9.2k Model professional expectations for therapeutic relationships. 
9.2l Facilitate communication that promotes a participatory approach.

9.3 Demonstrate accountability to the individual, society, and the profession. 
9.3i Advocate for nursing’s professional responsibility for ensuring optimal care outcomes 
9.3j Demonstrate leadership skills when participating in professional activities and/or organizations. 
9.3m Advocate for policies/practices that promote social justice and health equity. 
9.3n Foster strategies that promote a culture of civility across a variety of settings. 
9.3o Lead in the development of opportunities for professional and interprofessional activities.

9.4 Comply with relevant laws, policies, and regulations. 
9.4d Advocate for polices that enable nurses to practice to the full extent of their education. 
9.4e Assess the interaction between regulatory agency requirements and quality, fiscal, and value based indicators. 
9.4f Evaluate the effect of legal and regulatory policies on nursing practice and healthcare outcomes. 
9.4g Analyze efforts to change legal and regulatory policies that improve nursing practice and health outcomes. 
9.4h Participate in the implementation of policies and regulations to improve the professional practice environment and healthcare outcomes.

9.5 Demonstrate the professional identity of nursing. 
9.5h Identify opportunities to lead with moral courage to influence team decision-making.

9.6 Integrate diversity, equity, and inclusion as core to one’s professional identity. 
9.6d Model respect for diversity, equity, and inclusion for all team members. 
9.6i Ensure self and others are accountable in upholding moral, legal, and humanistic principles related to health.

Domain 10: Personal, Professional, and Leadership Development

10.2 Demonstrate a spirit of inquiry that fosters flexibility and professional maturity. 
10.2j Expand leadership skills through professional service. 
 

10.3 Develop capacity for leadership. 
10.3j Provide leadership to advance the nursing profession. 
10.3k Influence intentional change guided by leadership principles and theories. 
10.3m Evaluate strategies/methods for peer review. 
10.3n Participate in the evaluation of other members of the care team. 
10.3p Advocate for the promotion of social justice and eradication of structural racism and systematic inequity in nursing and society.