The Kaira Five Practices Framework (v1.6)
A practitioner-led model of professional nursing mastery.
The framework names what nursing mastery actually looks like across five dimensions: cognitive, relational, technical, integrative, and outcome. It maps each one to the 2021 AACN Essentials, so educators and accreditors can find the same competencies they already teach.
For faculty and accreditation reviewers
Written for the academic audience first.
If you are preparing an AACN-aligned curriculum review, the rest of this page is for you. Each Practice is defined in language that survives faculty senate. The crosswalk shows, for any sub-competency you already teach, where it lives in our Practice model. The Progression Indicators are honest about a constraint other frameworks hide: some competencies cannot be demonstrated alone.
The Five Practices
Five lenses, one nurse.
Each Practice asks one question. Each one is grounded in a primary evidence stream from the project's own research: voice memos with senior nurses, AACN-mapped reflective writing, preceptor observation transcripts, and quantitative outcome data. The order is not a maturity ladder; nurses move between them all day.
Head
“What do you know?”
The cognitive practice of nursing — clinical reasoning, judgment, interpretation, and reflection. Tanner CJM lives here.
Primary evidence: SAGE AI voice memo analysis (~50%)
Heart
“Who do you serve, and how?”
Heart is the Practice of personal anchoring — professional identity, ethical comportment, resilience, lifelong learning, and the caring presence that animates the relational encounter. Lifecycle-weighted: light for students, becomes the battery for mid-career and mature professionals.
Primary evidence: SAGE inferred + Preceptor LCJR (~50/40/10)
Hands
“What can you do?”
The procedural and technical execution of nursing care. Observable physical actions that deliver intervention, capture assessment, or maintain safety.
Primary evidence: Preceptor EPA observation (~50%)
Integration
“How do you bring it together?”
The relational and systemic terrain. Therapeutic communication, interprofessional teamwork, family inclusion, cultural humility, SDOH context, working within hospital hierarchies.
Primary evidence: Preceptor LCJR observation (~50%)
Impact
“What changes because of you?”
Stewardship as advocacy. Resource consciousness, outcome alignment, and the integration of caring with managing — best exemplified by surfacing patient values that may redirect care intensity.
Evidence labels use shorthand: SAGE for our LLM voice-memo analysis pipeline, LCJR for the Lasater Clinical Judgment Rubric, EPA for Entrustable Professional Activity. See the glossary for full definitions.
AACN Essentials crosswalk
Where the 2021 Essentials sit in the Five Practices.
We mapped all 434 AACN sub-competencies into the Five Practices. The matrix below counts how many sub-competencies from each AACN domain fall in each Practice. The mapping is additive: AACN identifiers are preserved verbatim so they remain citable in your own coursework.
Mapping changes are proposed, reviewed across audiences, and signed off by an admin. No silent edits.
| AACN domain | P1 Head | P2 Heart | P3 Hands | P4 Integration | P5 Impact | Total |
|---|---|---|---|---|---|---|
1.Knowledge for Nursing Practice Cleanest assignment. Cognitive foundation. | 18 | 3 | 0 | 1 | 1 | 23 |
2.Person-Centered Care Genuinely cross-Practice. Procedural assessment in Hands; clinical reasoning in Head; therapeutic communication in Integration. | 20 | 8 | 6 | 32 | 11 | 77 |
3.Population Health SDOH and community context = Integration. Outcomes = Impact. Analytical = Head. | 9 | 13 | 1 | 17 | 19 | 59 |
4.Scholarship for the Discipline EBP and inquiry: cognitive practice. | 13 | 9 | 0 | 6 | 5 | 33 |
5.Quality and Safety Safety actions = Hands. Quality outcomes = Impact. Workplace safety culture = Integration. | 12 | 1 | 1 | 10 | 9 | 33 |
6.Interprofessional Partnerships Working with the system. | 1 | 0 | 0 | 34 | 0 | 35 |
7.Systems-Based Practice Stewardship, value, cost-effectiveness = Impact. Systems navigation = Integration. | 12 | 1 | 2 | 11 | 2 | 28 |
8.Informatics & Healthcare Technologies EHR as tool = Hands. EHR as team comm = Integration. Privacy/ethics = Heart. | 19 | 12 | 4 | 13 | 3 | 51 |
9.Professionalism Identity/ethics = Heart. Cultural humility = Integration. Structural advocacy = Impact. | 1 | 43 | 0 | 8 | 12 | 64 |
10.Personal, Professional & Leadership Dev The battery Practice. | 5 | 21 | 1 | 2 | 2 | 31 |
Why Hands is small (and what fills the gap)
AACN Essentials is predominantly non-technical. The procedural depth lives in employer skills checklists.
P3 Hands is the smallest Practice on purpose: 15 universal sub-competencies that every nurse must demonstrate (PPE and hand hygiene, holistic physical assessment basics, accurate documentation, telehealth fluency, point-of-care testing protocol-following). The procedural and psychomotor depth of nursing (medication administration protocols, sterile technique, code-blue execution, dialysis cycler troubleshooting, telemetry rhythm interpretation) lives in employer and educator skills checklists (Cornerstone, HealthStream, Workday Learning, institutional Excel files). Those are already a mature, more-objective area of nursing pedagogy. Kaira ingests them. Kaira does not replace them.
Open edition
Ships the 15-item universal Hands substrate plus the full 434-code cross-Practice crosswalk for Head, Heart, Integration, and Impact. Free to read, cite, and teach from.
Community edition
Open plus a Hands extension layer ingested from the employer's existing skills checklists. Each extension item carries parent_extension_id (links it to the employer-defined competency set) and extension_owner (who owns the artifact). Practice remains Hands. The PI rubric is the employer's existing checklist text.
Chapter edition
Open plus Community-style extensions plus sector-specific configurations (Magnet-aligned, AACN-CCNP-aligned, specialty boards, regional consortia).
Open is the canonical AACN substrate. Community and Chapter extend it with employer-defined Hands depth using parent_extension_id and extension_owner provenance tags so the source of every Hands extension is always traceable.
Progression Indicators
Three buckets. Honest about the ceiling.
Each sub-competency is graded on a three-bucket rubric: Not Demonstrated, Developing, and Developed. The buckets are aligned to the AACN level descriptors so the language is portable. The honest part: some sub-competencies (most of P3, Hands) cap at Developing until a preceptor observation triangulates the self-report.
No evidence yet. Either the behavior has not been performed in a captured context, or the captured evidence does not yet meet the rubric.
Matches the AACN Developing descriptor for this sub-competency. Caps at Developing in solo activation mode for P3 (Hands) sub-comps without preceptor observation.
Matches the AACN Developed descriptor. For P3 sub-comps this requires a preceptor or peer observation to triangulate the self-report.
Sub-competencies
All 434, browsable.
Five Practices, every sub-competency. Selected hero sub-competencies (listed below) carry the full narrative and an anchored Progression Indicator rubric. The rest render with the AACN definition, Practice mapping, and a note that the longer narrative is being written.
Hero sub-competencies
The five carrying the longer narrative this version.
Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.
Respect individuals and families' self-determination in their healthcare decisions.
Employ individualized educational strategies based on learning theories, methodologies, and health literacy.
Assess the priorities of the community and/or the affected clinical population.
Engage in guided and spontaneous reflection of one's practice.
P1Head
The Game Plan110 sub-comps in 10 domains
Head
The Game PlanDomain 1Knowledge for Nursing Practice18
Identify concepts, derived from theories from nursing and other disciplines, which distinguish the practice of nursing.
Apply knowledge of nursing science that develops a foundation for nursing practice.
Understand the historical foundation of nursing as the relationship developed between the individual and nurse.
Articulate nursing's distinct perspective to practice.
Translate evidence from nursing science as well as other sciences into practice.
Demonstrate the application of nursing science to practice.
Integrate an understanding of nursing history in advancing nursing's influence in healthcare.
Apply or employ knowledge from nursing science as well as the natural, physical, and social sciences to build an understanding of the human experience and nursing practice.
Demonstrate intellectual curiosity.
Examine influence of personal values in decision making for nursing practice.
Synthesize knowledge from nursing and other disciplines to inform education, practice, and research.
Apply a systematic and defendable approach to nursing practice decisions.
Translate theories from nursing and other disciplines to practice.
Demonstrate clinical reasoning.
Integrate nursing knowledge (theories, multiple ways of knowing, evidence) and knowledge from other disciplines and inquiry to inform clinical judgment.
Integrate foundational and advanced specialty knowledge into clinical reasoning.
Synthesize current and emerging evidence to influence practice.
Analyze decision models from nursing and other knowledge domains to improve clinical judgment.
Domain 2Person-Centered Care20
Distinguish between normal and abnormal health findings.
Synthesize assessment data in the context of the individual's current preferences, situation, and experience.
Create a list of problems/health concerns.
Prioritize problems/health concerns.
Understand and apply the results of social screening, psychological testing, laboratory data, imaging studies, and other diagnostic tests in actions and plans of care.
Employ context driven, advanced reasoning to the diagnostic and decision-making process.
Integrate advanced scientific knowledge to guide decision making.
Prioritize care based on best evidence.
Incorporate evidence-based intervention to improve outcomes and safety.
Anticipate outcomes of care (expected, unexpected, and potentially adverse).
Demonstrate rationale for plan.
Prioritize risk mitigation strategies to prevent or reduce adverse outcomes.
Apply current and emerging evidence to the development of care guidelines/tools.
Reassess the individual to evaluate health outcomes/goals.
Modify plan of care as needed.
Recognize the need for modifications to standard practice.
Analyze data to identify gaps and uneven distribution of care and monitor trends in outcomes.
Synthesize outcome data to inform evidence-based practice, guidelines, and policies.
Recognize when additional expertise and knowledge is needed to manage the patient.
Evaluate communication pathways among providers and others across settings, systems, and communities.
Domain 3Population Health9
Compare and contrast local, regional, national, and global benchmarks to identify health patterns across populations.
Describe general principles and practices for the clinical management of populations across the age continuum.
Describe access implications for populations being served for proposed intervention(s).
Describe policy development processes.
Describe the impact of policies on population outcomes, including access to healthcare resources for populations being served.
Identify best evidence to support policy development.
Identify changes in conditions that might indicate a disaster or public health emergency.
Describe the health and safety hazards of disasters and public health emergencies.
Describe the overarching principles and methods regarding personal safety measures, including personal protective equipment (PPE).
Domain 4Scholarship for the Discipline13
Demonstrate an understanding of different approaches to scholarly practice.
Demonstrate application of different levels of evidence.
Apply theoretical framework(s)/models in practice.
Demonstrate an understanding of basic elements of the research process.
Evaluate research.
Apply and critically evaluate advanced knowledge in a defined area of nursing practice.
Engage in scholarship to advance health.
Discern appropriate applications of quality improvement, research, and evaluation methodologies.
Evaluate clinical practice to generate questions to improve nursing care.
Evaluate appropriateness and strength of the evidence.
Use best evidence in practice.
Use diverse sources of evidence to inform practice.
Evaluate outcomes and impact of new practices based on the evidence.
Domain 5Quality and Safety12
Recognize nursing's essential role in improving healthcare quality and safety.
Identify sources and applications of national safety and quality standards to guide nursing practice.
Interpret benchmark and unit outcome data to inform individual and microsystem practice.
Compare quality improvement methods in the delivery of patient care.
Identify strategies to improve outcomes of patient care in practice.
Describe the factors that create a culture of safety.
Examine basic safety design principles to reduce risk of harm.
Describe processes used in understanding causes of error.
Evaluate the alignment of system data and comparative patient safety benchmarks.
Design evidence-based interventions to mitigate risk.
Identify actual and potential level of risks to providers within the workplace.
Recognize how to prevent workplace violence and injury.
Domain 6Interprofessional Partnerships1
Domain 7Systems-Based Practice12
Describe organizational structure, mission, vision, philosophy, and values.
Explain the relationships of macrosystems, mesosystems, and microsystems.
Differentiate between various healthcare delivery environments across the continuum of care.
Recognize internal and external system processes that impact care coordination and transition of care.
Participate in system-wide initiatives that improve care delivery and/or outcomes.
Analyze system-wide processes to optimize outcomes.
Demonstrate a systematic approach for decision-making.
Participate in evaluating system effectiveness.
Recognize internal and external system processes and structures that perpetuate practices that contribute to lack of opportunities or access and any other form of treatment that is based on differences within healthcare.
Apply innovative and evidence-based strategies focusing on system preparedness and capabilities.
Manage change to sustain system effectiveness.
Design system improvement strategies that address internal and external system processes and structures that perpetuate embedded barriers in healthcare systems.
Domain 8Informatics & Healthcare Technologies19
Identify the variety of information and communication technologies used in care settings.
Identify the basic concepts of electronic health, mobile health, and telehealth systems for enabling patient care.
Describe the appropriate use of multimedia applications in healthcare.
Explain the importance of nursing engagement in the planning and selection of healthcare technologies.
Identify best evidence and practices for the application of information and communication technologies to support care.
Evaluate the unintended consequences of information and communication technologies on care processes, communications, and information flow across care settings.
Explore the fiscal impact of information and communication technologies on healthcare.
Identify the impact of information and communication technologies on workflow processes and healthcare outcomes.
Use appropriate data when planning care.
Generate information and knowledge from health information technology databases.
Evaluate the use of communication technology to improve consumer health information literacy.
Use standardized data to evaluate decision-making and outcomes across all systems levels.
Evaluate how decision support tools impact clinical judgment and safe patient care.
Examine how emerging technologies influence healthcare delivery and clinical decision making.
Identify impact of information and communication technology on quality and safety of care.
Identify the importance of reporting system processes and functional issues (error messages, mis-directions, device malfunctions, etc.) according to organizational policies and procedures.
Evaluate the use of information and communication technology to address needs, gaps, and inefficiencies in care.
Evaluate the potential uses and impact of emerging technologies in healthcare.
Discuss how clinical judgment and critical thinking must prevail in the presence of information and communication technologies.
Domain 9Professionalism1
Domain 10Personal, Professional & Leadership Dev5
Expand personal knowledge to inform clinical judgment.
Compare and contrast leadership principles and theories.
Recognize the importance of nursing's contributions as leaders in practice and policy issues.
Evaluate the outcomes of intentional change.
Evaluate strategies/methods for peer review.
P2Heart
The Inner Compass111 sub-comps in 9 domains3 hero
Heart
The Inner CompassDomain 1Knowledge for Nursing Practice3
Domain 2Person-Centered Care82 hero
Employ individualized educational strategies based on learning theories, methodologies, and health literacy.
Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.
Identify personal, system, and community resources available to support self-care management.
Develop strategies that promote self-care management.
Incorporate the use of current and emerging technologies to support self-care management.
Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management.
Evaluate adequacy of resources available to support self-care management.
Foster partnerships with community organizations to support self-care management.
Domain 3Population Health13
Identify ethical principles to protect the health and safety of populations being served.
Incorporate ethical principles in resource allocation in achieving optimal level of health for all people.
Propose modifications to or development of policy based on population findings.
Develop an awareness of the interconnectedness of population health across borders.
Identify opportunities to influence the policy process.
Design comprehensive advocacy strategies to support the policy process.
Engage in strategies to influence policy change.
Contribute to policy development at the system, local, regional, or national levels.
Assess the impact of policy changes.
Evaluate the ability of policy to address access to resources to achieve optimal level of health for populations being served.
Evaluate the risks to population health associated with globalization.
Demonstrate leadership skills to promote advocacy efforts that include principles of collective well-being, access, connection, and engagement.
Participate in ethical decision making that includes access, connection, and engagement in advanced preparedness to protect populations.
Domain 4Scholarship for the Discipline9
Explain the rationale for ethical research guidelines, including Institutional Review Board (IRB) guidelines.
Demonstrate ethical behaviors in scholarly projects including quality improvement and EBP initiatives.
Advocate for the protection of participants in the conduct of scholarly initiatives.
Recognize the impact of the key principles of ethics in research.
Identify and mitigate potential risks and areas of ethical concern in the conduct of scholarly activities.
Apply IRB guidelines throughout the scholarship process.
Ensure the protection of participants in the conduct of scholarship.
Implement processes that support ethical conduct in practice and scholarship.
Apply ethical principles to the dissemination of nursing scholarship.
Domain 5Quality and Safety1
Domain 7Systems-Based Practice1
Domain 8Informatics & Healthcare Technologies12
Describe the importance of standardized nursing data to reflect the unique contribution of nursing practice.
Identify common risks associated with using information and communication technology.
Demonstrate ethical use of social networking applications.
Comply with legal and regulatory requirements while using communication and information technologies.
Educate patients on their rights to access, review, and correct personal data and medical records.
Deliver care using remote technology.
Apply risk mitigation and security strategies to reduce misuse of information and communication technology.
Assess potential ethical and legal issues associated with the use of information and communication technology.
Recommend strategies to protect health information when using communication and information technology.
Promote patient engagement with their personal health data.
Advocate for policies and regulations that support the appropriate use of technologies impacting healthcare.
Analyze the impact of federal and state policies and regulation on health data and technology in care settings.
Domain 9Professionalism43
Apply principles of professional nursing ethics and human rights in patient care and professional situations.
Reflect on one's actions and their consequences.
Demonstrate ethical behaviors in practice.
Change behavior based on self and situational awareness.
Report unethical behaviors when observed.
Safeguard privacy, confidentiality, and autonomy in all interactions.
Advocate for the individual's right to self-determination.
Analyze current policies and practices in the context of an ethical framework.
Model ethical behaviors in practice and leadership roles.
Suggest solutions when unethical behaviors are observed.
Assume accountability for working to resolve ethical dilemmas.
Foster opportunities for intentional presence in practice.
Model professional expectations for therapeutic relationships.
Demonstrate the moral courage to report concerns related to actual or potential hazards and/or errors.
Demonstrate professional and personal honesty and integrity.
Take responsibility for one's roles, decisions, obligations, actions, and care outcomes.
Engage in professional activities and/or organizations.
Demonstrate adherence to a culture of civility.
Advocate for collective well-being and access to quality healthcare, including addressing the health of vulnerable populations.
Engage in peer evaluation.
Demonstrate leadership skills when participating in professional activities and/or organizations.
Address actual or potential hazards and/or errors.
Foster a practice environment that promotes accountability for care outcomes.
Advocate for policies/practices that promote collective well-being and access to quality healthcare for populations being served.
Foster strategies that promote a culture of civility across a variety of settings.
Describe nursing's professional identity and contributions to the healthcare team.
Demonstrate the core values of professional nursing identity.
Demonstrate sensitivity to the values of others.
Demonstrate ethical comportment and moral courage in decision making and actions.
Demonstrate emotional intelligence.
Articulate nursing's unique professional identity to other interprofessional team members and the public.
Evaluate practice environment to ensure that nursing core values are demonstrated.
Identify opportunities to lead with moral courage to influence team decision-making.
Engage in professional organizations that reflect nursing's values and identity.
Demonstrate respect for individual differences within communities and populations.
Demonstrate awareness of and respect for individual personal and professional values.
Integrate core principles of collective well-being and human rights into practice.
Model respect for access, connection, and engagement for team members.
Critique one's personal and professional practices in the context of nursing's core values.
Analyze the impact of organizational and societal influences on nursing's professional identity.
Ensure that care provided by self and others is reflective of nursing's core values.
Structure the practice environment to facilitate care that is culturally and linguistically appropriate.
Ensure self and others are accountable in upholding moral, legal, and humanistic principles related to health.
Domain 10Personal, Professional & Leadership Dev211 hero
Demonstrate healthy, self-care behaviors that promote wellness and resiliency.
Manage conflict between personal and professional responsibilities.
Contribute to an environment that promotes self-care, personal health, and well-being.
Evaluate the workplace environment to determine level of health and well-being.
Engage in guided and spontaneous reflection of one's practice.
Commit to personal and professional development.
Identify role models and mentors to support professional growth.
Participate in ongoing activities that embrace principles of access, connection, engagement, and nondiscriminatory treatment.
Demonstrate cognitive flexibility in managing change within complex environments.
Mentor others in the development of their professional growth and accountability.
Foster activities that support a culture of lifelong learning.
Expand leadership skills through professional service.
Formulate a personal leadership style.
Demonstrate leadership behaviors in professional situations.
Demonstrate self-efficacy consistent with one's professional development.
Modify one's own leadership behaviors based on guided self-reflection.
Demonstrate self-awareness of one's own biases and their relationship to one's culture and environment.
Provide leadership to advance the nursing profession.
Influence intentional change guided by leadership principles and theories.
Demonstrate leadership skills in times of uncertainty and crisis.
Advocate for the nursing profession in a manner that is consistent, positive, relevant, accurate, and distinctive.
P3Hands
Tools & Techniques15 sub-comps in 6 domains
Hands
Tools & TechniquesDomain 2Person-Centered Care6
Obtain a complete and accurate history in a systematic manner.
Perform a clinically relevant, holistic health assessment.
Perform point of care screening/diagnostic testing (e.g., blood glucose, PO2, EKG).
Demonstrate that one's practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice.
Implement individualized plan of care using established protocols.
Monitor the implementation of the plan of care.
Domain 3Population Health1
Domain 5Quality and Safety1
Domain 7Systems-Based Practice2
Domain 8Informatics & Healthcare Technologies4
Enter accurate data when chronicling care.
Demonstrate appropriate use of information and communication technologies.
Identify the basic concepts of electronic health, mobile health, and telehealth systems in enabling patient care.
Assess best practices for the use of advanced information and communication technologies to support patient and team communications.
Domain 10Personal, Professional & Leadership Dev1
P4Integration
The Big Picture134 sub-comps in 10 domains2 hero
Integration
The Big PictureDomain 1Knowledge for Nursing Practice1
Domain 2Person-Centered Care321 hero
Demonstrate qualities of empathy.
Demonstrate compassionate care.
Establish mutual respect with the individual and family.
Promote caring relationships to effect positive outcomes.
Foster caring relationships.
Demonstrate relationship-centered care.
Consider individual beliefs, values, and personalized information in communications.
Use a variety of communication modes appropriate for the context.
Demonstrate the ability to conduct sensitive or difficult conversations.
Use evidence-based patient teaching materials, considering health literacy, vision, hearing, social awareness, and adaptability.
Demonstrate emotional intelligence in communications.
Demonstrate advanced communication skills and techniques using a variety of modalities with respect to different backgrounds and perspectives of all audiences.
Design evidence-based, person-centered engagement materials.
Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized healthcare.
Facilitate difficult conversations and disclosure of sensitive information.
Create an environment during assessment that promotes a dynamic interactive experience.
Apply nursing knowledge to gain a holistic perspective of the person, family, community, and population.
Communicate findings of a comprehensive assessment.
Contribute as a team member to the formation and improvement of diagnoses.
Engage the individual and the team in plan development.
Lead and collaborate with an interprofessional team to develop a comprehensive plan of care.
Incorporate innovations into practice when evidence is not available.
Communicate care delivery through multiple modalities.
Delegate appropriately to team members.
Model best care practices to the team.
Promote delivery of care that supports practice at the full scope of education.
Assist the individual to engage in self-care management.
Respect individuals and families' self-determination in their healthcare decisions.
Facilitate continuity of care based on assessment of assets and needs.
Communicate with relevant stakeholders across health systems.
Promote collaboration by clarifying responsibilities among individual, family, and team members.
Provide coordination of care of individuals and families in collaboration with care team.
Domain 3Population Health171 hero
Define a target population including its functional and problem-solving capabilities (anywhere in the continuum of care).
Assess the priorities of the community and/or the affected clinical population.
Apply an understanding of the public health system and its interfaces with clinical healthcare in addressing population health needs.
Participate in the implementation of sociocultural and linguistically responsive interventions.
Collaborate with appropriate stakeholders to implement a sociocultural and linguistically responsive intervention plan.
Engage with other health professionals to address population health issues.
Demonstrate effective collaboration and mutual accountability with relevant stakeholders.
Use culturally and linguistically responsive communication strategies.
Ascertain collaborative opportunities for individuals and organizations to improve population health.
Challenge biases and preferences that influence decisions, judgments, or behaviors and barriers that impact population health outcomes.
Evaluate the effectiveness of partnerships to ensure the absence of avoidable or remediable differences.
Lead partnerships to improve population health outcomes.
Assess preparation and readiness of partners to organize during natural and manmade disasters.
Collaborate with partners to secure and leverage resources necessary for effective, sustainable interventions.
Understand the impact of climate change on environmental and population health.
Collaborate with interdisciplinary teams to lead preparedness and mitigation efforts to protect population health for all, including vulnerable populations.
Coordinate the implementation of evidence-based infection control measures and proper use of personal protective equipment.
Domain 4Scholarship for the Discipline6
Participate in scholarly inquiry as a team member.
Communicate scholarly findings.
Collaborate to advance one's scholarship.
Disseminate one's scholarship to all audiences using a variety of approaches or modalities.
Advocate within the interprofessional team and with other stakeholders for the contributions of nursing scholarship.
Collaborate in the development of new/revised policy or regulation in the light of new evidence.
Domain 5Quality and Safety10
Implement standardized, evidence-based processes for care delivery.
Participate in the implementation of a practice change.
Use national safety resources to lead team-based change initiatives.
Collaborate in analyzing organizational process improvement initiatives.
Articulate the nurse's role within an interprofessional team in promoting safety and preventing errors and near misses.
Promote policies for prevention of violence and risk mitigation.
Recognize one's role in sustaining a just culture reflecting civility and respect.
Advocate for structures, policies, and processes that promote a culture of safety and prevent workplace risks and injury.
Foster a just culture reflecting civility and respect.
Create a safe and transparent culture for reporting incidents.
Domain 6Interprofessional Partnerships34
Communicate the nurse's roles and responsibilities clearly.
Use various communication tools and techniques effectively.
Elicit the perspectives of team members to inform person-centered care decision making.
Articulate impact of access, connection, and engagement on team-based communications.
Communicate individual information in a professional, accurate, and timely manner.
Communicate as informed by legal, regulatory, and policy guidelines.
Evaluate effectiveness of interprofessional communication tools and techniques to support and improve the efficacy of team-based interactions.
Facilitate improvements in interprofessional communications of individual information (e.g., EHR).
Role model respect for access, connection, and engagement in team-based communications.
Communicate nursing's unique disciplinary knowledge to strengthen interprofessional partnerships.
Provide expert consultation for other members of the healthcare team in one's area of practice.
Demonstrate capacity to resolve interprofessional conflict.
Apply principles of team dynamics, including team roles, to facilitate effective team functioning.
Delegate work to team members based on their roles and competency.
Engage in the work of the team as appropriate to one's scope of practice and competency.
Recognize how one's uniqueness (as a person and a nurse) contributes to effective interprofessional working relationships.
Apply principles of team leadership and management. performance to improve quality and assure safety.
Evaluate performance of individual and team to improve quality and promote safety.
Evaluate the impact of team dynamics and performance on desired outcomes.
Reflect on how one's role and expertise influences team performance.
Foster positive team dynamics to strengthen desired outcomes.
Integrate the roles and responsibilities of healthcare professionals through interprofessional collaborative practice.
Leverage roles and abilities of team members to optimize care.
Communicate with team members to clarify responsibilities in executing plan of care.
Direct interprofessional activities and initiatives.
Demonstrate an awareness of one's biases and how they may affect mutual respect and communication with team members.
Demonstrate respect for the perspectives and experiences of other professions.
Engage in constructive communication to facilitate conflict management.
Collaborate with interprofessional team members to establish mutual healthcare goals for individuals, communities, or populations.
Practice self-assessment to recognize and counteract bias towards team members.
Foster an environment that supports the constructive sharing of multiple perspectives and enhances interprofessional learning.
Integrate access, connection, and engagement into team practices.
Manage disagreements, conflicts, and challenging conversations among team members.
Promote an environment that advances interprofessional learning.
Domain 7Systems-Based Practice11
Describe the financial and payment models of healthcare.
Recognize the impact of differences in healthcare access, quality of care, and social determinants of health on care outcomes.
Describe the impact of healthcare cost and payment models on the delivery, access, and quality of care.
Explain the relationship of policy, regulatory requirements, and economics on care outcomes.
Incorporate considerations of efficiency, value, and cost in providing care.
Identify the impact of differing system structures, leadership, and workforce needs on care outcomes.
Analyze relevant internal and external factors that drive healthcare costs and reimbursement.
Design practices that enhance value, access, quality, and cost-effectiveness.
Advocate for healthcare economic policies and regulations to enhance value, quality, and cost-effectiveness.
Formulate, document, and disseminate the return on investment for improvement initiatives collaboratively with an interdisciplinary team.
Recommend system-wide strategies that improve cost-effectiveness considering structure, leadership, and workforce needs.
Domain 8Informatics & Healthcare Technologies13
Effectively use electronic communication tools.
Demonstrate best practice use of social networking applications.
Demonstrate the appropriate use of health information literacy assessments and improvement strategies.
Clarify how the collection of standardized data advances the practice, understanding, and value of nursing and supports care.
Interpret primary and secondary data and other information to support care.
Use information and communication technology in a manner that supports the nurse-patient relationship.
Formulate a plan to influence decision-making processes for selecting, implementing, and evaluating support tools.
Appraise the role of information and communication technologies in engaging the patient and supporting the nurse-patient relationship.
Explain the role of communication technology in enhancing clinical information flows.
Describe how information and communication technology tools support patient and team communications.
Explain the impact of health information exchange, interoperability, and integration on healthcare.
Employ electronic health, mobile health, and telehealth systems to enable quality, ethical, and efficient patient care.
Evaluate the impact of health information exchange, interoperability, and integration to support patient-centered care.
Domain 9Professionalism8
Employ the use of intentional presence to facilitate shared meaning of the experience between nurse and recipient of care.
Facilitate health and healing through compassionate caring.
Demonstrate empathy to the individual's life experience.
Demonstrate sensitivity and humility to all regardless of background and perspective in practice.
Apply principles of therapeutic relationships and professional boundaries.
Communicate in a professional manner.
Facilitate communication that promotes a participatory approach.
Lead in the development of opportunities for professional and interprofessional activities.
Domain 10Personal, Professional & Leadership Dev2
P5Impact
Stewardship & Outcomes64 sub-comps in 9 domains
Impact
Stewardship & OutcomesDomain 1Knowledge for Nursing Practice1
Domain 2Person-Centered Care11
Organize care based on mutual health goals.
Address individuals' experiences and perspectives in designing plans of care.
Develop evidence-based interventions to improve outcomes and safety.
Monitor aggregate metrics to assure accountability for care outcomes.
Contribute to the development of policies and processes that promote transparency and accountability.
Ensure accountability throughout transitions of care across the health continuum.
Monitor epidemiological and system-level aggregate data to determine healthcare outcomes and trends.
Develop strategies to optimize care coordination and transitions of care.
Guide the coordination of care across health systems.
Analyze system-level and public policy influence on care coordination.
Participate in system-level change to improve care coordination across settings.
Domain 3Population Health19
Assess population health data.
Develop an action plan to meet an identified need(s), including evaluation methods.
Assess the efficacy of a system's capability to serve a target sub-population's healthcare needs.
Analyze primary and secondary population health data for multiple populations against relevant benchmarks.
Use established or evolving methods to determine population-focused priorities for care.
Develop a collaborative approach with relevant stakeholders to address population healthcare needs, including evaluation methods.
Prioritize patient-focused and/or community action plans that are safe, effective, and efficient in the context of available resources.
Analyze cost-benefits of selected population-based interventions.
Advocate for interventions that maximize cost effective, accessible resources for populations being served.
Articulate a need for change.
Describe the intent of the proposed change.
Define stakeholders, including members of the community and/or clinical populations, and their level of influence.
Implement messaging strategies appropriate to audience and stakeholders.
Evaluate the effectiveness of advocacy actions.
Appraise advocacy priorities for a population.
Strategize with an interdisciplinary group and others to develop effective advocacy approaches.
Engage in relationship-building activities with stakeholders at any level of influence, including system, local, state, national, and/or global.
Collaboratively initiate rapid response activities to protect population health.
Contribute to system-level planning, decision making, and evaluation for disasters and public health emergencies.
Domain 4Scholarship for the Discipline5
Participate in the implementation of a practice change to improve nursing care.
Participate in the evaluation of outcomes and their implications for practice.
Lead the translation of evidence into practice.
Address opportunities for innovation and changes in practice.
Articulate inconsistencies between practice policies and best evidence.
Domain 5Quality and Safety9
Develop a plan for monitoring quality improvement change.
Establish and incorporate data driven benchmarks to monitor system performance.
Integrate outcome metrics to inform change and policy recommendations.
Lead the development of a business plan for quality improvement initiatives.
Advocate for change related to financial policies that impact the relationship between economics and quality care delivery.
Advance quality improvement practices through dissemination of outcomes.
Use national patient safety resources, initiatives, and regulations at the point of care.
Lead analysis of actual errors, near misses, and potential situations that would impact safety.
Evaluate emergency preparedness system-level plans to protect safety.
Domain 7Systems-Based Practice2
Domain 8Informatics & Healthcare Technologies3
Domain 9Professionalism12
Advocate for practices that advance access, connection, and engagement.
Advocate for practices that advance access, connection, and engagement.
Engage in advocacy that promotes the best interest of the individual, community, and profession.
Advocate for nursing's professional responsibility for ensuring optimal care outcomes.
Advocate for policies that promote health and prevent harm.
Adhere to the registered nurse scope and standards of practice.
Adhere to regulatory requirements and workplace policies consistent with one's educational preparation.
Advocate for polices that enable nurses to practice to the full extent of their education.
Assess the interaction between regulatory agency requirements and quality, fiscal, and value-based indicators.
Evaluate the effect of legal and regulatory policies on nursing practice and healthcare outcomes.
Analyze efforts to change legal and regulatory policies that improve nursing practice and health outcomes.
Participate in the implementation of policies and regulations to improve the professional practice environment and healthcare outcomes.
Domain 10Personal, Professional & Leadership Dev2
Bring your curriculum to the framework.
The same framework powers the role-transition methodology. See how a residency curriculum lands on these 434 sub-competencies.