The Essentials of Masters Education in Nursing

The Essentials of Masters Education in Nursing

The Essentials of Master’s Education in Nursing

The Essentials of Master’s Education in Nursing reflect the profession’s continuing call for
imagination, transformative thinking, and evolutionary change in graduate education. The
extraordinary explosion of knowledge, expanding technologies, increasing diversity, and global
health challenges produce a dynamic environment for nursing and amplify nursing’s critical
contributions to health care. Master’s education prepares nurses for flexible leadership and
critical action within complex, changing systems, including health, educational, and
organizational systems. Master’s education equips nurses with valuable knowledge and skills to
lead change, promote health, and elevate care in various roles and settings. Synergy with these
Essentials, current and future healthcare reform legislation, and the action-oriented
recommendations of the Initiative on the Future of Nursing (IOM, 2010) highlights the value and
transforming potential of the nursing profession.
These Essentials are core for all master’s programs in nursing and provide the necessary
curricular elements and framework, regardless of focus, major, or intended practice setting. These
Essentials delineate the outcomes expected of all graduates of master’s nursing programs. These
Essentials are not prescriptive directives on the design of programs. Consistent with the
Baccalaureate and Doctorate of Nursing Practice Essentials, this document does not address
preparation for specific roles, which may change and emerge over time. These Essentials also
provide guidance for master’s programs during a time when preparation for specialty advanced
nursing practice is transitioning to the doctoral level.
Master’s education remains a critical component of the nursing education trajectory to prepare
nurses who can address the gaps resulting from growing healthcare needs. Nurses who obtain the
competencies outlined in these Essentials have significant value for current and emerging roles in
healthcare delivery and design through advanced nursing knowledge and higher level leadership
skills for improving health outcomes. For some nurses, master’s education equips them with a
fulfilling lifetime expression of their mastery area. For others, this core is a graduate foundation
for doctoral education. Each preparation is valued.
The dynamic nature of the healthcare delivery system underscores the need for the
nursing profession to look to the future and anticipate the healthcare needs for which
nurses must be prepared to address. The complexities of health and nursing care today
make expanded nursing knowledge a necessity in contemporary care settings. The
transformation of health care and nursing practice requires a new conceptualization of
master’s education. Master’s education must prepare the graduate to:
• Lead change to improve quality outcomes,
• Advance a culture of excellence through lifelong learning,
• Build and lead collaborative interprofessional care teams,
• Navigate and integrate care services across the healthcare system,
• Design innovative nursing practices, and
• Translate evidence into practice.
Graduates of master’s degree programs in nursing are prepared with broad knowledge
and practice expertise that builds and expands on baccalaureate or entry-level nursing
practice. This preparation provides graduates with a fuller understanding of the discipline
of nursing in order to engage in higher level practice and leadership in a variety of
settings and commit to lifelong learning. For those nurses seeking a terminal degree, the
highest level of preparation within the discipline, the new conceptualization for master’s
education will allow for seamless movement into a research or practice-focused doctoral
program (AACN, 2006, 2010).
The nine Essentials addressed in this document delineate the knowledge and skills that all
nurses prepared in master’s nursing programs acquire. These Essentials guide the
preparation of graduates for diverse areas of practice in any healthcare setting.
• Essential I: Background for Practice from Sciences and Humanities
o Recognizes that the master’s-prepared nurse integrates scientific findings
from nursing, biopsychosocial fields, genetics, public health, quality
improvement, and organizational sciences for the continual improvement
of nursing care across diverse settings.
• Essential II: Organizational and Systems Leadership
o Recognizes that organizational and systems leadership are critical to the
promotion of high quality and safe patient care. Leadership skills are
needed that emphasize ethical and critical decision making, effective
working relationships, and a systems-perspective.
• Essential III: Quality Improvement and Safety
o Recognizes that a master’s-prepared nurse must be articulate in the
methods, tools, performance measures, and standards related to quality, as
well as prepared to apply quality principles within an organization.
• Essential IV: Translating and Integrating Scholarship into Practice
o Recognizes that the master’s-prepared nurse applies research outcomes
within the practice setting, resolves practice problems, works as a change
agent, and disseminates results.
• Essential V: Informatics and Healthcare Technologies
o Recognizes that the master’s-prepared nurse uses patient-care technologies
to deliver and enhance care and uses communication technologies to
integrate and coordinate care.
• Essential VI: Health Policy and Advocacy
o Recognizes that the master’s-prepared nurse is able to intervene at the
system level through the policy development process and to employ
advocacy strategies to influence health and health care.
• Essential VII: Interprofessional Collaboration for Improving Patient and
Population Health Outcomes
o Recognizes that the master’s-prepared nurse, as a member and leader of
interprofessional teams, communicates, collaborates, and consults with
other health professionals to manage and coordinate care.
• Essential VIII: Clinical Prevention and Population Health for Improving
o Recognizes that the master’s-prepared nurse applies and integrates broad,
organizational, client-centered, and culturally appropriate concepts in the
planning, delivery, management, and evaluation of evidence-based clinical
prevention and population care and services to individuals, families, and
aggregates/identified populations.
• Essential IX: Master’s-Level Nursing Practice
o Recognizes that nursing practice, at the master’s level, is broadly defined
as any form of nursing intervention that influences healthcare outcomes
for individuals, populations, or systems. Master’s-level nursing graduates
must have an advanced level of understanding of nursing and relevant
sciences as well as the ability to integrate this knowledge into practice. .
Nursing practice interventions include both direct and indirect care
Master’s Education in Nursing and Areas of Practice
Graduates with a master’s degree in nursing are prepared for a variety of roles and areas
of practice. Graduates may pursue new and innovative roles that result from health
reform and changes in an evolving and global healthcare system. Some graduates will
pursue direct care practice roles in a variety of settings (e.g., the Clinical Nurse Leader,
nurse educator). Others may choose indirect care roles or areas of practice that focus on
aggregate, systems, or have an organizational focus, (e.g. nursing or health program
management, informatics, public health, or clinical research coordinator). In addition to
developing competence in the nine Essential core areas delineated in this document, each
graduate will have additional coursework in an area of practice or functional role. This
coursework may include more in-depth preparation and competence in one or two of the
Essentials or in an additional/ supplementary area of practice.
For example, more concentrated coursework or further development of the knowledge
and skills embedded in Essential IV (Translational Scholarship for Evidence-Based
Practice) will prepare the nurse to manage research projects for nurse scientists and other
healthcare researchers working in multi-professional research teams. More in-depth
preparation in Essential II (Organizational and System Leadership) will provide
knowledge useful for nursing management roles.
In some instances, graduates of master’s in nursing programs will seek to fill roles as
educators. As outlined in Essential IX, all master’s-prepared nurses will develop
competence in applying teaching/learning principles in work with patients and/or students
across the continuum of care in a variety of settings. However, as recommended in the
Carnegie Foundation report (2009), Educating Nurses: A Call for Radical
Transformation, those individuals, as do all master’s graduates, who choose a nurse
educator role require preparation across all nine Essential areas, including graduate-level
clinical practice content and experiences. In addition, a program preparing individuals for
a nurse educator role should include preparation in curriculum design and development,
teaching methodologies, educational needs assessment, and learner-centered theories and
methods. Master’s prepared nurses may teach patients and their families and/or student
nurses, staff nurses, and variety of direct-care providers. The master’s prepared nurse
educator differs from the BSN nurse in depth of his/her understanding of the nursing
discipline, nursing practice, and the added pedagogical skills. To teach students, patients,
and caregivers regarding health promotion, disease prevention, or disease management,
the master’s-prepared nurse educator builds on baccalaureate knowledge with graduatelevel
content in the areas of health assessment, physiology/pathophysiology, and
pharmacology to strengthen his/her scientific background and facilitate his/her
understanding of nursing and health-related information. Those master’s students who
aspire to faculty roles in baccalaureate and higher degree programs will be advised that
additional education at the doctoral level is needed (AACN, 2008).
Context for Nursing Practice
Health care in the United States and globally is changing dramatically. Interest in
evolving health care has prompted greater focus on health promotion and illness
prevention, along with cost-effective approaches to high acuity, chronic disease
management, care coordination, and long-term care. Public concerns about cost of health
care, fiscal sustainability, healthcare quality, and development of sustainable solutions to
healthcare problems are driving reform efforts. Attention to affordability and accessibility
of health care, maintaining healthy environments, and promoting personal and
community responsibility for health is growing among the public and policy makers.
In addition to broad public mandates for a reformed and responsive healthcare system, a
number of groups are calling for changes in the ways all health professionals are educated
to meet current and projected needs for contemporary care delivery. The Institute of
Medicine (IOM), an interprofessional healthcare panel, described a set of core
competencies that all health professionals regardless of discipline will demonstrate: 1) the
provision of patient-centered care, 2) working in interprofessional teams, 3) employing
evidence-based practice, 4) applying quality improvement approaches, and 5) utilizing
informatics (IOM, 2003).
Given the ongoing public trust in nursing (Gallup, 2010), and the desire for fundamental
reorganization of relationships among individuals, the public, healthcare organizations
and healthcare professionals, graduate education for nurses is needed that is wide in
scope and breadth, emphasizes all systems-level care and includes mastery of practice
knowledge and skills. Such preparation reflects mastery of higher level thinking and
conceptualization skills than at the baccalaureate level, as well as an understanding of the
interrelationships among practice, ethical, and legal issues; financial concerns and
comparative effectiveness; and interprofessional teamwork.
Master’s Nursing Education Curriculum
The master’s nursing curriculum is conceptualized in Figure 1 and includes three
1. Graduate Nursing Core: foundational curriculum content deemed essential
for all students who pursue a master’s degree in nursing regardless of the
functional focus.
2. Direct Care Core: essential content to provide direct patient services at an
advanced level.
3. Functional Area Content: those clinical and didactic learning experiences
identified and defined by the professional nursing organizations and
certification bodies for specific nursing roles or functions.
This document delineates the graduate nursing core competencies for all master’s
graduates. These core outcomes reflect the many changes in the healthcare system
occurring over the past decade. In addition, these expected outcomes for all master’s
degree graduates reflect the increasing responsibility of nursing in addressing many of the
gaps in health care as well as growing patient and population needs.
Master’s nursing education, as is all nursing education, is evolving to meet these needs
and to prepare nurses to assume increasing accountabilities, responsibilities, and
leadership positions. As master’s nursing education is re-envisioned and preparation of
individuals for advanced specialty nursing practice transitions to the practice doctorate
these Essentials delineate the foundational, core expectations for these master’s program
graduates until the transition is completed.
Figure 1: Model of Master’s Nursing Curriculum
* All master’s degree programs that prepare graduates for roles that have a component of
direct care practice are required to have graduate level content/coursework in the
following three areas: physiology/pathophysiology, health assessment, and
pharmacology. However, graduates being prepared for any one of the four APRN roles
(CRNA, CNM, CNS, or CNP), must complete three separate comprehensive, graduate
level courses that meet the criteria delineated in the 2008 Consensus Model for APRN
Licensure, Accreditation, Certification and Education.
( In addition, the expected
outcomes for each of these three APRN core courses are delineated in The Essentials of
Doctoral Education for Advanced Nursing Practice (pg. 23-24)
+ The nursing educator is a direct care role and therefore requires graduate-level content
in the three Direct Care Core courses. All graduates of a master’s nursing program must
have supervised practice experiences that are sufficient to demonstrate mastery of the
Essentials. The term “supervised” is used broadly and can include precepted experiences
with faculty site visits. These learning experiences may be accomplished through diverse
teaching methods, including face-to-face or simulated methods.
In addition, development of clinical proficiency is facilitated through the use of focused
and sustained clinical experiences designed to strengthen patient care delivery skills, as
well as system assessment and intervention skills, which will lead to an enhanced
understanding of organizational dynamics. These immersion experiences afford the
student an opportunity to focus on a population of interest or may focus on a specific
role. Most often, the immersion experience occurs toward the end of the program as a
culminating synthesis experience.
The Essentials of Master’s Education in Nursing
Essential I: Background for Practice from Sciences and Humanities
Master’s-prepared nurses build on the competencies gained in a baccalaureate nursing
program by developing a deeper understanding of nursing and the related sciences needed
to fully analyze, design, implement, and evaluate nursing care. These nurses are well
prepared to provide care to diverse populations and cohorts of patients in clinical and
community-based systems. The master’s-prepared nurse integrates findings from the
sciences and the humanities, biopsychosocial fields, genetics, public health, quality
improvement, health economics, translational science, and organizational sciences for the
continual improvement of nursing care at the unit, clinic, home, or program level.
Master’s-prepared nursing care reflects a more sophisticated understanding of
assessment, problem identification, design of interventions, and evaluation of aggregate
outcomes than baccalaureate-prepared nursing care.
Students being prepared for direct care roles will have graduate-level content that builds
upon an undergraduate foundation in health assessment, pharmacology, and
pathophysiology. Having master’s-prepared graduates with a strong background in these
three areas is seen as imperative from the practice perspective. It is recommended that the
master’s curriculum preparing individuals for direct care roles include three separate
graduate-level courses in these three content areas. In addition, the inclusion of these
three separate courses facilitates the transition of these master’s program graduates into
the DNP advanced-practice registered-nurse programs.
Master’s-prepared nurses understand the intersection between systems science and
organizational science in order to serve as integrators within and across systems of care.
Care coordination is based on systems science (Nelson et al., 2008). Care management
incorporates an understanding of the clinical and community context, and the research
relevant to the needs of the population. Nurses at this level use advanced clinical
reasoning for ambiguous and uncertain clinical presentations, and incorporate concerns of
family, significant others, and communities into the design and delivery of care.
Master’s-prepared nurses use a variety of theories and frameworks, including nursing and
ethical theories in the analysis of clinical problems, illness prevention, and health
promotion strategies. Knowledge from information sciences, health communication, and
health literacy are used to provide care to multiple populations. These nurses are able to
address complex cultural issues and design care that responds to the needs of multiple
populations, who may have potentially conflicting cultural needs and preferences. As
healthcare technology becomes more sophisticated and its use more widespread,
master’s-prepared nurse are able to evaluate when its use is appropriate for diagnostic,
educational, and therapeutic interventions. Master’s-prepared nurses use improvement
science and quality processes to evaluate outcomes of the aggregate of patients,
community members, or communities under their care, monitor trends in clinical data,
and understand the implications of trends for changing nursing care.
The master’s-degree program prepares the graduate to:
1. Integrate nursing and related sciences into the delivery of advanced nursing care to
diverse populations.
2. Incorporate current and emerging genetic/genomic evidence in providing advanced
nursing care to individuals, families, and communities while accounting for patient
values and clinical judgment.
3. Design nursing care for a clinical or community-focused population based on
biopsychosocial, public health, nursing, and organizational sciences.
4. Apply ethical analysis and clinical reasoning to assess, intervene, and evaluate
advanced nursing care delivery.
5. Synthesize evidence for practice to determine appropriate application of interventions
across diverse populations.
6. Use quality processes and improvement science to evaluate care and ensure patient
safety for individuals and communities.
7. Integrate organizational science and informatics to make changes in the care
environment to improve health outcomes.
8. Analyze nursing history to expand thinking and provide a sense of professional
heritage and identity.
Sample Content
• Healthcare economics and finance models
• Advanced nursing science, including the major streams of nursing scientific
• Scientific bases of illness prevention, health promotion, and wellness
• Genetics, genomics, and pharmacogenomics
• Public health science, such as basic epidemiology, surveillance, environmental
science, and population health analysis and program planning
• Organizational sciences
• Systems science and integration, including microsystems, mesosystems, and macrolevel
• Chaos theory and complexity science
• Leadership science
• Theories of bioethics
• Information science
• Quality processes and improvement science
• Technology assessment
• Nursing Theories
Essential II: Organizational and Systems Leadership
Organizational and systems leadership are critical to the promotion of high quality and
safe patient care. Leadership skills are needed that emphasize ethical and critical decision
making. The master’s-prepared nurse’s knowledge and skills in these areas are consistent
with nursing and healthcare goals to eliminate health disparities and to promote
excellence in practice. Master’s-level practice includes not only direct care but also a
focus on the systems that provide care and serve the needs of a panel of patients, a
defined population, or community.
To be effective, graduates must be able to demonstrate leadership by initiating and
maintaining effective working relationships using mutually respectful communication
and collaboration within interprofessional teams, demonstrating skills in care
coordination, delegation, and initiating conflict resolution strategies. The master’sprepared
nurse provides and coordinates comprehensive care for patients–individuals,
families, groups, and communities–in multiple and varied settings. Using information
from numerous sources, these nurses navigate the patient through the healthcare system
and assume accountability for quality outcomes. Skills essential to leadership include
communication, collaboration, negotiation, delegation, and coordination.
Master’s-prepared nurses are members and leaders of healthcare teams that deliver a
variety of services. These graduates bring a unique blend of knowledge, judgment, skills,
and caring to the team. As a leader and partner with other health professionals, these
nurses seek collaboration and consultation with other providers as necessary in the
design, coordination, and evaluation of patient care outcomes.
In an environment with ongoing changes in the organization and financing of health care,
it is imperative that all master’s-prepared nurses have a keen understanding of healthcare
policy, organization, and financing. The purpose of this content is to prepare a graduate
to provide quality cost-effective care; to participate in the implementation of care; and to
assume a leadership role in the management of human, fiscal, and physical healthcare
resources. Program graduates understand the economies of care, business principles, and
how to work within and affect change in systems.
The master’s-prepared nurse must be able to analyze the impact of systems on patient
outcomes, including analyzing error rates. These nurses will be prepared with knowledge
and expertise in assessing organizations, identifying systems’ issues, and facilitating
organization-wide changes in practice delivery. Master’s-prepared nurses must be able to
use effective interdisciplinary communication skills to work across departments
identifying opportunities and designing and testing systems and programs to improve
care. In addition, nurse practice at this level requires an understanding of complexity
theory and systems thinking, as well as the business and financial acumen needed for the
analysis of practice quality and costs.
The master’s-degree program prepares the graduate to:
1. Apply leadership skills and decision making in the provision of culturally responsive,
high-quality nursing care, healthcare team coordination, and the oversight and
accountability for care delivery and outcomes.
2. Assume a leadership role in effectively implementing patient safety and quality
improvement initiatives within the context of the interprofessional team using effective
communication (scholarly writing, speaking, and group interaction) skills.
3. Develop an understanding of how healthcare delivery systems are organized and
financed (and how this affects patient care) and identify the economic, legal, and political
factors that influence health care.
4. Demonstrate the ability to use complexity science and systems theory in the design,
delivery, and evaluation of health care.
5. Apply business and economic principles and practices, including budgeting,
cost/benefit analysis, and marketing, to develop a business plan.
6. Design and implement systems change strategies that improve the care environment.
7. Participate in the design and implementation of new models of care delivery and
Sample Content
• Leadership, including theory, leadership styles, contemporary approaches, and
strategies (organizing, managing, delegating, supervising, collaborating, coordinating)
• Data-driven decision-making based on an ethical framework to promote culturally
responsive, quality patient care in a variety of settings, including creative and imaginative
strategies in problem solving
• Communication–both interpersonal and organizational–including elements and
channels, models, and barriers
• Conflict, including conflict resolution, mediation, negotiation, and managing conflict
• Change theory and social change theories
• Systems theory and complexity science
• Healthcare systems and organizational relationships (e.g., finance, organizational
structure, and delivery of care, including mission/vision/philosophy and values)
• Healthcare finance, including budgeting, cost/benefit analysis, variance analysis, and
• Operations research (e.g., queuing theory, supply chain management, and systems
designs in health care)
• Teams and teamwork, including team leadership, building effective teams, and
nurturing teams
Essential III: Quality Improvement and Safety
Continuous quality improvement involves every level of the healthcare organization. A
master’s-prepared nurse must be articulate in the methods, tools, performance measures,
culture of safety principles, and standards related to quality, as well as prepared to apply
quality principles within an organization to be an effective leader and change agent.
The Institute of Medicine report (1998) To Err is Human defined patient safety as
“freedom from accidental injury” and stated that patients should not be at greater risk for
accidental injury in a hospital or healthcare setting than they are in their own home.
Improvement in patient safety along with reducing and ultimately eliminating harm to
patients is fundamental to quality care. Skills are needed that assist in identifying actual
or potential failures in processes and systems that lead to breakdowns and errors and then
redesigning processes to make patients safe.
Knowledge and skills in human factors and basic safety design principles that affect
unsafe practices are essential. Graduates of master’s-level programs must be able to
analyze systems and work to create a just culture of safety in which personnel feel
comfortable disclosing errors—including their own—while maintaining professional
accountability. Learning how to evaluate, calculate, and improve the overall reliability of
processes are core skills needed by master’s-prepared nurses.
Knowledge of both the potential and the actual impact of national patient safety
resources, initiatives, and regulations and the use of national benchmarks are required.
Changes in healthcare reimbursement with the introduction of Medicare’s list of “never
events” and the regulatory push for more transparency on quality outcomes require
graduates to be able to determine if the outcomes of standards of practice, performance,
and competence have been met and maintained.
The master’s-prepared nurse provides leadership across the care continuum in diverse
settings using knowledge regarding high reliability organizations. These organizations
achieve consistently safe and effective performance records despite unpredictable
operating environments or intrinsically hazardous endeavors (Weick, 2001). The
master’s-prepared nurse will be able to monitor, analyze, and prioritize outcomes that
need to be improved. Using quality improvement and high reliability organizational
principles, these nurses will be able to quantify the impact of plans of action.
The master’s-degree program prepares the graduate to:
1. Analyze information about quality initiatives recognizing the contributions of
individuals and inter-professional healthcare teams to improve health outcomes across the
continuum of care.
2. Implement evidence-based plans based on trend analysis and quantify the impact on
quality and safety.
3. Analyze information and design systems to sustain improvements and promote
transparency using high reliability and just culture principles.
4. Compare and contrast several appropriate quality improvement models.
5. Promote a professional environment that includes accountability and high-level
communication skills when involved in peer review, advocacy for patients and families,
reporting of errors, and professional writing.
6. Contribute to the integration of healthcare services within systems to affect safety and
quality of care to improve patient outcomes and reduce fragmentation of care.
7. Direct quality improvement methods to promote culturally responsive, safe, timely,
effective, efficient, equitable, and patient-centered care.
8. Lead quality improvement initiatives that integrate socio-cultural factors affecting the
delivery of nursing and healthcare services.
Sample Content
• Quality improvement models differentiating structure, process, and outcome indicators
• Principles of a just culture and relationship to analyzing errors
• Quality improvement methods and tools: Brainstorming, Fishbone cause and effect
diagram, flow chart, Plan, Do Study, Act (PDSA), Plan, Do, Check, Act (PDCA),Find,
Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA), Six Sigma,
• High-Reliability Organizations (HROs) / High-reliability techniques
• National patient safety goals and other relevant regulatory standards (e.g., CMS core
measures, pay for performance indicators, and never events)
• Nurse-sensitive indicators
• Data management (e.g., collection tools, display techniques, data analysis, trend
analysis, control charts)
•Analysis of errors (e.g., Root Cause Analysis [RCA], Failure Mode Effects Analysis
[FMEA], serious safety events)
• Communication (e.g., hands-off communication, chain-of-command, error disclosure)
• Participate in executive patient safety rounds
• Simulation training in a variety of settings (e.g., disasters, codes, and other high-risk
clinical areas)
• RN fit for duty/impact of fatigue and distractions in care environment on patient safety
Essential IV: Translating and Integrating Scholarship into Practice
Professional nursing practice at all levels is grounded in the ethical translation of current
evidence into practice. Fundamentally, nurses need a questioning/inquiring attitude
toward their practice and the care environment.
The master’s-prepared nurse examines policies and seeks evidence for every aspect of
practice, thereby translating current evidence and identifying gaps where evidence is
lacking. These nurses apply research outcomes within the practice setting, resolve
practice problems (individually or as a member of the healthcare team), and disseminate
results both within the setting and in wider venues in order to advance clinical practice.
Changing practice locally, as well as more broadly, demands that the master’s-prepared
nurse is skilled at challenging current practices, procedures, and policies. The emerging
sciences referred to as implementation or improvement sciences are providing evidence
about the processes that are effective when making needed changes where the change
processes and context are themselves evidence based (Damschroder et al., 2009; Sobo,
Bowman, & Gifford, 2008; van Achterberg, Schoonhoven, & Grol, 2008). Master’s-
prepared nurses, therefore, must be able to implement change deemed appropriate given
context and outcome analysis, and to assist others in efforts to improve outcomes.
Master’s-prepared nurses lead continuous improvement processes based on translational
research skills. The cyclical processes in which these nurses are engaged includes
identifying questions needing answers, searching or creating the evidence for potential
solutions/innovations, evaluating the outcomes, and identifying additional questions.
Master’s-prepared nurses, when appropriate, lead the healthcare team in the
implementation of evidence-based practice. These nurses support staff in lifelong
learning to improve care decisions, serving as a role model and mentor for evidencebased
decision making. Program graduates must possess the skills necessary to bring
evidence-based practice to both individual patients for whom they directly care and to
those patients for whom they are indirectly responsible. Those skills include knowledge
acquisition and dissemination, working in groups, and change management.
The master’s-degree program prepares the graduate to:
1. Integrate theory, evidence, clinical judgment, research, and interprofessional
perspectives using translational processes to improve practice and associated health
outcomes for patient aggregates.
2. Advocate for the ethical conduct of research and translational scholarship (with
particular attention to the protection of the patient as a research participant).
3. Articulate to a variety of audiences the evidence base for practice decisions, including
the credibility of sources of information and the relevance to the practice problem
4. Participate, leading when appropriate, in collaborative teams to improve care
outcomes and support policy changes through knowledge generation, knowledge
dissemination, and planning and evaluating knowledge implementation.
5. Apply practice guidelines to improve practice and the care environment.
6. Perform rigorous critique of evidence derived from databases to generate meaningful
evidence for nursing practice.
Sample Content:
• Research process
• Implementation/Improvement science
• Evidence-based practice:
Clinical decision making
Critical thinking
Problem identification
Outcome measurement
• Translational science:
Data collection in nursing practice
Design of databases that generate meaningful evidence for nursing practice
Data analysis in practice
Evidence-based interventions
Prediction and analysis of outcomes
Patterns of behavior and outcomes
Gaps in evidence for practice
Importance of cultural relevance
• Scholarship:
Application of research to the clinical setting
Resolution of clinical problems
Appreciative inquiry
Dissemination of results
• Advocacy in research
• Research ethics
• Knowledge acquisition
• Group process
• Management of change
• Evidence-based policy development in practice
• Quality improvement models/methodologies
• Safety issues in practice
• Innovation processes
Essential V: Informatics and Healthcare Technologies
Informatics and healthcare technologies encompass five broad areas:
• Use of patient care and other technologies to deliver and enhance care;
• Communication technologies to integrate and coordinate care;
• Data management to analyze and improve outcomes of care;
• Health information management for evidence-based care and health education;
• Facilitation and use of electronic health records to improve patient care.
Knowledge and skills in each of these four broad areas is essential for all master’sprepared
nurses. The extent and focus of each will vary depending upon the nurse’s role,
setting, and practice focus.
Knowledge and skills in information and healthcare technology are critical to the delivery
of quality patient care in a variety of settings (IOM, 2003a). The use of technologies to
deliver, enhance, and document care is changing rapidly. In addition, information
technology systems, including decision-support systems, are essential to gathering
evidence to impact practice. Improvement in cost effectiveness and safety depend on
evidence-based practice, outcomes research, interprofessional care coordination, and
electronic health records, all of which involve information management and technology
(McNeil et al., 2006). As nursing and healthcare practices evolve to better meet patient
needs, the application of these technologies will change as well.
As the use of technology expands, the master’s-prepared nurse must have the knowledge
and skills to use current technologies to deliver and coordinate care across multiple
settings, analyze point of care outcomes, and communicate with individuals and groups,
including the media, policymakers, other healthcare professionals, and the public.
Integral to these skills is an attitude of openness to innovation and continual learning, as
information systems and care technologies are constantly changing, including their use at
the point of care.
Graduates of master’s-level nursing programs will have competence to determine the
appropriate use of technologies and integrate current and emerging technologies into
one’s practice and the practice of others to enhance care outcomes. In addition, the
master’s-prepared nurse will be able to educate other health professionals, staff, patients,
and caregivers using current technologies and about the principles related to the safe and
effective use of care and information technologies.
Graduates ethically manage data, information, knowledge, and technology to
communicate effectively with healthcare team, patients, and caregivers to integrate safe
and effective care within and across settings. Master’s-prepared nurses use research and
clinical evidence to inform practice decisions.
Master’s-degree graduates are prepared to gather, document, and analyze outcome data
that serve as a foundation for decision making and the implementation of interventions or
strategies to improve care outcomes. The master’s-prepared nurse uses statistical and
epidemiological principles to synthesize these data, information, and knowledge to
evaluate and achieve optimal health outcomes.
The usefulness of electronic health records and other health information management
systems to evaluate care outcomes is improved by standardized terminologies. Integration
of standardized terminologies in information systems supports day-to-day nursing
practice and also the capacity to enhance interprofessional communication and generate
standardized data to continuously evaluate and improve practice (American Nurses
Association, 2008). Master’s-prepared nurses use information and communication
technologies to provide guidance and oversight for the development and implementation
of health education programs, evidence-based policies, and point-of-care practices by
members of the interdisciplinary care team.
Health information is growing exponentially. Health literacy is a powerful tool in health
promotion, disease prevention, management of chronic illnesses, and quality of life–all of
which are hallmarks of excellence in nursing practice. Master’s-prepared nurses serve as
information managers, patient advocates, and educators by assisting others(including
patients, students, caregivers and healthcare professionals) in accessing, understanding,
evaluating, and applying health-related information. The master’s-prepared nurse designs
and implements education programs for cohorts of patients or other healthcare providers
using information and communication technologies.
The master’s-degree program prepares the graduate to:
1. Analyze current and emerging technologies to support safe practice environments,
and to optimize patient safety, cost-effectiveness, and health outcomes.
2. Evaluate outcome data using current communication technologies, information
systems, and statistical principles to develop strategies to reduce risks and improve
health outcomes.
3. Promote policies that incorporate ethical principles and standards for the use of health
and information technologies.
4. Provide oversight and guidance in the integration of technologies to document patient
care and improve patient outcomes.
5. Use information and communication technologies, resources, and principles of
learning to teach patients and others.
6. Use current and emerging technologies in the care environment to support lifelong
learning for self and others.
Sample Content
• Use of technology, information management systems, and standardized
• Use of standardized terminologies to document and analyze nursing care
• Bio-health informatics
• Regulatory requirements for electronic data monitoring systems
• Ethical and legal issues related to the use of information technology, including
copyright, privacy, and confidentiality issues
• Retrieval information systems, including access, evaluation of data, and
application of relevant data to patient care
• Statistical principles and analyses of outcome data
• Online review and resources for evidence-based practice
• Use and implementation of technology for virtual care delivery and monitoring
• Electronic health record, including policies related to the implementation of and
use to impact care outcomes
• Complementary roles of the master’s-prepared nursing and information
technology professionals, including nurse informaticist and quality officer
• Use of technology to analyze data sets and their use to evaluate patient care
• Effective use of educational/instructional technology
• Point-of-care information systems and decision support systems
Essential VI: Health Policy and Advocacy
The healthcare environment is ever-evolving and influenced by technological, economic,
political, and sociocultural factors locally and globally. Graduates of master’s degree
nursing programs have requisite knowledge and skills to promote health, help shape the
health delivery system, and advance values like social justice through policy processes
and advocacy. Nursing’s call to political activism and policy advocacy emerges from
many different viewpoints. As more evidence links the broad psychosocial, economic,
and cultural factors to health status, nurses are compelled to incorporate these factors into
their approach to care. Most often, policy processes and system-level strategies yield the
strongest influence on these broad determinants of health. Being accountable for
improving the quality of healthcare delivery, nurses must understand the legal and
political determinants of the system and have the requisite skills to partner for an
improved system. Nurses’ involvement in policy debates brings our professional values
to bear on the process (Warner, 2003). Master’s-prepared nurses will use their political
efficacy and competence to improve the health outcomes of populations and improve the
quality of the healthcare delivery system.
Policy shapes healthcare systems, influences social determinants of health, and therefore
determines accessibility, accountability, and affordability of health care. Health policy
creates conditions that promote or impede equity in access to care and health outcomes.
Implementing strategies that address health disparities serves as a prelude to influencing
policy formation. In order to influence policy, the master’s-prepared nurse needs to work
within and affect change in systems. To effectively collaborate with stakeholders, the
master’s-prepared nurse must understand the fiscal context in which they are practicing
and make the linkages among policy, financing, and access to quality health care. The
graduate must understand the principles of healthcare economics, finance, payment
methods, and the relationships between policy and health economics.
Advocacy for patients, the profession, and health-promoting policies is operationalized in
divergent ways. Attributes of advocacy include safeguarding autonomy, promoting social
justice, using ethical principles, and empowering self and others (Grace, 2001; Hanks,
2007; Xiaoyan & Jezewski, 2006). Giving voice and persuasion to needs and preferred
direction at the individual, institution, state, or federal policy level is integral for the
master’s-prepared nurse.
The master’s-degree program prepares the graduate to:
1. Analyze how policies influence the structure and financing of health care,
practice, and health outcomes.
2. Participate in the development and implementation of institutional, local, and state
and federal policy.
3. Examine the effect of legal and regulatory processes on nursing practice,
healthcare delivery, and outcomes.
4. Interpret research, bringing the nursing perspective, for policy makers and
5. Advocate for policies that improve the health of the public and the profession of
Sample Content
• Policy process: development, implementation, and evaluation
• Structure of healthcare delivery systems
• Theories and models of policy making
• Policy making environments: values, economies, politics, social
• Policy-making process at various levels of government
• Ethical and value-based frameworks guiding policy making
• General principles of microeconomics and macroeconomics, accounting, and
marketing strategies.
• Globalization and global health
• Interaction between regulatory processes and quality control
• Health disparities
• Social justice
• Political activism
• Economics of health care
Essential VII: Interprofessional Collaboration for Improving Patient and
Population Health Outcomes
In a redesigned health system a greater emphasis will be placed on cooperation,
communication, and collaboration among all health professionals in order to integrate
care in teams and ensure that care is continuous and reliable. Therefore, an expert panel
at the Institute of Medicine (IOM) identified working in interdisciplinary teams as one of
the five core competencies for all health professionals (IOM, 2003).
Interprofessional collaboration is critical for achieving clinical prevention and health
promotion goals in order to improve patient and population health outcomes (APTR,
2008; 2009). Interprofessional practice is critical for improving patient care outcomes
and, therefore, a key component of health professional education and lifelong learning
(American Association of Colleges of Nursing & the Association of American Medical
Colleges, 2010).
The IOM also recognized the need for care providers to demonstrate a greater awareness
to “patient values, preferences, and cultural values,” consistent with the Healthy People
2010 goal of achieving health equity through interprofessional approaches (USHHS,
2000). In this context, knowledge of broad determinants of health will enable the
master’s graduate to succeed as a patient advocate, cultural and systems broker, and to
lead and coordinate interprofessional teams across care environments in order to reduce
barriers, facilitate access to care, and improve health outcomes. Successfully leading
these teams is achieved through skill development and demonstrating effective
communication, planning, and implementation of care directly with other healthcare
professionals (AACN, 2007).
Improving patient and population health outcomes is contingent on both horizontal and
vertical health delivery systems that integrate research and clinical expertise to provide
patient-centered care. Inherently the systems must include patients’ expressed values,
needs, and preferences for shared decision making and management of their care. As
members and leaders of interprofessional teams, the master’s-prepared nurse will actively
communicate, collaborate, and consult with other health professionals to manage and
coordinate care across systems.
The master’s-degree program prepares the graduate to:
1. Advocate for the value and role of the professional nurse as member and leader of
interprofessional healthcare teams.
2. Understand other health professions’ scopes of practice to maximize contributions
within the healthcare team.
3. Employ collaborative strategies in the design, coordination, and evaluation of
patient-centered care.
4. Use effective communication strategies to develop, participate, and lead
interprofessional teams and partnerships.
5. Mentor and coach new and experienced nurses and other members of the
healthcare team.
6. Functions as an effective group leader or member based on an in-depth
understanding of team dynamics and group processes.
Sample Content
• Scopes of practice for nursing and other professions
• Differing world views among healthcare team members
• Concepts of communication, collaboration, and coordination
• Conflict management strategies and principles of negotiation
• Organizational processes to enhance communication
• Types of teams and team roles
• Stages of team development
• Diversity of teams
• Cultural diversity
• Patient-centered care
• Change theories
• Multiple-intelligence theory
• Group dynamics
• Power structures
• Health-work environments
Essential VIII: Clinical Prevention and Population Health for Improving Health
Globally, the burden of illness, communicable disease, chronic disease conditions, and
subsequent health inequity and disparity, is borne by those living in poverty and living in
low-income and middle-income countries (Beaglehole et al., 2007; Gaziano et al., 2007;
WHO, 2008). Similarly, in the U.S. population, health disparities continue to affect
disproportionately low-income communities, people of color, and other vulnerable
populations (USHHS, 2006).
The implementation of clinical prevention and population health activities is central to
achieving the national goal of improving the health status of the population of the United
States. Unhealthy lifestyle behaviors continue to account for over 50 percent of
preventable deaths in the U.S., yet prevention interventions remain under-utilized in
healthcare settings. In an effort to address this national goal, Healthy People 2010
supported the transformation of clinical education by creating an objective to increase the
proportion of schools of medicine, nursing, and other health professionals that have a
basic curriculum that includes the core competencies in health promotion and disease
prevention (Allan et al., 2004; USHHS, 2000). In the Healthy People 2010 Midcourse
Review, health disparities are not declining overall, reiterating the necessity to implement
and evaluate the effectiveness of disease prevention and health promotion efforts
(USHHS, 2006). Cognizant of these trends and successive health outcome data, it will be
necessary to re-evaluate these data and for nursing to re-assess its leadership role and
responsibility toward improving the population’s health.
The Healthy People Curriculum Task Force developed the Clinical Prevention and
Population Health Curriculum Framework, which identifies four focal areas, including
individual and population-oriented preventive interventions. This curriculum guides the
development and evaluation of educational competencies expected of health
professionals in clinical prevention and population health, and endorsed by clinical
professional associations, including AACN (Allan, 2004; APTR, 2009).
As the diversity of the U.S. population increases, it is crucial that the health system
provides care and services that are equitable and responsive to the unique cultural and
ethnic identity, socio-economic condition, emotional and spiritual needs, and values of
patients and the population (IOM, 2001; 2003). Nursing leadership within health systems
is required to design and ensure the delivery of clinical prevention interventions and
population-based care that promotes health, reduces the risk of chronic illness, and
prevents disease. Acquiring the skills and knowledge necessary to meet this demand is
essential for nursing practice (Allan et al., 2004; Allan et al., 2005).
The master’s-prepared nurse applies and integrates broad, organizational, patientcentered,
and culturally responsive concepts into daily practice. Mastery of these
concepts based on a variety of theories is essential in the design and delivery (planning,
management, and evaluation) of evidence-based clinical prevention and population care
and services to individuals, families, communities, and aggregates/clinical populations
nationally and globally.
The master’s-degree program prepares the graduate to:
1. Synthesize broad ecological, global and social determinants of health; principles
of genetics and genomics; and epidemiologic data to design and deliver evidencebased,
culturally relevant clinical prevention interventions and strategies.
2. Evaluate the effectiveness of clinical prevention interventions that affect
individual and population-based health outcomes using health information
technology and data sources.
3. Design patient-centered and culturally responsive strategies in the delivery of
clinical prevention and health promotion interventions and/or services to
individuals, families, communities, and aggregates/clinical populations.
4. Advance equitable and efficient prevention services, and promote effective
population-based health policy through the application of nursing science and
other scientific concepts.
5. Integrate clinical prevention and population health concepts in the development of
culturally relevant and linguistically appropriate health education, communication
strategies, and interventions.
Sample Content
• Environmental health
• Epidemiology
• Biostatistical methods and analysis
• Disaster preparedness and management
• Emerging science of complementary and alternative medicine and therapeutics
• Ecological model of the social determinants of health
• Teaching and learning theories
• Health disparities, equity and social justice
• Program planning, design, and evaluation
• Quality improvement and change management
• Health promotion and disease prevention
• Application of health behavior modification
• Health services financing
• Health information management
• Ethical frameworks
• Interprofessional collaboration
• Theories and applications of health literacy and health communication
• Genetics/genomic risk assessment for vulnerable populations
• Organization of clinical, public health, and global systems
• Frameworks for community and political engagement, advocacy, and
• Frameworks for addressing global health and emerging health issues
• Nursing Theories
Essential IX: Master’s-Level Nursing Practice
Essential IX describes master’s-level nursing practice at the completion of the master’s
program in nursing. Nursing practice at the master’s level is broadly defined as any form
of nursing intervention that influences healthcare outcomes for individuals, populations,
or systems. Master’s-level nursing graduates must have an expanded level of
understanding of nursing and related sciences built on the Essentials of Baccalaureate
Education for Professional Nursing Practice. Master’s-prepared nurses have developed a
deeper understanding of the nursing profession based on reflective practices and continue
to develop their own plans for lifelong learning and professional development.
Nursing-practice interventions include both direct and indirect care components. As a
practice discipline, clinical care is the core business of nursing practice whether the
graduate is focused on the provision of care to individuals, population-focused care,
administration, informatics, education or health policy. Master’s nursing education
prepares graduates to implement safe, quality care in a variety of settings and roles.
This Essential includes the practice-focused outcomes for all master’s-prepared nurses.
Master’s level nursing practice builds upon the practice competencies delineated in the
Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008).
Master’s-prepared nurses possess a mastery level of understanding of nursing theory,
science and practice. Recent and evolving trends in health care require integration of key
concepts into all master’s-prepared nursing practice. This includes concepts related to
quality improvement, patient safety, economics of health care, environmental science,
epidemiology, genetics/genomics, gerontology, global healthcare environment and
perspectives, health policy, informatics, organizations and systems, communication,
negotiation, advocacy, and interprofessional practice.
Master’s nursing education prepares graduates to influence the delivery of safe, quality
care to diverse populations in a variety of settings and roles. The realities of a global
society, expanding technologies, and an increasingly diverse population require these
nurses to master complex information, to coordinate a variety of care experiences, to use
technology for healthcare information and evaluation of nursing outcomes, and to assist
diverse patients with managing an increasingly complex system of care. The master’sprepared
nurse is accountable for assessing the impact of research and advocates for
participants, personnel, and systems integrity. As master’s-prepared nurses practicing in
any setting or role, graduates must understand the foundations of care and the art and
science of nursing practice as it relates to individuals, families, and clinical populations
within an increasingly complex healthcare system. The extraordinary explosion of
knowledge in the field also requires an increased emphasis on lifelong learning.
Essential IX specifies the foundational practice competencies that cut across all areas of
practice and are seen as requisite for all master’s level nursing practice. Master’s-degree
nursing programs provide learning experiences that are based in a variety of settings.
These learning experiences will be integrated throughout the master’s program of study,
to provide additional practice experiences beyond those acquired in a baccalaureate or
entry-level nursing program.
The master’s-degree program prepares the graduate to:
1. Conduct a comprehensive and systematic assessment as a foundation for decision
2. Apply the best available evidence from nursing and other sciences as the
foundation for practice.
3. Advocate for patients, families, caregivers, communities and members of the
healthcare team.
4. Use information and communication technologies to advance patient education,
enhance accessibility of care, analyze practice patterns, and improve health care
outcomes, including nurse sensitive outcomes.
5. Use leadership skills to teach, coach, and mentor other members of the healthcare
6. Use epidemiological, social, and environmental data in drawing inferences
regarding the health status of patient populations and interventions to promote and
preserve health and healthy lifestyles.
7. Use knowledge of illness and disease management to provide evidence-based care
to populations, perform risk assessments, and design plans or programs of care.
8. Incorporate core scientific and ethical principles in identifying potential and
actual ethical issues arising from practice, including the use of technologies, and
in assisting patients and other healthcare providers to address such issues.
9. Apply advanced knowledge of the effects of global environmental, individual and
population characteristics to the design, implementation, and evaluation of care.
10. Employ knowledge and skills in economics, business principles, and systems in
the design, delivery, and evaluation of care.
11. Apply theories and evidence-based knowledge in leading, as appropriate, the
healthcare team to design, coordinate, and evaluate the delivery of care.
12. Apply learning, and teaching principles to the design, implementation, and
evaluation of health education programs for individuals or groups in a variety of
13. Establish therapeutic relationships to negotiate patient-centered, culturally
appropriate, evidence-based goals and modalities of care.
14. Design strategies that promote lifelong learning of self and peers and that
incorporate professional nursing standards and accountability for practice.
15. Integrate an evolving personal philosophy of nursing and healthcare into one’s
nursing practice.
Sample Content
• Principles of leadership, including horizontal and vertical leadership
• Effective use of self
• Advocacy for patients, families, and the discipline
• Conceptual analysis of the master’s-prepared nurse’s role(s)
• Principles of lateral integration of care
• Clinical Outcomes Management, including the measurement and analysis of patient
• Epidemiology
• Biostatistics
• Health promotion and disease reduction/ prevention management for patients and
clinical populations
• Risk assessment
• Health literacy
• Principles of mentoring, coaching and counseling
• Principles of adult learning
• Evidence-based practice:
o Clinical decision making and judgment
o Critical thinking
o Problem Identification
o Outcome measurement
• Care environment management
• Team coordination, including delegation, coaching, interdisciplinary care, group
• Negotiation, understanding group dynamics, conflict resolution
• Healthcare reimbursement and reform and how it impacts practice
• Resource allocation
• Use of healthcare technologies to improve patient care delivery and outcomes
• Healthcare finance and socioeconomic principles
• Principles of quality management/risk reduction/patient safety
• Informatics principles and use of standardized language to document care and
outcomes of care
• Educational strategies
• Learning styles
• Cultural competence/awareness
• Global health care environment, international law, geopolitics, and geo-economics
• Nursing and other scientific theories
• Appreciative inquiry
• Reflective practices
Clinical/Practice Learning Expectations for Master’s Programs
All graduates of a master’s nursing program must have supervised clinical experiences,
which are sufficient to demonstrate mastery of the Essentials. The term “supervised” is
used broadly and can include precepted experiences with faculty site visits. These
learning experiences may be accomplished through diverse teaching methodologies,
including face-to-face and simulated means. The primary goals of clinical learning
experiences are the opportunities to:
• Lead change to improve quality care outcomes,
• Advance a culture of excellence through lifelong learning
• Build and lead collaborative interprofessional care teams,
• Navigate and integrate care services across the healthcare system,
• Design innovative nursing practices, and
• Translate evidence into practice.
Mastery in nursing practice is acquired by the student through a series of applied learning
experiences designed to allow the learner to integrate cognitive learning with the
affective and psychomotor domains of nursing practice. The clinical/practice experiences
allow the learner to experiment and acquire competence with new knowledge and skills.
These experiences provide the opportunity for delivery of services or programs of wide
diversity and focus and may occur in multiple settings including hospitals, community
settings, public health departments, primary care practice offices, integrated health care
systems, and an array of other settings.
The clinical experience is an opportunity to integrate didactic learning, promote
innovative thinking, and test new potential solutions to clinical/practice or system issues.
Therefore, the development of new skills and practice expectations can be facilitated
through the use of creative learning opportunities in diverse settings. These learning
opportunities may include experiences in business, industries, and with disciplines that
are recognized as innovators in safety, quality, finance, management, or technology.
Through these experiences, the student may develop an appreciation and use the wisdom
from other industries and disciplines in nursing practice that can occur through
application of knowledge or evidence developed in other industries.
These learning experiences also can occur using simulation designed as a mechanism for
verifying early mastery of new levels of practice or designed to create access to data or
health care situations that are not readily accessible to the student. These experiences may
include simulated mass casualty events, simulated database problems, simulated
interpersonal communication scenarios, and other new emerging learning technologies.
The simulation is an adjunct to the learning that will occur with direct human interface or
human experience learning.
Development of mastery also is facilitated through the use of focused and sustained
clinical experiences, which provide the learner with the opportunity to master the patient
care delivery skills as well as the system assessment and intervention skills which require
an understanding of organizational dynamics. These immersion experiences afford the
student an opportunity to focus on a population of interest and a specific role. Most often,
the immersion experience occurs toward the end of the program as a culminating
synthesis experience for the program. In some instances, the master’s student may engage
in a clinical experience at the student’s employing agency. This arrangement requires a
systematic assessment of that setting’s ability to allow the student to engage in new
practice activities, framed by the learning objectives of the program, and overseen or
supervised by a mentor/preceptor or faculty member. This type of learning experience
will be designed to assist the learner to acquire master’s-degree nursing knowledge and
practice master’s-degree roles.
Supervised clinical experiences will be verified and documented. One example of such
documentation is the use of a professional portfolio. This portfolio may also provide a
foundation or template for the graduate’s future professional career trajectory and
The Essentials of Master’s Education in Nursing serves to transform nursing education
and is critical to the innovations needed in health care. Due to the ever-changing and
complex healthcare environment, this document emphasizes that the master’s-prepared
nurse will be able to: 1) lead change for quality care outcomes; 2) advance a culture of
excellence through lifelong learning; 3) build and lead collaborative interprofessional
care teams; 4) navigate and integrate care services across the healthcare system; 5) design
innovative nursing practices; and 6) translate evidence into practice. Master’s degree
nursing programs prepare graduates with enhanced nursing knowledge and skills to
address the evolving needs of the healthcare system.
Essentials I-IX delineate the outcomes expected of graduates of master’s nursing
programs. Achievement of these outcomes will enable graduates to lead and practice in
complex healthcare systems in a variety of direct and/or indirect care roles. The breadth
of knowledge, the extent of experiential learning, and therefore the time needed to
accomplish each Essential will vary, and each Essential does not require a separate course
for achievement of the outcomes.
Clinical experiences in master’s programs are opportunities to integrate didactic learning,
promote innovative thinking and test new potential solutions to clinical/practice or
system issues. Therefore, the development of new skills and practice expectations can be
facilitated through the use of creative learning opportunities in diverse settings. In
addition, the extraordinary explosion of knowledge in the healthcare field requires the
master’s-prepared nurse to have an increased emphasis on lifelong learning and
professional development.
Administration: Administration comprises working with and through others to achieve
the mission, values, and vision of an organization. Administration is an executive
function within an organization and has ultimate accountability for defining and
achieving the organization’s strategic plan. Administration designates responsibility for
implementing organizational goals. (Council on Graduate Education for Administration
in Nursing, 2010)
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,
Advanced Practice Registered Nurse (APRN): 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 nonpharmacologic
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 practitioner (CNP).
(APRN Consensus Model, 2008)
Advocacy: Defending or maintaining a cause or proposal on behalf of the patient, client,
or profession to achieve societal or other goals (Interprofessional Professionalism
Collaborative, 2008)
Aggregate(s): A community or a group of individuals defined by shared characteristics
such as, age, culture, diagnosis, gender, geography, or values (adapted from Allan et al.,
Altruism: A concern for the welfare and well being of others. In professional practice,
altruism is reflected by the nurse’s concern and advocacy for the welfare of patients,
other nurses, and other healthcare providers (American Association of Colleges of
Nursing, 2008, p. 27).
Autonomy: The right to self-determination. Professional practice reflects autonomy when
the nurse respects patients’ rights to make decisions about their health care (AACN,
2008, p. 27).
Care Coordination: Ensures patients receive well-coordinated care across all healthcare
organizations, settings, and levels of care (National Priorities Partnership, 2008).
Clinical Practice: The care of individuals or families, irrespective of setting.
Clinical Prevention: Health promotion and risk reduction/illness prevention for
individuals, families, aggregates, or clinical populations (Allan et al, 2004).
Clinical Preventive Services: Screening, vaccination, counseling, or other preventive
service delivered to one patient at a time by a healthcare practitioner in an office, clinic,
healthcare system, or other practice environment (adapted from Centers for Disease
Control and Prevention, 2009). See also Community Preventive Services.
Community Preventive Services: Interventions that provide or increase the provision of
preventive services such as screening, education, counseling, or other programs to groups
of people, in community settings, healthcare systems, or other practice environments
(adapted from Centers for Disease Control and Prevention, 2009). See also Clinical
Preventive Services.
Culturally Responsive: Culturally responsive refers to being cognizant of patients’
norms, beliefs, language, and behaviors that not only shape the meaning of their health
but also their health-seeking and health-related behaviors. The constructs reinforce the
idea that each practitioner should be engaged continuously in self reflection about their
own personal beliefs, norms, behaviors and language and how together they guide their
perceptions, beliefs, and interactions with patients. The culturally responsive practitioner
focuses on the importance of building upon each patient’s personal strengths as well as
available resource and supports which provide the foundational underpinning of these
respective strengths. The culturally responsive practitioner also engages in a dynamic,
respectful, and reciprocal dialogue with each person irrespective of their race, ethnicity,
gender, social position, sexual orientation, immigration status, and educational level
(Ring et al, 2009).
Delivery: The planning, management, and evaluation of evidence-based practice and
clinical care across healthcare settings.
Direct Care/ Indirect Care:
Direct care refers to nursing care provided to individuals or families that is intended to
achieve specific health goals or achieve selected health outcomes. Direct care may be
provided in a wide range of settings, including acute and critical care, long term care,
home health, community-based settings, and educational settings (AACN, 2004, 2006;
Suby, 2009; Upenieks, Akhavan, Kotlerman et al., 2007).
Indirect care refers to nursing decisions, actions, or interventions that are provided
through or on behalf of individuals, families, or groups. These decisions or interventions
create the conditions under which nursing care or self care may occur. Nurses might use
administrative decisions, population or aggregate health planning, or policy development
to affect health outcomes in this way. Nurses who function in administrative capacities
are responsible for direct care provided by other nurses. Their administrative decisions
create the conditions under which direct care is provided. Public health nurses organize
care for populations or aggregates to create the conditions under which care and
improved health outcomes are more likely. Health policies create broad scale conditions
for delivery of nursing and health care (AACN, 2004, 2006; Suby, 2009; Upenieks,
Akhavan, Kotlerman et al., 2007).
Diverse populations: Diversity is an all-inclusive concept, and includes differences in
race, color, ethnicity, national origin, immigration status (refugee, sojourner, immigrant,
or undocumented), religion, age, gender, gender identity, sexual orientation,
ability/disability, political beliefs, social and economic status, education, occupation,
spirituality, marital and parental status, urban versus rural residence, enclave identity, and
other attributes of groups of people in society (Giger et al., 2007; Purnell & Paulanka,
Ethics: The rules or principles that govern right conduct (Kozier & Erb, 2007).
Evidenced-based Practice: The integration of best research evidence, clinical research,
and patient values in making decisions about the care of individual patients (IOM, 2003).
Genetics: Study of individual genes and their impact on relatively rare single-gene
disorders (Guttmacher & Collins, 2002).
Genomics: Study of all the genes in the human genome together, including their
interactions with each other, the environment, and the influence of other psychosocial and
cultural factors (Guttmacher & Collins, 2002).
Health Disparities: Health disparities are differences in the incidence, prevalence,
mortality, and burden of disease and other adverse health conditions that exist among
specific population groups in the United States (National Institutes of Health, 2002-
2006). The definition of health disparities assumes not only a difference in health but a
difference in which disadvantaged social groups—who have persistently experienced
social disadvantage or discrimination—systematically experience worse health or greater
health risks than more advantaged social groups (Braveman, 2006). Consideration of who
is considered to be within a health disparity population has policy and resource
implications (American Association of Colleges of Nursing, 2009).
Health Education Programs: Any program designed to educate individuals, families,
groups, communities, health professionals to improve health outcomes.
Health Equity: A basic principle that all people have a right to health. Health equity
concerns those differences in population health that can be traced to unequal economic
and social conditions and are systemic and avoidable and thus inherently unjust and
unfair (Brennan, Baker, & Meltzer, 2008).
Health Literacy: The degree to which individuals have the capacity to obtain, process,
and understand basic health information and services needed to make appropriate health
decisions (U.S. Department of Health and Human Services, 2000b).
High-Reliability Organizations (HRO): Organizations or systems that operate in
hazardous conditions but have fewer than their fair share of adverse events (Weick, 2001;
Reason, 2001). Commonly discussed examples include air traffic control systems,
nuclear power plants, and naval aircraft carriers (LaPorte, 1988; Roberts, 1990). It is
worth noting that, in the patient safety literature, HROs are considered to operate with
nearly failure-free performance records, not simply better than average ones. These
organizations achieve consistently safe and effective performance records despite
unpredictable operating environments or intrinsically hazardous endeavors. Some
common features of HROs include:
• Preoccupation with failure—the acknowledgment of the high-risk, error-prone
nature of an organization’s activities and the determination to achieve consistently
safe operations.
• Commitment to resilience—the development of capacities to detect unexpected
threats and contain them before they cause harm, or bounce back when they do.
• Sensitivity to operations—an attentiveness to the issues facing workers at the
frontline. This feature comes into play when conducting analyses of specific
events but also in connection with organizational decision making. Management
units at the frontline are given some autonomy in identifying and responding to
threats, rather than adopting a rigid top-down approach.
• A culture of safety—the atmosphere in which individuals feel comfortable
drawing attention to potential hazards or actual failures without fear of censure
from management (Agency for Healthcare Research and Quality, 2009).
Horizontal and Vertical Health Delivery Systems: Health systems are comprised of a
“horizontal system” focused on integrated resource sharing health services, providing
prevention and care for prevailing health problems, and of “vertical systems” focused on
disease specific interventions for specific health conditions (World Health Organization,
Human Dignity: Respect for the inherent worth and uniqueness of individuals and
populations. In professional practice, concern for human dignity is reflected when the
nurse values and respects all patients and colleagues (American Association of Colleges
of Nursing, 2008, p. 28).
Informatics: The use of information and technology to communicate, manage
knowledge, mitigate error, and support decision making (Quality and Safety Education
for Nurses, 2010).
Integrity: Acting in accordance with an appropriate code of ethics and accepted standards
of practice. Integrity is reflected in professional practice when the nurse is honest and
provides care based on an ethical framework that is accepted within the profession
(AACN, 2008, p. 28).
Interprofessional: Working across healthcare professions to cooperate, collaborate,
communicate, and integrate care in teams to ensure that care is continuous and reliable.
The team consists of the patient, the nurse, and other healthcare providers as appropriate
(IOM, 2003)
Just Culture: This phrase was popularized in the patient safety lexicon by a report
(Marx, 2001) that outlined principles for achieving a culture in which frontline personnel
are comfortable disclosing errors—including their own—while maintaining professional
accountability. The examples in the report relate to transfusion safety, but the principles
clearly generalize across domains within health care organizations.
Traditionally, healthcare’s culture has held individuals accountable for all errors or
mishaps that befall patients under their care. By contrast, a just culture recognizes that
individual practitioners should not be held accountable for system failings over which
they have no control. A just culture also recognizes many individual or “active” errors
represent predictable interactions between human operators and the systems in which
they work. However, in contrast to a culture that touts “no blame” as its governing
principle, a just culture does not tolerate conscious disregard of clear risks to patients or
gross misconduct.
In summary, a just culture recognizes that competent professionals make mistakes and
acknowledges that even competent professionals will develop unhealthy norms but has
zero tolerance for reckless behavior (Agency for Healthcare Research and Quality, 2009).
Leadership: Leadership is the process of influencing others toward the attainment of one
or more goals. Leadership comprises two types: formal and informal. Formal leadership
occurs through official titular designations within an organization or society. Informal
leadership occurs when the perceptions and actions of others are influenced by
individuals without such official organizational or societal designations. Leadership is not
limited to the accomplishment of organizational goals (Council on Graduate Education
for Administration in Nursing, 2010).
Liberal Education: A comprehensive sets of aims and outcomes that are essential both
for a globally engaged democracy and for a dynamic, innovation-fueled economy
(American Association of Colleges &Universities, 2007).
Management: Management is the process of aligning resources with needs to attain
specific goals. Management includes planning, organizing, motivating, monitoring, and
evaluating human and material resources. Although management usually refers to a midlevel
formal leadership function within an organization, it is also the process used at any
level to align and allocate resources (Council on Graduate Education for Administration
in Nursing, 2010).
Metaparadigm: Represents the worldview of a discipline (the most global perspective
that subsumes more specific views and approaches to the central concepts with which it is
concerned). There is considerable agreement that nursing’s metaparadigm consists of the
central concepts of person, environment, health, and nursing (Powers & Knapp, 1990, p.
Macrosystem: Actions taken by senior leaders who are responsible for organization-wide
performance (Nelson et al, 2007, p.205).
Mesosystem: Actions taken by the midlevel leaders who are responsible for large clinical
programs, clinical support services, and administrative services (Nelson et al., 2007,
Microsystem: Clinical Microsystems are the small, functional frontline units that provide
most health care to most people (Nelson et al., 2007, p.3).
Nursing Science: A basic science that is the substantive, discipline-specific knowledge
that focuses on the human-universe-health process articulated in nursing frameworks and
theories. The discipline-specific knowledge resides within schools of thought that reflect
differing philosophical perspectives that give rise to ontological, epistemological, and
methodological processes for the development and use of knowledge concerning
nursing’s unique phenomenon of concern (Parse et al., 2000).
Organizational Science: An interdisciplinary field of inquiry focusing on employee and
organizational health, well-being, and effectiveness. Organizational Science is both a
science and a practice, founded on the notion that enhanced understanding leads to
applications and interventions that benefit the individual, work groups, the organization,
the customer, the community, and the larger society in which the organization operates
(University of North Carolina, 2009).
Patient: The term refers to the recipient of a healthcare service or intervention at the
individual, family, community, aggregate/population level. Further, patients may function
in independent, interdependent, or dependent roles, and may seek or receive nursing
interventions related to disease prevention, health promotion, or health maintenance, as
well as illness and end-of-life care. Depending on the context or setting, patients may, at
times, more appropriately be termed clients, consumers, or clients of nursing services
(AACN, 1998, p. 2).
Population: Refers to a set of persons having a common personal or environmental
characteristic. The common characteristic might be anything thought to relate to health,
such as age, race, sex, social class, medical diagnosis, level of disability, exposure to a
toxin, or participation in a health-seeking behavior, such as smoking cessation. It is the
researcher or health practitioner who identifies the characteristic and set of persons that
make up this population (Maurer & Smith, 2004).
Population-based Health: Inclusive of aggregates, community, and/or clinical
populations that consider the environmental, occupational, and cultural, socio-economic
and other dimensions of health (Allan et al., 2004), and derives evidence from population
level data and statistics (Starfield, Hyde, Gervas, & Heath, 2007).
Professionalism: The consistent demonstration of core values evidenced by nurses
working with other professionals to achieve optimal health and wellness outcomes in
patients, families, and communities by wisely applying principles of altruism, excellence,
caring, ethics, respect, communication, and accountability (Interprofessional
Professionalism Collaborative, 2008). Professionalism involves accountability for one’s
self and nursing practice, including continuous professional engagement and lifelong
learning. As discussed in the American Nurses Association Code of Ethics for Nursing
(2005, p.16), “The nurse is responsible for individual nursing practice and determines the
appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum
patient care.” Also, inherent in accountability is responsibility for individual actions and
behaviors, including civility. In order to demonstrate professionalism, civility must be
present. Civility is a fundamental set of accepted behaviors for a society/culture upon
which professional behaviors are based (Hammer, 2003; American Association of
Colleges of Nursing, 2008).
Quality Improvement (QI): In health care, QI refers to giving patients the appropriate
care at the appropriate time and place with the appropriate mix of information and
supporting resources. In many cases, healthcare systems are overly cumbersome,
fragmented, and indifferent to patients’ needs. Quality improvement tools range from
those that simply make recommendations but leave decision-making largely in the hands
of individual practitioners (e.g., practice guidelines) to those that prescribe patterns of
care (e.g., critical pathways). Typically, QI efforts are strongly rooted in evidence-based
procedures and rely extensively on data collected about processes and outcomes (Robert
Wood Johnson Foundation, 2009).
Risk Management/Risk Mitigation: A managed program or effort directed at reducing
risk, avoiding accidents, and making effective use of purchased insurance (American
Nurses Association, 2009).
Self Mastery: The intentional growth and development of physical, emotional, mental,
and spiritual being. It allows for flexibility; comfort with chaos, ambiguity, and
uncertainty; and the ability to let go of control. The journey of self-mastery increases our
capacity to support and move others beyond fear (Viney & Rivers, 2007).
Social Justice: This concept relates to upholding moral, legal, and humanistic principles.
This value is reflected in professional practice when assuring equal treatment under the
law and equal access to quality health care (American Association of Colleges of
Nursing, 2007). Social Justice is acting in accordance with fair treatment regardless of
economic status, race, ethnicity, age, citizenship, disability, or sexual orientation”
(American Association of Colleges of Nursing, 2008, p. 28).
Translational research: Translational research includes two areas of translation. One is
the process of applying discoveries generated during research in the laboratory, and in
preclinical studies, to the development of trials and studies in humans. The second area of
translation concerns research aimed at enhancing the adoption of best practices in the
Values: Something of worth; a belief held dearly by a person (Kozier & Erb, 2007).
Vulnerable Populations: Refers to social groups with increased relative risk (e.g.,
exposure to risk factors) or susceptibility to health-related problems. Vulnerability is
evidenced in higher comparative mortality rates, lower life expectancy, reduced access to
care, and diminished quality of life (UCLA School of Nursing, 2008).

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