Week 11_journal entry

POPULATION-FOCUSED NURSE
PRACTITIONER COMPETENCIES

Family/Across the Lifespan

Neonatal

Pediatric Acute Care

Pediatric Primary Care

Psychiatric-Mental Health

Women’s Health/Gender-Related

2013

Population-Focused Competencies Task Force
2013

3 Population-Focused Nurse Practitioner Competencies

Population-Focused Competencies Task Force

Task Force Chair
Anne Thomas, PhD, ANP-BC, GNP, FAANP
National Organization of Nurse Practitioner Faculties

Task Force Members
Robin Bissinger, PhD, APRN, NNP-BC
National Certification Corporation
NNP Work Group

Margaret Brackley, PhD, RN, FAAN, FAANP
National Organization of Nurse Practitioner Faculties
PMHNP Work Group

Bill Buron, PhD, RN, FNP/GNP-BC
American Academy of Nursing Gero-Psych Project
FNP Work Group

Renee Davis, MSN, RN, CPNP
American Association of Colleges of Nursing
PCPNP Work Group

Kathleen R. Delaney, PhD, PMH-NP
American Association of Colleges of Nursing
PMHNP Work Group

Evelyn Duffy, DNP, G/ANP-BC, FAANP
Gerontological Advanced Practice Nurses Association
FNP Work Group

Deb Gayer, PhD, RN, CPNP-PC
Pediatric Nursing Certification Board
PCPNP Work Group

Cathy Haut, DNP, CPNP, CCRN
American Association of Colleges of Nursing
ACPNP Work Group

Caroline Hewitt, DNS(c), WHNP-BC, ANP-BC
National Certification Corporation
WHNP Work Group

Susan Hoffstetter, PhD, WHNP-BC, FAANP
National Association of Nurse Practitioners in Women’s Health
FNP Work Group

Judy Honig, EdD, DNP
National Organization of Nurse Practitioner Faculties
PCPNP Work Group

Jean Ivey, DSN, CRNP, PNP-PC
Association of Faculties of PNPs
PCPNP Work Group

Tess Judge-Ellis, DNP, ARNP
National Organization of Nurse Practitioner Faculties
FNP Work Group

Rebecca Koeniger-Donahue, PhD, APRN-BC, WHNP-BC, FAANP
American Association of Colleges of Nursing
WHNP Work Group

Judy LeFlore, PhD, RN, NNP-BC, CPNP-PC&AC, ANEF, FAAN
National Organization of Nurse Practitioner Faculties
ACPNP Work Group

Nancy Magnuson, DSN, CS, FNP-BC
American Association of Colleges of Nursing
FNP Work Group

Julie Marfell, DNP, FNP-BC, FAANP
National Organization of Nurse Practitioner Faculties
FNP Work Group

Kathleen McCoy, DNSc PMHNP/BC, PMHCNS-BC, FNP-BC FAANP
American Nurses Credentialing Center
PMHNP Work Group

Karen Melillo, PhD, ANP-C, FAANP, FGSA
American Academy of Nursing Gero-Psychiatric Project
WHNP Work Group

Julie Miller, MSN, APRN, PNP-BC, FNP
American Nurses Credentialing Center
PCPNP Work Group

Jamille Nagtalon-Ramos, MSN, CRNP
National Association of Nurse Practitioners in Women’s Health
WHNP Work Group

Carol Patton, DrPH, RN, FNP-BC, CRNP, CNE
American Nurses Credentialing Center
FNP Work Group

Karin Reuter-Rice, PhD, CPNP-AC, CCRN, FCCM
Pediatric Nursing Certification Board
ACPNP Work Group

Lori Baas Rubarth, PhD, APRN-NP, NNP-BC
American Association of Colleges of Nursing
NNP Work Group

Debra Sansoucie, EdD, ARNP, NNP-BC
National Association of Neonatal Nurse Practitioners
NNP Work Group

Carol Savrin, CPNP, FNP, BC, FAANP
Association of Faculties of PNPs
FNP Work Group

Margaret Scharf, DNP, PMHCNS-BC, FNP-BC
International Society of Psychiatric Nursing
PMHNP Work Group

Lorna Schumann, PhD, NP-C, ACNP, BC, ACNS, BC, CCRN-R, FAANP
American Association of Nurse Practitioners Certification Program
FNP Work Group

Diane Seibert, PhD, ARNP, FAANP
National Organization of Nurse Practitioner Faculties
WHNP Work Group

Diane Snow, PhD, RN, PMHNP-BC, CARN, FAANP
National Organization of Nurse Practitioner Faculties
PMHNP Work Group

Joan Stanley, PhD, CRNP, FAAN, FAANP
American Association of Colleges of Nursing
FNP, NNP, ACPNP, PCPNP, PMHNP, WHNP Work Groups

Judy Verger, RN, PhD
Association of Faculties of PNPs
ACPNP Work Group

Mary Weber, PhD, PMHNP-BC
American Psychiatric Nurses Association
PMHNP Work Group

5 Population-Focused Nurse Practitioner Competencies

POPULATION-FOCUSED NURSE PRACTITIONER COMPETENCIES:
Family/Across the Lifespan, Neonatal, Acute Care Pediatric, Primary Care
Pediatric, Psychiatric-Mental Health, & Women’s Health/Gender-Related

Introduction
Since the release of the 2008 APRN Consensus Model: Licensure, Accreditation, Certification, and Education, the
nurse practitioner (NP) community has been undertaking efforts to ensure congruence with the model. Within
education, NP programs have focused on changes to align educational tracks with the NP populations delineated
in the model. National organizations have supported these efforts through collaborative work on the NP
competencies that guide curriculum development. The first initiatives focused on the development of adult-
gerontology competencies (2010 and 2012). In 2011, a multi-organizational task force embarked on the challenge
to identify current competencies for the remaining NP population foci. This document presents the entry into
practice competencies for the Family/Across the Lifespan, Neonatal, Pediatric Acute Care, Pediatric Primary
Care, Psychiatric-Mental Health, and Women’s Health/Gender-Related nurse practitioners. These competencies
explicate the unique characteristics and role of each population foci and are designed to augment the NP core
competencies.

Background
The National Organization of Nurse Practitioner Faculties (NONPF) released the first set of core competencies for
all nurse practitioners in 1990 and subsequently has revised them in 1995, 2000, 2002, 2006, 2011, and 2012.
Recognizing the need to give NP programs further guidance in an area of focus, NONPF, in collaboration with the
American Association of Colleges of Nursing (AACN), facilitated the development of the first sets of population-
specific competencies. In 2002, a national panel completed the work to identify competencies in the NP primary
care areas of Adult, Family, Gerontological, Pediatric, and Women’s Health. In 2003, work groups released the
Acute Care Nurse Practitioner Competencies and the Psychiatric-Mental Health Nurse Practitioner
Competencies. The development of these population-focused competencies involved a national, consensus
process that remains in place today and was used with the 2012 population-focused competencies.

The APRN Consensus Model made a few changes to the population foci for NP educational tracks. Notably, the
adult and gerontology foci were merged, and both the adult-gerontology and pediatric foci are distinguished as
being primary care or acute care. In addition, the Consensus Model stipulates that the Psychiatric-Mental Health
focus crosses the lifespan. Competencies specific to these newly defined population foci did not exist. In 2011
with funding from The John A. Hartford Foundation, AACN, in collaboration with NONPF, delineated the adult-
gerontology competencies in primary care and acute care. Recognizing the need for competencies that align with
each population foci in the Model, NONPF convened a national task force in 2011 to review previous work and
delineate updated entry-level competencies for the remaining population foci.

The task force includes representatives of various organizations from nursing education and certification. The task
force formed sub-groups to identify the competencies for each population focus and also convened periodically as
a whole for discussion. The sub groups included representatives from the stakeholder organizations that
corresponded with the focus area. The task force invited review of the competencies in an external validation
process, and the final competencies reflect the feedback obtained in this step.

The APRN Core
The APRN Consensus Model stipulates that an APRN education program must include at a minimum three
separate comprehensive graduate-level courses known as the APRN core. The APRN core consists of: advanced
physiology/pathophysiology, including general principles that apply across the lifespan; advanced health
assessment, which includes assessment of all human systems, advanced assessment techniques, concepts and
approaches; and advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and
pharmacotherapeutics of all broad categories of agents. In addition to the broad-based content described above,
the work groups chose to suggest content within the population-focused competencies related to the three core
courses as it pertained to the specific population. This was done to illustrate the differences in application of the
broad-based core courses as it related to therapeutic management of the various populations.

The Relationship of the NP Core and Population-Focused Competencies
Each entry-level NP is expected to meet both the NP core competencies and the population-focused
competencies in the area of educational preparation. Accordingly, NP educational programs use both NP core
competencies and population-focused competencies to guide curriculum development.

At the time the task force began its work, NONPF had just released a new set of core competencies for NPs. This
new set represented NONPF’s endorsement of the transition of NP education to the doctoral level and an
integration of previous Master’s-level core competencies with the practice doctorate NP competencies released
by NONPF in 2006. The NONPF Board had charged a task force to integrate the two documents with the goal of
having one set of NP core competencies to guide educational programs preparing NPs to implement the full
scope of practice as a licensed independent practitioner.

The new core competencies moved away from the previous 7 domains as a framework and instead used nine
core competency areas that delineate the essential behaviors of all NPs. These are demonstrated upon
graduation regardless of the population focus of the program. The competencies are necessary for NPs to meet
the complex challenges of translating rapidly expanding knowledge into practice and function in a changing health
care environment. The new, nine competency areas also provide the framework for the population-focused
competencies.

Other Resource Material for NP Programs
During the development of the population-focused competencies, the task force recognized that other national
documents are critical to NP curriculum development. The task force felt it very important to delineate the
following as critical resources for refinement of specific skill sets necessary to provide evidence-based, patient-
centered care across all settings:

 The Future of Nursing: Leading Change, Advancing Health (IOM, 2011)
 Core Competencies for Interprofessional Collaborative Practice (2011)
 Quality and Safety Education for Nurses (QSEN) Graduate Competency KSAs (2012)
 Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (2012)
 The Essentials of Master’s Education in Nursing (AACN, 2011)
 The Essentials of Doctoral Education for Advanced Practice Nursing (AACN, 2006)
 Oral Health Core Clinical Competencies for non-Dental Providers (to be released 2013)

How to Use This Document
The following pages include five sets of population-focused competencies. Each set is presented in a table format
to emphasize the relationship of the population-focused competencies with the NP core competencies. The
expectation is that an educational program will prepare the student to meet both sets of competencies.

In the development of the competencies, the task force had extensive discussions of competencies vs. content.
The task force concluded that it would be beneficial to programs if some content could be included as exemplars
of how to support curriculum development for addressing a competency. The final column in each table presents
the competency work group’s ideas of relevant content. This list is not intended to be required content, nor is
the content list comprehensive for all that a program would cover with the core competencies. The
content column reflects only suggestions for content from the specific perspective of this population
focus. Content specific to the core might be highlighted here only because of particular relevance to the
population focus.

A Glossary of Terms appears after the competencies. Any population-specific terms have been added to this
glossary. The task force hopes that this glossary will facilitate common understanding of key terms.

Each set of competencies includes a brief preamble to describe the population focus. The preamble is
intentionally brief and not intended to be a full description of the NP. Definitions of the NP are found in the APRN
Consensus Model (2008).

Future Work
To supplement the tables presented herein and give further guidance to NP educational programs, an addendum
will soon be available to show the content supporting the core competencies that crosses all the population foci.

NONPF will maintain a commitment to reconvene organizational representatives for periodic re-evaluation and
updating of the population-focused competencies.

Family / Across the Lifespan NP Competencies
These are entry-level competencies for the family nurse practitioners (FNP) and supplement the core
competencies for all nurse practitioners.

The graduate of an FNP program is prepared to care for individuals and families across the lifespan. The FNP
role includes preventative healthcare, as well as the assessment, diagnosis and treatment of acute and chronic
illness and preventative health care for individuals and families. Family nurse practitioners demonstrate a
commitment to family –centered care and understand the relevance of the family’s identified community in the
delivery of family- centered care.

See the “Introduction” for how to use this document and to identify other critical resources to supplement these
competencies.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and
evidence for improving advanced
nursing practice.

2. Integrates knowledge from the
humanities and sciences within the
context of nursing science.

3. Translates research and other
forms of knowledge to improve
practice processes and outcomes.

4. Develops new practice
approaches based on the
integration of research, theory,
and practice knowledge.

Leadership
Competencies

1. Assumes complex and
advanced leadership roles to
initiate and guide change.

1. Works with individuals of other professions
to maintain a climate of mutual respect and
shared values.

Roles of the Family/Lifespan NP: health care
provider, coordinator, consultant, educator,
coach, advocate, administrator, researcher,

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to
improve health care…

3. Demonstrates leadership that uses
critical and reflective thinking.

4. Advocates for improved access,
quality and cost effective health
care.

5. Advances practice through the
development and implementation
of innovations incorporating
principles of change.

6. Communicates practice
knowledge effectively, both orally
and in writing.

7. Participates in professional
organizations and activities that
influence advanced practice
nursing and/or health outcomes of
a population focus.

2. Engages diverse health care professionals
who complement one’s own professional
expertise, as well as associated resources, to
develop strategies to meet specific patient
care needs.

3. Engages in continuous professional and
interprofessional development to enhance
team performance.

4. Assumes leadership in interprofessional
groups to facilitate the development,
implementation and evaluation of care
provided in complex systems.

and leader.

Building and maintaining a therapeutic team to
provide optimum therapy.

Skills for interpretation and marketing
strategies of the family/lifespan nurse
practitioner role for the public, legislators,
policy-makers, and other health care
professions.

Advocacy for the role of the advanced practice
nurse in the health care system.

Importance of participation in professional
organizations.

Acceptance and embracement of cultural
diversity and individual differences that
characterize patients, populations, and the
health care team and embrace the cultural
diversity and individual differences that
characterize patients, populations, and the
health care team.

Recognition and respect for the unique
cultures, values, roles/responsibilities and
expertise of other health care team members.

Importance of honesty and integrity in
relationships with patients, families and other
team members .

Importance of knowledge and opinions to team
members involved in patient care with
confidence, clarity, and respect and work to

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

ensure common understanding of information,
treatment and care decisions.

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety
and their influence on health care.

3. Evaluates how organizational
structure, care processes,
financing, marketing and policy
decisions impact the quality of
health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice
and is proactive in implementing
interventions to ensure quality.

Interpretation of professional strengths, role,
and scope of ability for peers, patients, and
colleagues.

Accountability for practice.

Highest standards of practice.

Self-evaluation concerning practice.

Use of self-evaluative information, including
peer review, to improve care and practice.

Professional development and the
maintenance of professional competence and
credentials.

Monitoring of quality of own practice .

Continuous quality improvement based on
professional practice standards and relevant
statutes and regulation.

Research to improve quality care.

Practice Inquiry
Competencies

1. Provides leadership in the
translation of new knowledge into
practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills
to improve health outcomes.

4. Leads practice inquiry, individually

Translation and application of research that is
client or patient centered and contributes to
positive change in the health of or the
healthcare delivery.

Use of an evidence-based approach to patient
management that critically evaluates and
applies research findings pertinent to patient
care management and outcomes.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

or in partnership with others.
5. Disseminates evidence from

inquiry to diverse audiences using
multiple modalities.

6. Analyzes clinical guidelines for
individualized application into
practice.

Technology and
Information Literacy
Competencies

1. Integrates appropriate
technologies for knowledge
management to improve health
care.

2. Translates technical and scientific
health information appropriate for
various users’ needs.
1.a Assesses the patient’s and

caregiver’s educational needs
to provide effective,
personalized health care.

1.b Coaches the patient and
caregiver for positive
behavioral change.

3. Demonstrates information literacy
skills in complex decision making.

4. Contributes to the design of
clinical information systems that
promote safe, quality and cost
effective care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

Use of available technology that enhances
safety and monitors health status and
outcomes.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality,
and cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

5. Analyzes the implications of health
policy across disciplines.

6. Evaluates the impact of
globalization on health care policy
development.

Strategies to influence legislation to promote
health and improve care delivery models
through collaborative and/or individual efforts.

The relationship between community/public
health issues and social problems (poverty,
literacy, violence, etc.) as they impact the
health care of patients.

Health Delivery
System
Competencies

1. Applies knowledge of
organizational practices and
complex systems to improve
health care delivery.

2. Effects health care change using
broad based skills including
negotiating, consensus-building,
and partnering.

3. Minimizes risk to patients and
providers at the individual and
systems level.

4. Facilitates the development of
health care systems that address
the needs of culturally diverse
populations, providers, and other
stakeholders.

Relationship- building values and the
principles of team dynamics to perform
effectively in different team roles to plan and
deliver patient/population-centered care that is
safe, timely, efficient, effective and equitable.

Planning, development, and implementation of
public and community health programs.

Policies that reduce environmental health
risks.

Cost, safety, effectiveness, and alternatives
when proposing changes in care and practice.

Organizational decision making.

Interpreting variations in outcomes.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

5. Evaluates the impact of health
care delivery on patients,
providers, other stakeholders, and
the environment.

6. Analyzes organizational structure,
functions and resources to
improve the delivery of care.

7. Collaborates in planning for
transitions across the continuum of
care.

Uses of data from information systems to
improve practice.

Business principles that affect long-term
financial viability of a practice, the efficient use
of resources, and quality of care.

Relevant legal regulations for nurse
practitioner practice, including reimbursement
of services.

Skills needed to assist individuals, their
families, and caregivers to navigate transitions
and negotiate care across healthcare delivery
system(s).

Process of design, implementation, and
evaluation of evidence-based, age-appropriate
professional standards and guidelines for care.

Ethics
Competencies

1. Integrates ethical principles in
decision making.

2. Evaluates the ethical
consequences of decisions.

3. Applies ethically sound solutions
to complex issues related to
individuals, populations and
systems of care.

Ethical dilemmas specific to interprofessional
patient/population-centered care situations.

Ethics to meet the needs of patients.

Ethical implications of scientific advances and
practices accordingly.

Independent
Practice
Competencies

1. Functions as a licensed
independent practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing

1. Obtains and accurately documents a relevant
health history for patients of all ages and in
all phases of the individual and family life
cycle using collateral information, as needed.

2. Performs and accurately documents
appropriate comprehensive or symptom-

The influence of the family or psychosocial
factors on patient illness.

Conditions related to developmental delays
and learning disabilities in all ages.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to include
health promotion, disease
prevention, health protection,
anticipatory guidance,
counseling, disease
management, palliative, and
end-of-life care.

3.b Uses advanced health
assessment skills to
differentiate between normal,
variations of normal and
abnormal findings.

3.c Employs screening and
diagnostic strategies in the
development of diagnoses.

3.d Prescribes medications within
scope of practice.

3.e Manages the health/illness
status of patients and families
over time.

4. Provides patient-centered care
recognizing cultural diversity and
the patient or designee as a full
partner in decision-making.
4.a Works to establish a

relationship with the patient
characterized by mutual
respect, empathy, and
collaboration.

focused physical examinations on patients of
all ages (including developmental and
behavioral screening, physical exam and
mental health evaluations).

3. Identifies health and psychosocial risk factors
of patients of all ages and families in all
stages of the family life cycle.

4. Identifies and plans interventions to promote
health with families at risk.

5. Assesses the impact of an acute and/or
chronic illness or common injuries on the
family as a whole.

6. Distinguishes between normal and abnormal
change across the lifespan.

7. Assesses decision-making ability and
consults and refers, appropriately.

8. Synthesizes data from a variety of sources to
make clinical decisions regarding appropriate
management, consultation, or referral.

9. Plans diagnostic strategies and makes
appropriate use of diagnostic tools for
screening and prevention, with consideration
of the costs, risks, and benefits to individuals.

10. Formulates comprehensive differential
diagnoses.

11. Manages common acute and chronic
physical and mental illnesses, including
acute exacerbations and injuries across the
lifespan to minimize the development of
complications, and promote function and
quality of living.

Women’s and men’s reproductive health,
including, but not limited to, sexual health,
pregnancy, and postpartum care.

Problems of substance abuse and violence, e.
mental health, f. cultural factors, g. genetics, h.
dental health, i. families at risk, j. cultural
health, k. spiritual, and l. sexual, M. academic
functioning Family assessment.

Functional assessment of family members
(e.g., elderly, disabled).

Signs and symptoms indicative of change in
mental status, e.g. agitation, anxiety,
depression, substance use, delirium, and
dementia.

Comprehensive assessment that includes the
differentiation of normal age changes from
acute and chronic medical and
psychiatric/substance use disease processes,
with attention to commonly occurring atypical
presentations and co-occurring health
problems including cognitive impairment.

Assessment processes for persons with
cognitive impairment and
psychiatric/substance use disorders.

Evidence-based screening tools for
assessment of:

a. ADHD
b. Anxiety disorders
c. Mood disorders

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy,
comfort, emotional support,
mutual trust, and respect.

4.c Incorporates the patient’s
cultural and spiritual
preferences, values, and
beliefs into health care.

4.d Preserves the patient’s control
over decision making by
negotiating a mutually
acceptable plan of care.

12. Prescribes medications with knowledge of
altered pharmacodynamics and
pharmacokinetics with special populations,
such as infants and children, pregnant and
lactating women, and older adults.

13. Prescribes therapeutic devices.
14. Adapts interventions to meet the complex

needs of individuals and families arising from
aging, developmental/life transitions, co-
morbities, psychosocial, and financial issues.

15. Assesses and promotes self-care in patients
with disabilities.

16. Plans and orders palliative care and end-of-
life care, as appropriate.

17. Performs primary care procedures.
18. Uses knowledge of family theories and

development stages to individualize care
provided to individuals and families.

19. Facilitates family decision-making about
health.

20. Analyzes the impact of aging and age-and
disease-related changes in
sensory/perceptual function, cognition,
confidence with technology, and health
literacy and numeracy on the ability and
readiness to learn and tailor interventions
accordingly.

21. Demonstrates knowledge of the similarities
and differences in roles of various health
professionals proving mental health services,
e.g., psychotherapists, psychologist,
psychiatric social worker, psychiatrist, and

d. Developmental variations to include
physical differences, behavior and
function

e. Autistic Spectrum disorders
f. Substance disorders
g. Suicidal ideation and self-injurious

behavior

Risks to health related to:
a. Bullying and victimization
b. Environmental factors
c. Risk-taking behaviors

Signs and symptoms of acute physical and
mental illnesses, and atypical presentations
across the life span.

Resiliency and healthy coping.

Pharmacologic assessment addressing
polypharmacy; drug interactions and other
adverse events; over-the-counter;
complementary alternatives; and the ability to
obtain, purchase, self-administer, and store
medications safely and correctly.

Epidemiology, environmental and community
characteristics, cultural, and life stage
development, including the presentation seen
with increasing age, family, and behavioral risk
factors.

Assessment of families and individuals in the
development of coping systems and lifestyle
adaptations.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

advanced practice psychiatric nurse.
22. Evaluates the impact of life transitions on the

health/illness status of patients and the
impact of health and illness on patients
(individuals, families, and communities).

23. Applies principles of self-
efficacy/empowerment in promoting behavior
change.

24. Develops patient-appropriate educational
materials that address the language and
cultural beliefs of the patient.

25. Monitors specialized care coordination to
enhance effectiveness of outcomes for
individuals and families

Referrals to other health care professionals
and community resources for individuals and
families, for example, coordination of care
transitions within and between health care
systems.

Women’s reproductive health, including sexual
health, prenatal, and postpartum care and pre
and post-menopausal care.

Performance of common office procedures
which may include, but are not limited to,
suturing, lesion removal, incision and
drainage, casting/splinting, microscopy, and
gynecology procedures.

Comprehensive plan of care:

Assistive devices which may include but not
limited to nebulizers, walkers, CPAP.

Appropriate referral for physical therapy,
occupational therapy, speech therapy, home
health, hospice and nutritional therapy.

Establishment of sustainable partnership with
individuals and families

Ethical issues related to balancing differing
needs, age-related transitions, illness, or
health among family members.

Culturally appropriate communication skills
adapted to the individual’s cognitive,
developmental, physical, mental and
behavioral health status.

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Discussion techniques for sensitive issues
such as:

a. suicide prevention, self-injury
b. sexually-related issues
c. substance use/abuse
d. risk-taking behavior
e. driving safety
f. independence
g. finances
h. violence, abuse, and mistreatment
i. prognosis

Assessment of decisional capacity (including
the balance between autonomy and safety),
guardianship, financial management and
durable and healthcare powers of attorney to
the treatment of older adults.

Intervention/crisis management and
appropriate referrals to mental health care
professionals and community agencies with
resources

Cognitive, sensory, and perceptual problems
with special attention to temperature
sensation, hearing and vision

Relationship development with patients,
families, and other caregivers to address
sensitive issues, such as driving, independent
living, potential for abuse, end-of-life issues,
advanced directives, and finances.

Education on preventive health care and end-

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

of-life choices.

Resources for payment of services related to
fixed income (retired), entitlements (Medicaid
and Medicare), and available resources

Provider communication skills which include
validating and verifying findings, and the
acknowledgement of patients strengths in
meeting needs.

Patient comfort and support.

Importance of “being present” during
communication with others.

Self-reflection

Evaluation of therapeutic interaction

Termination of nurse practitioner patient
relationship and issue related to transition to
another health care provider.

Patient and or caregiver support and
resources.

Respect for the inherent dignity of every
human being, whatever their age, gender,
religion, socioeconomic class, sexual
orientation, and ethnicity.

Rights of individuals to choose their care
provider, participate in care, and refuse care.

Influence of cultural variations on child health
practices, including child rearing.

Spiritual needs in the context of health and

Competency Area

NP Core Competencies Family/Across the Lifespan
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

illness experiences, including referral for
pastoral services.

Assessment of the influence of patient’s
spirituality on his/her health care behaviors
and practices.

Appropriate incorporation of spiritual beliefs
into the plan of care.

Collaboration with patients and families to
discuss their wishes for end of life decision-
making and care.

Learning style assessment for the patients

Patient education about self-management of
acute/chronic illness with sensitivity to the
patient’s learning ability and cultural/ethnic
background.

How to adapt teaching-learning approaches
based on physiological and psychological
changes, age, developmental stage, readiness
to learn, health literacy, the environment, and
resources.

Neonatal NP Competencies
These are entry-level competencies for the neonatal nurse practitioner (NNP) and supplement the core
competencies for all nurse practitioners.

Neonatal nurse practitioners provide health care to neonates, infants, and children up to 2 years of age. Practice
as a NNP requires specialized knowledge and skills if safe, high-quality care is to be delivered to patients.
Competencies are identified by the professional organization, along with an established set of standards that
protect the public, ensuring patients’ access to safe, high-quality care. The National Association of Neonatal
Nurse Practitioners (NANNP, 2010) had established competencies for the neonatal population focus that built
upon the Domains and Core Competencies of Nurse Practitioner Practice developed by the National Organization
of Nurse Practitioner Faculties (NONPF, 2006). The NNP competencies presented here build on that previous
work and relate to the more recent Nurse Practitioner Core Competencies published by NONPF in 2012. The core
competencies, which are demonstrated upon graduation regardless of population focus, are necessary for NPs to
meet the complex challenges of translating rapidly expanding knowledge into practice and function in a changing
health care environment.

See the “Introduction” for how to use this document and to identify other critical resources to supplement these
competencies.

Competency Area

NP Core Competencies Neonatal NP Competencies Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and
evidence for improving advanced
nursing practice.

2. Integrates knowledge from the
humanities and sciences within
the context of nursing science.

3. Translates research and other
forms of knowledge to improve
practice processes and outcomes.

Advanced Neonatal Pathophysiology
Advanced Neonatal Pharmacology
Advanced Neonatal Assessment
Research and Quality Improvement
 Research process and methods
 Information databases
 Critical evaluation of research findings
 Translational research
 Research on vulnerable populations

Competency Area

NP Core Competencies Neonatal NP Competencies Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

4. Develops new practice
approaches based on the
integration of research, theory,
and practice knowledge

 Funding for research
 Research dissemination
 Institutional review boards

 Safety
 Continuous Quality Improvement

Professional Role
 Nursing Theories
 Evidence based practice

Leadership
Competencies

1. Assumes complex and advanced
leadership roles to initiate and
guide change.

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to
improve health care.

3. Demonstrates leadership that
uses critical and reflective
thinking.

4. Advocates for improved access,
quality and cost effective health
care.

5. Advances practice through the
development and implementation
of innovations incorporating
principles of change.

6. Communicates practice
knowledge effectively both orally
and in writing.

7. Participates in professional

Interprets the role of the neonatal nurse
practitioner (NNP) to the infant’s family, other
healthcare professionals, and the community.

Professional Role
 Professional leadership
 Professional accountability
 Evidence-based practice
 Role theory
 Advanced practice role
 Role of the NNP
 Scope of practice of the NNP
 Standards of practice
 Professional regulation and licensure
 Credentialing and certification
 Clinical decision making and problem

solving
 Professional scholarship

Teaching and Education
 Theories—motivational, change,

education, communication
 Program planning and evaluation
 Instructional technology
 Cultural sensitivity
 Communication

Competency Area

NP Core Competencies Neonatal NP Competencies Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

organizations and activities that
influence advanced practice
nursing and/or health outcomes of
a population focus.

 Communication theory
 Collaboration
 Conflict resolution
 Assertiveness
 Collaborative practice models
 Informatics
 Consultation

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety
and their influence on health care.

3. Evaluates how organizational
structure, care processes,
financing, marketing and policy
decisions impact the quality of
health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice
and is proactive in implementing
interventions to ensure quality.

Healthcare Policy and Advocacy
 Economics of health care

Research and Quality Improvement
 Information databases
 Critical evaluation of research findings
 Translational research
 Research dissemination
 Institutional review boards

 Safety
 Continuous Quality Improvement
 Finance and Value added care

Practice Inquiry
Competencies

1. Provides leadership in the
translation of new knowledge into
practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills
to improve health outcomes.

Research and Quality Improvement
 Research process and methods
 Information databases
 Critical evaluation of research findings
 Translational research
 Research on vulnerable populations
 Research dissemination

Competency Area

NP Core Competencies Neonatal NP Competencies Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

4. Leads practice inquiry, individually
or in partnership with others.

5. Disseminates evidence from
inquiry to diverse audiences using
multiple modalities.

6. Analyze clinical guidelines for
individualized application into
practice

 Institutional review boards
 Safety
 Continuous Quality Improvement

Technology and
Information Literacy
Competencies

1. Integrates appropriate
technologies for knowledge
management to improve health
care.

2. Translates technical and scientific
health information appropriate for
various users’ needs.
2.a Assesses the patient’s and

caregiver’s educational needs
to provide effective,
personalized health care.

2.b Coaches the patient and
caregiver for positive
behavioral change.

3. Demonstrates information literacy
skills in complex decision making.

4. Contributes to the design of
clinical information systems that
promote safe, quality and cost
effective care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

Communication
 Communication theory
 Collaboration
 Conflict resolution
 Assertiveness
 Collaborative practice models
 Informatics
 Information data bases/technology
 Consultation

Professional Role
 Information technology

Teaching and Education
 Theories—motivational, change,

education, communication
 Program planning and evaluation
 Instructional technology
 Cultural sensitivity

Competency Area

NP Core Competencies Neonatal NP Competencies Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality,
and cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

5. Analyzes the implications of health
policy across disciplines.

6. Evaluates the impact of
globalization on health care policy
development.

Healthcare Policy and Advocacy
 Process of healthcare legislation
 Maternal and child health legislation
 Implications of healthcare policy
 Economics of health care
 Third-party reimbursement
 Legislation and regulations concerning

advanced practice
 Advocacy

Ethical and Legal Issues
 Ethical decision making
 Ethical issues—reproductive, prenatal,

neonatal, and infancy
 Ethical use of information
 Patient advocacy
 Resource allocation
 Legal issues affecting patient care and

professional practice
 Cultural sensitivity

Global Health Care
Communication
 Communication theory
 Collaboration
 Conflict resolution
 Assertiveness
 Collaborative practice models
 Informatics
 Consultation

Health Delivery
System
Competencies

1. Applies knowledge of
organizational practices and
complex systems to improve
health care delivery.

2. Effects health care change using
broad based skills including
negotiating, consensus-building,
and partnering.

3. Minimizes risk to patients and
providers at the individual and
systems level.

4. Facilitates the development of
health care systems that address
the needs of culturally diverse
populations, providers, and other
stakeholders.

5. Evaluates the impact of health
care delivery on patients,
providers, other stakeholders, and
the environment.

6. Analyzes organizational structure,
functions and resources to
improve the delivery of care.

7. Collaborates in planning for
transitions across the continuum
of care.

Management and Organization
 Organizational theory
 Principles of management
 Models of planned change
 Collaborative practice
 Healthcare system financing
 Reimbursement systems
 Standards of practice
 Cost, quality, outcome measures
 Resource management
 Evaluation models
 Peer review

Communication
 Communication theory
 Collaboration
 Conflict resolution
 Assertiveness
 Collaborative practice models
 Informatics
 Consultation

Healthcare Policy and Advocacy
 Process of healthcare legislation
 Maternal and child health legislation
 Implications of healthcare policy
 Economics of health care
 Third-party reimbursement
 Legislation and regulations concerning

advanced practice
 Advocacy

Research and Quality Improvement
 Safety
 Continuous Quality Improvemen

Ethics
Competencies

1. Integrates ethical principles in
decision making.

2. Evaluates the ethical
consequences of decisions.

3. Applies ethically sound solutions
to complex issues related to
individuals, populations and
systems of care.

Conforms to the national Code of Ethics of the
National Association of Neonatal Nurses.

Ethical and Legal Issues
 Ethical decision making
 Ethical issues—reproductive, prenatal,

neonatal, and infancy
 Ethical use of information
 Patient advocacy
 Bioethics committees
 Clinical research
 Resource allocation
 Genetic counseling
 Legal issues affecting patient care and

professional practice
 Informed consent
 Cultural sensitivity

Independent
Practice
Competencies

1. Functions as a licensed
independent practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing
previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to
include health promotion,
disease prevention, health
protection, anticipatory
guidance, counseling, disease
management, palliative, and
end of life care.

3.b Uses advanced health
assessment skills to
differentiate between normal,
variations of normal and

1. Obtains a thorough health history to include
maternal medical, antepartum, intrapartum,
and newborn history.

2. Performs a complete, systems-focused
examination to include physical, behavioral,
and developmental assessments.

3. Develops a comprehensive database that
includes pertinent history, diagnostic tests,
and physical assessment.

4. Demonstrates critical thinking and diagnostic
reasoning skills in clinical decision-making.

5. Establishes priorities of care.
6. Initiates therapeutic interventions according

to established standards of care.
7. Demonstrates competency in the technical

skills considered essential for NNP practice
according to the standards set forth by
national, professional.

8. Intervenes according to established
standards of care to resuscitate and stabilize

Advanced Neonatal Pathophysiology
Advanced Neonatal Pharmacology
Advanced Neonatal Assessment
Perinatal Issues

A. Perinatal physiology
 Maternal physiology (physiologic

adaptation to pregnancy, pathologic
changes or disease in pregnancy,
effects of pre-existing disease)

 Fetal physiology
 Transitional changes
 Neonatal physiology

B. Pharmacology
 Principles of pharmacology and

pharmacotherapeutics, including those
at the cellular response level

 Principles of pharmacokinetics and
pharmacodynamics of broad categories

abnormal findings.
3.c Employs screening and

diagnostic strategies in the
development of diagnoses.

3.d Prescribes medications within
scope of practice.

3.e Manages the health/illness
status of patients and families
over time.

4. Provides patient-centered care
recognizing cultural diversity and
the patient or designee as a full
partner in decision-making.
4.a Works to establish a

relationship with the patient
characterized by mutual
respect, empathy, and
collaboration.

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy,
comfort, emotional support,
mutual trust, and respect.

4.c Incorporates the patient’s
cultural and spiritual
preferences, values, and
beliefs into health care.

4.d Preserves the patient’s
control over decision making
by negotiating a mutually
acceptable plan of care.

compromised newborns and infants.
9. Implements developmentally appropriate

care.
10. Ensures that principles of pain management

are applied to all aspects of neonatal care.
11. Documents assessment, plan, interventions,

and outcomes of care.
12. Considers community and family resources

and strengths, when planning patient care
and follow up needs across the continuum of
care.

13. Communicates with family members and
caregivers regarding the newborn and
infant’s healthcare status and needs.

14. Applies principles of crisis management to
assist family members in coping with their
infant’s illness.

15. Participates in the learning needs of students
and other healthcare professionals.

16. Participates as a member of an
interdisciplinary team through the
development of collaborative and innovative
practices.

17. Identify strategies to deliver culturally
sensitive, high quality care free of personal
biases.

of drugs
 Common categories of drugs used in

the newborn and infant
 Effects of drugs during pregnancy and

lactation

C. Genetics
 Principles of human genetics
 Genetic testing and screening
 Genetic abnormalities
 Human Genome Project
 Gene therapy
 Genetic Counseling

General Assessment
 Perinatal history
 Antepartum conditions
 Prenatal diagnostic testing
 Intrapartum conditions
 Influence of altered environment on the

newborn and infant
 Gestational age assessment
 Neonatal physical exam
 Behavioral assessment
 Developmental assessment
 Pain assessment
 Assessment of family adaptation, coping

skills, and resources

Sociocultural Assessment

A. Family assessment
 Family function

1. roles
2. interactions
3. effect of childbearing

 Social, cultural, and spiritual variations
 Support systems

B. Families in crisis
 Crisis theory
 Principles of intervention
 Crises of childbearing

1. sick or premature infant
2. chronically ill or malformed infant
3. death of an infant

 Grief
1. stages
2. factors influencing grieving

process
3. pathologic grief
4. sibling reactions

C. Principles of family-centered care

Clinical and Diagnostic Laboratory
Assessments
Clinical laboratory tests
 Microbiologic
 Biochemical
 Hematologic
 Serologic
 Metabolic and endocrine
 Immunologic
 Routine newborn screening
 Other

Diagnostic tests (types and techniques)
 Ultrasound
 Computed tomography (CT)
 Magnetic resonance imaging (MRI),

magnetic resonance angiogram (MRA),
magnetic resonance spectroscopy (MRS)

 X-ray
 Electrocardiogram (EKG)
 Electroencephalogram (EEG)

 Echocardiogram
 Cardiac catheterization

Selection of diagnostic tests
 Indications
 Reliability
 Advantages and disadvantages
 Cost-effectiveness
 Interpretation of results
 Performance of procedures for neonates,

including, but not limited to:
 Lumbar puncture
 Umbilical vessel catheterization
 Percutaneous arterial and venous

catheters
 Arterial puncture
 Venipuncture
 Capillary heel-stick blood sampling
 Suprapubic bladder aspiration
 Bladder catheterization
 Endotracheal intubation
 Laryngeal airway placement
 Intraosseous (to be alike)
 Assisted ventilation
 Resuscitation and stabilization
 Needle aspiration of pneumothorax
 Chest-tube insertion and removal
 Exchange transfusion

General Management

A. Thermoregulation
 Factors affecting heat loss and

production
 Mechanisms of heat loss and gain
 Temperature assessment techniques
 Hypothermia, hyperthermia

 Management techniques to minimize
heat loss or maintain body temperature

B. Resuscitation and stabilization
 Assessment of risk factors
 Physiology of asphyxia
 Indications for intubation, ventilation,

and cardiac compressions (see also
section on neonatal procedures)

 Resuscitation equipment
 Pharmacotherapeutics
 Stabilization
 Neonatal transport
 Neonatal Resuscitation Program (NRP)

provider

C. Pain management
 Physiology of pain
 Pain management

1. Nonpharmacologic
2. Pharmacologic

D. Palliative and end-of-life care
 Ethical considerations
 Pain management at end of life
 Hospice care
 Bereavement

Clinical Management

A. Cardiovascular system
 Embryology
 Physiology
 Fetal, transitional, neonatal circulation
 Rhythm disturbances/EKG

interpretation
 Myocardial dysfunction
 Shock, hypotension, hypertension

 Congenital heart disease
(pathophysiology, clinical presentation,
differential diagnosis, medical
management, pre- and postoperative
management)

 Cardiovascular radiology and
echocardiogram interpretation

 Cardiovascular pharmacology

B. Pulmonary system
 Embryology
 Physiology (oxygenation and

ventilation, gas exchange, acid-base
balance)

 Asphyxia
 Pulmonary diseases (pathophysiology,

etiology, clinical presentation,
differential diagnosis, treatment)

 Pulmonary radiology
 Respiratory therapy

1. Physiologic principles
2. Physiologic monitoring
3. Continuous distending pressure
4. Ventilation strategies
5. Extracorporeal membrane

oxygenation (ECMO)
 Respiratory pharmacology

C. Gastrointestinal (GI) system
 Embryology
 Anatomy and physiology of the GI tract

1. Structure and function
2. Hormonal influence
3. Motility
4. Digestion and absorption

 Digestive and absorptive disorders
1. Disorders of sucking and

swallowing
2. Motility
3. Gastroesophageal (GE) reflux
4. Malabsorption
5. Diarrhea or short gut

 Anomalies and obstruction
 Necrotizing enterocolitis

D. Nutrition
 Effects of maturational changes on

management of nutritional requirements
and feeding

 Caloric and nutritional requirements
 Feeding methods

1. Breast
2. Bottle
3. Gavage
4. Gastrostomy
5. Transpyloric
6. Trophic

 Breast milk versus formula
1. Composition
2. Benefits
3. Preterm infants

 Parenteral nutrition
1. Composition
2. Indications
3. Benefits
4. Complications
5. Monitoring

 Dietary supplementation for term and
preterm infants

 Dietary adjustments in special
circumstances
1. Cholestasis
2. Short gut syndrome
3. Osteopenia

4. Inborn errors of metabolism

E. Renal and genitourinary
 Embryology and anatomy
 Renal physiology
 Evaluation of renal function
 Urinary tract infections
 Congenital anomalies
 Functional abnormalities of the renal

system
 Renal failure

1. Predisposing factors and etiologies
2. Pathophysiology
3. Management

a. Fluid and electrolytes
b. Nutritional modification
c. Drug modification
d. Hemofiltration
e. Dialysis
f. Transplant

F. Fluid and electrolytes
 Physiology

1. Electrolyte homeostasis
2. Body composition in fetal and

neonatal periods
3. Transitional changes
4. Insensible water loss
5. Endocrine control,

(mineralocorticoids, antidiuretic
hormone (ADH),
calcitonin/parathyroid hormone
(PTH)

6. Renal function, physiology
 Calcium and phosphorus homeostasis
 Principles of fluid therapy

1. Assessment of hydration

2. Maintenance requirements
3. Factors affecting total fluid

requirements
 Disorders of fluids and electrolytes
 Immune and nonimmune hydrops

G. Endocrine and metabolic system
 Neuroendocrine regulation
 Carbohydrate metabolism
 Infant of a diabetic mother
 Adrenal disorders
 Thyroid disorders
 Inborn errors of metabolism
 Newborn screening
 Ambiguous genitalia, intersex disorders

H. Hematologic system and malignancies
 Development of the hematopoietic

system
 Anemia
 Polycythemia and hyperviscosity
 Bilirubin

1. Physiology of bilirubin production,
metabolism, and excretion

2. Hyperbilirubinemia
3. Breast milk jaundice
4. Encephalopathy

 Hepatic disorders
 Coagulation and platelets

1. Physiology
2. Disorders of coagulation and

platelets
 Disorders of leukocytes
 Blood transfusions and blood products
 Malignancies, neoplasms

I. Immunologic system

 Development of the immune system
 Function of the immune system

 Allo- and auto-immune disorders
 Infectious diseases
 Evaluation of the infant
1. History
2. Physical examination
3. Laboratory data
4. Other diagnostic tests

 Treatment
1. Antimicrobial
2. Adjunctive therapy

 Infection with specific microorganisms

J. Musculoskeletal system
 Embryology
 Congenital abnormalities
 Birth injuries
 Metabolic bone disease

K. Neurobehavioral system
 Development of the nervous system

1. 1.Embryology
2. Anatomy
3. Cerebral circulation
4. Maturation

 Birth injuries
 Anomalies and defects of central

nervous system (CNS) and spine
 Ischemic brain injury
 Seizures
 Intracranial hemorrhage
 Disorders of movement and tone
 Growth and development
 Developmentally supportive care
 Developmental follow-up of infants

L. Eyes, ears, nose, and throat
 Embryology and anatomy
 Abnormalities of the airway

1. Congenital
2. Acquired

 Auditory system
1. Physiology of hearing and speech
2. Speech and language alterations
3. Hearing screening methods

4. Abnormalities
 Visual system
1. Physiology of vision and visual

development
2. Visual acuity
3. Visual screening
4. Pharmacotherapy
5. Abnormalities
6. Retinopathy of prematurity (ROP)

M. Integumentary system
 Embryology
 Anatomy and physiology
 Terminology
 Common variations
 Skin disorders
 Pharmacology

N. Intrauterine drug exposure
 Screening for maternal substance use
 Laboratory tests
 Ethical considerations
 Physiologic effects
 Clinical management

1. Pharmacologic
2. Nonpharmacologic

Health Promotion and Disease Prevention

A. Discharge planning
 Discharge planning process

 Technologically dependent infants
 Parent education

1. infant cue recognition
2. emergency measures
3. medical equipment
4. disease-specific instructions
5. well-child care (normal growth and

development, nutrition, dental
health)

 Community resources
 Home care and follow-up

B. Primary care up to 2 years
 Physical assessment
 Immunization
 Hearing screening
 Eye exams
 Neurologic follow-up
 Developmental screening
 Safety issues

Acute Care Pediatric Nurse Practitioner Competencies
These are entry-level competencies for the acute care pediatric nurse practitioner (ACPNP) and supplement the
core competencies for all nurse practitioners.

The graduate of an ACPNP program is prepared to care for children with complex acute, critical and chronic
illness across the entire pediatric age spectrum, from birth to young adulthood. Circumstances may exist in which
a patient, by virtue of age, could fall outside the traditionally defined ACPNP population but by virtue of special
need, the patient is best served by the ACPNP. The ACPNP implements the full scope of the role through
assessment, diagnosis and management with interventions for patients and their families. The ACPNP
implements the full scope of the role through assessment, diagnosis and management with interventions for
patients and their families. The ACPNP provides care to patients who are characterized as “physiologically
unstable, technologically dependent, and/or are highly vulnerable to complications” (AACN Scope and Standards,
2006, p 9), and a continuum of care ranging from disease prevention to critical care in order to “stabilize the
patient’s condition, prevent complications, restore maximum health and/or provide palliative care” (AACN p. 10).
Patients may be encountered across the continuum of care settings and require ongoing monitoring and
intervention.

See the “Introduction” for how to use this document and to identify other critical resources to supplement these
competencies.

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and
evidence for improving advanced
nursing practice.

2. Integrates knowledge from the
humanities and sciences within
the context of nursing science.

3. Translates research and other
forms of knowledge to improve

1. Contributes to knowledge development for
improved child and family-centered care.

2. Participates in child and family focused
quality improvement, program evaluation,
translation, and dissemination of evidence
into practice.

3. Delivers of evidence-based practice for
pediatric patients.

The following curriculum considers advanced
pathophysiology; advanced physical
examination findings; and advanced
pharmacology (kinetics, dynamics, genomics)
that pertains to the unique aspects of the
infant, child, and adolescent.

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

practice processes and outcomes.
4. Develops new practice

approaches based on the
integration of research, theory,
and practice knowledge

Scientific Foundations
 Clinical practice guidelines
 Evidence based care
 Translational research
 Vulnerable and diverse populations and

cultures

Leadership
Competencies

1. Assumes complex and advanced
leadership roles to initiate and
guide change.

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to
improve health care.

3. Demonstrates leadership that
uses critical and reflective
thinking.

4. Advocates for improved access,
quality and cost effective health
care.

5. Advances practice through the
development and implementation
of innovations incorporating
principles of change.

6. Communicates practice
knowledge effectively both orally
and in writing.

7. Participates in professional
organizations and activities that
influence advanced practice

1. Advances the knowledge of the
interprofessional team to improve pediatric
healthcare delivery and patient outcomes.

2. Participates actively in pediatric focused
professional organizations that promote
optimal health care for children and their
families.

3. Advocates within health care agencies for
unrestricted access to all health care
providers that provide quality, cost effective
care to children and families.

Professional Role
 Professional accountability
 Role theory
 Role of the ACPNP
 Scope & standards of practice of the

ACPNP
 Professional regulation and licensure
 Credentialing and certification
 Clinical decision making and problem

solving
 Professional scholarship
 Engagement in Professional organizations
 Advocacy
 Self-evaluation and peer review

Teaching and Education
 Theories – change, education,

communication, family
 Cultural sensitivity

Communication
 Communication theory
 Collaboration
 Conflict resolution
 Collaborative practice models

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

nursing and/or health outcomes of
a population focus.

 Simulation with role-playing for learning
skills such as history taking as well as for
more complex communication techniques
such as sharing bad news or potential poor
outcomes with patients and families.

Clinical practicum
 Incorporation into interprofessional team

member.
 Quality improvement initiatives
 Safety

Continuous Quality Improvement

Replication of clinical scenarios with a focus
on team training for the purpose of learning
leadership, followership, and team concepts.

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety
and their influence on health care.

3. Evaluates how organizational
structure, care processes,
financing, marketing and policy
decisions impact the quality of
health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice
and is proactive in implementing
interventions to ensure quality.

Articulates the importance of collaborating with
local, state and national child organizations to
foster best practices and child safety.

Healthcare Policy and Advocacy
 Economics of health care
 Safety (local, state, national)

Quality Improvement Process in measuring
outcomes

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Practice Inquiry
Competencies

1. Provides leadership in the
translation of new knowledge into
practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills
to improve health outcomes.

4. Leads practice inquiry, individually
or in partnership with others.

5. Disseminates evidence from
inquiry to diverse audiences using
multiple modalities.

6. Analyze clinical guidelines for
individualized application into
practice

Ensures pediatric assent and consent, and/or
parental permission when conducting clinical
inquiry.

Aspects of conducting research with children.

Application of research and EBP findings
pertinent to pediatric patients and their families
to improve outcomes.

Technology and
Information Literacy
Competencies

1. Integrates appropriate
technologies for knowledge
management to improve health
care.

2. Translates technical and scientific
health information appropriate for
various users’ needs.
2.a Assesses the patient’s and

caregiver’s educational needs
to provide effective,
personalized health care.

2.b Coaches the patient and
caregiver for positive
behavioral change.

3. Demonstrates information literacy
skills in complex decision making.

1. Considers developmental level of child and
the family when translating health information
to support positive health outcomes.

2. Uses pediatric focused simulation based
learning to improve practice.

3. Evaluates information systems to assure the
inclusion of data appropriate for pediatric
patients.

Educational initiatives that translate health
information to children and families.

Integration of hospital information systems and
evaluation appropriateness for pediatric
patients.

Distance linked services.

Use of electronic information to enhance
patient care and outcomes.

Technology that enhances safety, such as with
information databases.

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

4. Contributes to the design of
clinical information systems that
promote safe, quality and cost
effective care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality,
and cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

5. Analyzes the implications of health
policy across disciplines.

6. Evaluates the impact of
globalization on health care policy
development.

1. Demonstrates an understanding of pediatric
and acute care advocacy/ legislation and
policy statements.

2. Uses relevant policy specific to children to
direct appropriate patient care.

3. Advocates for unrestricted financial and
legislative access for children and families to
quality, cost effective healthcare.

Healthcare Policy and Advocacy
 Process of healthcare legislation
 Child and family health legislation
 Implications of healthcare policy
 Third-party reimbursement
 Legislation and regulations concerning

advanced practice
 Resource allocation

Health Delivery
System
Competencies

1. Applies knowledge of
organizational practices and
complex systems to improve
health care delivery.

2. Effects health care change using
broad based skills including
negotiating, consensus-building,

1. Serves as an advocate for the needs of
children and their families within the health
care system including facilitating transitions
across settings.

2. Applies knowledge of family, child
development, healthy work environment
standards, and organizational theories and

Management and Organization
 Organizational theory
 Models of planned change
 Healthcare system financing
 Reimbursement systems
 Resource management

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

and partnering.
3. Minimizes risk to patients and

providers at the individual and
systems level.

4. Facilitates the development of
health care systems that address
the needs of culturally diverse
populations, providers, and other
stakeholders.

5. Evaluates the impact of health
care delivery on patients,
providers, other stakeholders, and
the environment.

6. Analyzes organizational structure,
functions and resources to
improve the delivery of care.

7. Collaborates in planning for
transitions across the continuum
of care.

systems to support safe, high quality, and
cost effective care within health care delivery
systems.

 Informatics

Collaboration and planning for transition to
adult health care.

Integration of palliative and end-of-health care.

Ethics
Competencies

1. Integrates ethical principles in
decision making.

2. Evaluates the ethical
consequences of decisions.

3. Applies ethically sound solutions
to complex issues related to
individuals, populations and
systems of care.

Ethical and Legal Issues
 Ethical decision making
 Ethical use of information
 Bioethics committees
 Clinical research, including informed

consent/assent
 Clinical trials for therapeutic management
 Legal issues affecting patient care and

professional practice
 Cultural sensitivity
 Strategies for connecting the student to the

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

local, national and international
community.

Independent
Practice
Competencies

1. Functions as a licensed
independent practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing
previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to
include health promotion,
disease prevention, health
protection, anticipatory
guidance, counseling, disease
management, palliative, and
end of life care.

3.b Uses advanced health
assessment skills to
differentiate between normal,
variations of normal and
abnormal findings.

3.c Employs screening and
diagnostic strategies in the
development of diagnoses.

3.d Prescribes medications within
scope of practice.

3.e Manages the health/illness
status of patients and families
over time.

4. Provides patient-centered care

1. Recognizes the importance of
interprofessional team practice in providing
safe, comprehensive clinical care.

2. Obtains relevant comprehensive problem
focused health histories for children with
complex acute, critical, and chronic
conditions.

3. Applies advanced assessment skills to
determine appropriate management in the
care of children with single and/or multi
system organ dysfunction.

4. Integrates knowledge of pathophysiology to
anticipate and identify rapidly changing
physiologic conditions and organ system
failure in children.

5. Responds to children with complex acute,
critical, and chronic problems to address
rapidly changing conditions, including the
recognition and management of emerging
health crises, and organ dysfunction using
both physiologically and technology derived
data.

6. Prioritizes data recognizing the dynamic
nature of a child with a complex acute,
critical, and chronic condition.

7. Interprets age, developmental and situational
appropriate screening and diagnostic studies
essential in the diagnosis and management
of the child with a complex acute, critical, or
chronic health condition.

Consider the unique aspects of the infant,
child, and adolescent as they pertain to:
 Advanced Pathophysiology
 Advanced Physical Assessment
 Advanced Pharmacology (kinetics,

dynamics, genomics)

Genetics
 Principles of human genetics
 Genetic testing and screening
 Genetic abnormalities
 Human Genome Project
 Gene therapy
 Genetic Counseling

Foundational concepts of the child & family
 Health and family assessment with

emphasis on normal and abnormal growth
and development

 Behavioral assessment
 Health promotion and disease prevention
 Common acute and chronic conditions
 Assessment of family adaptation, coping

skills, and resources

Sociocultural Assessment
 Family assessment
 Family function

1. roles
2. interactions

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

recognizing cultural diversity and
the patient or designee as a full
partner in decision-making.
4.a Works to establish a

relationship with the patient
characterized by mutual
respect, empathy, and
collaboration.

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy,
comfort, emotional support,
mutual trust, and respect.

4.c Incorporates the patient’s
cultural and spiritual
preferences, values, and
beliefs into health care.

4.d Preserves the patient’s
control over decision making
by negotiating a mutually
acceptable plan of care.

8. Develops appropriate differential diagnosis
with an understanding of new or
exacerbation of complex acute, critical, and
chronic conditions.

9. Provides ongoing monitoring of children with
single or multi-system organ dysfunction.

10. Seeks and integrates the perspectives of
interprofessional team members in
developing and implementing the plan of
care.

11. Performs specific diagnostic maneuvers
and/or technical skills to monitor and sustain
physiological function.

12. Appropriately orders and performs
interventions to monitor, sustain and restore
stability in children with deteriorating
conditions.

13. Understands the complexity and interaction
of prescribing pharmacologic and non-
pharmacologic therapies required in the care
of children with complex acute, critical, and
chronic conditions.

14. Prescribes medications and complex medical
regimes monitoring for adverse outcomes
specific to the child with high risk complex
acute, critical, and chronic conditions.

15. Manages the medically fragile technology
dependent child who presents with complex
acute, critical, and chronic illness and injury

16. Stabilizes children in emergent and life
threatening situations.

17. Performs consultations in a variety of
settings for children with complex acute,

 Social, cultural, and spiritual variations
 Support systems

Families in crisis
 Crisis theory
 Principles of intervention
 Grief

1. stages
2. factors influencing grieving process
3. pathologic grief
4. sibling reactions

 Principles of family-centered care

Foundational concepts of the acutely ill
child
 Responding to rapidly changing clinical

conditions, including the recognition and
management of emerging crises and organ
dysfunction and failure. Complex
monitoring and ongoing management of
intensive therapies in a variety of settings,
including but not limited to:
 inpatient and outpatient hospital

settings
 specialty services
 emergency departments
 home care settings

 Essential knowledge of unique challenges
and management of the chronically ill child
and their family.

 Assessment of clinical laboratory and
diagnostic imaging; including but not
limited to:

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

critical and chronic conditions based on
knowledge and expertise.

18. Initiates and facilitates the child’s transition
within and outside of the health care setting
and across all levels of care including
admission, transfer and discharge.

 Microbiologic, biochemical,
hematologic, and other relevant test.

 Diagnostic imaging studies
 Indications
 Reliability
 Advantages and disadvantages
 Cost-effectiveness
 Interpretation of results

 Screening tests, such as:
 Auditory, visual, and others as

indicated.
 Indication for and principles of

procedures, including but not limited to:
 Lumbar puncture
 Percutaneous arterial and venous

catheters
 Arterial puncture
 Endotracheal intubation
 Laryngeal mask airway placement
 Assisted ventilation
 Intraosseous
 Needle aspiration of pneumothorax
 Chest-tube insertion and removal

 Fluid and electrolytes:
 Physiology
1. Electrolyte homeostasis
2. Body
3. Transitional changes
4. Insensible water loss
5. Endocrine control
 Renal function, physiology

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Calcium and phosphorus homeostasis
 Principles of fluid therapy
1. Assessment of hydration
2. Maintenance requirements
3. Factors affecting total fluid

requirements
 Disorders of fluids and electrolytes
 Nutrition

 Caloric and nutritional requirements
 Feeding methods

1. Human milk
2. Bottle
3. Gavage
4. Gastrostomy
5. Transpyloric
6. Trophic

 Human milk, common formulas,
specialty formulas
1. Composition
2. Benefits
3. Indication/contraindications

 Parenteral nutrition
1. Composition
2. Indications
3. Benefits
4. Complications
5. Monitoring

 Dietary supplementation
 Dietary adjustments in special

circumstances
 Discharge planning

 Discharge planning process

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Technologically dependent children
 Parent education
 Community resources
 Home care and follow-up

Assessment, diagnosis, and management
of the following system specific problems:
Cardiology:
 Arrhythmias
 Cardiomyopathy
 Cardiogenic Shock
 Congenital heart lesions
 Congestive heart failure
 Postpericardiotomy syndrome
 Pulmonary hypertension
 Rheumatic fever
 Syncope
 Transplantation

Gastroenterology:
 Abdominal injuries
 Appendicitis
 Esophageal disorders
 Foreign Body
 Gastroenteritis
 Gastrointestinal bleeding
 Hepatitis
 Hyperbilirubinemia in the neonate
 Ingestions

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Inflammatory bowel disease
 Intestinal obstructions
 Hepatic insufficiency/failure
 Pancreatitis
 Superior mesenteric artery syndrome

Genito-urinary/ Nephrology:
 Dialysis
 Female genitorurinary disorders (e.g.

pelvic inflammatory disease, ovarian
torsion)

 Hematuria
 Hypertension
 Renal Insufficiency/failure
 Male genitorurinary disorders (e.g.

testicular torsion)
 Nephrotic syndrome
 Pylenonephritis/nephritis
 Renal tubular acidosis
 Transplantation
 Urosepsis

Infectious Diseases:
 Bacterial infections (e.g. apparent life-

threatening events, bacteremia, epiglottitis,
tracheitis)

 Health care associated infections
 Fever
 Fungal infections
 Multiple organ dysfunction syndrome
 Opportunistic infections
 Parapneumonic infections

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Resistant organisms
 Septic shock
 Systemic inflammatory response

syndrome
 Travel Associated Infection
 Tuberculosis
 Viral infections (e.g. CMV, EBV, H1N1,

RSV)

Neurology:
 Arteriovenous malformation
 Brain death
 Cerebral palsy
 Cerebral vascular accidents
 Encephalopathy
 Hydrocephalus
 Hypotonia
 Meningitis
 Muscular dystrophies
 Neuropathy
 Spinal Cord Injury
 Status Epilepticus
 Submersion injuries
 Traumatic Brain Injury

Pulmonary:
 Acute respiratory distress syndrome
 Air leak syndromes
 Airway obstructive/failure disorders
 Bronchiolitis
 Chronic lung disease
 Congenital central hypoventilation

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

syndrome
 Cystic fibrosis
 Obstructive sleep apnea
 Pertussis
 Pneumonia
 Pulmonary edema
 Smoke inhalation
 Status asthmaticus
 Transplantation
 Congenital central hypoventilation

syndrome
 Obstructive sleep apnea
 Pulmonary edema
 Smoke inhalation
 Status asthmatic
 Transplantation

Oncology:
 Blood cell tumors
 Graft versus host disease
 Long-term effects of cancer therapy
 Solid tumors
 Transplant
 Tumor lysis syndrome

Endocrine and Metabolic
 Adrenal disorders
 Cerebral salt wasting syndrome
 Diabetes I & II
 Diabetic ketoacidosis
 Diabetes insipidus
 Inborn errors of metabolism

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Metabolic syndromes
 Syndrome of inappropriate antidiuretic

hormone
 Thyroid/parathyroid disorders

Hematology:
 Anemias (e.g. aplastic, sickle cell)
 Coagulation disorders (e.g. disseminated

intravascular coagulation, hemophilia,
Henoch Schönlein purpura, heparin
induced thrombocytopenia, idiopathic
thrombocytopenia purpura)

 Thrombotic disorders (e.g. deep vein
thrombosis)

Inflammatory:
 Anaphylaxis
 Immunodeficiencies
 Juvenile Idiopathic Arthritis,
 Systemic Lupus Erythematosus
 Vasculitis

Otolaryngology:
 Laryngomalacia
 Mastoiditis
 Orbital/periorbital cellulitis
 Retropharyngeal abscess
 Vocal cord paralysis
 Musculoskeletal:
 Compartment syndrome
 Legg-Calvé-Perthes disease
 Myositis
 Osteomyelitis

Competency Area

NP Core Competencies Acute Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Rhabdomyolisis
 Septic arthritis
 Spinal fusion

Pain management:
 Physiology of pain
 Pain management

1. Nonpharmacologic
2. Pharmacologic

 Palliative and end-of-life care:
 Ethical considerations
 Pain management at end of life
 Hospice care
 Bereavement

Primary Care Pediatric Nurse Practitioner Competencies
The following are entry-level competencies for the primary care pediatric nurse practitioner. These pediatric
population-focused competencies expand upon the core competencies set forth for all nurse practitioners. The
role of the primary care pediatric nurse practitioner is to provide care to children from birth through young adult
with an in-depth knowledge and experience in pediatric primary health care including well child care and
prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to
support optimal health of children within the context of their family, community, and environmental setting.
Although primary care pediatric nurse practitioners practice primarily in private practices and ambulatory clinics,
their scope of practice may also extend into the inpatient setting and is based upon the needs of the patient.

Upon entry into practice, the pediatric nurse practitioner should demonstrate competence in the categories as
described. See the “Introduction” for how to use this document and to identify other critical resources to
supplement these competencies.

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and
evidence for improving advanced
nursing practice.

2. Integrates knowledge from the
humanities and sciences within the
context of nursing science.

3. Translates research and other
forms of knowledge to improve
practice processes and outcomes.

4. Develops new practice approaches
based on the integration of
research, theory, and practice
knowledge

1. Contributes to knowledge development for
improved child and family centered care.

2. Participates in child and family focused
quality improvement, program evaluation,
translation and dissemination of evidence
into practice.

3. Delivers evidence-based practice for
pediatric patients.

Genetic disorders

Genetic risks, human inheritance, molecular
genetics, human genome, genetic variation,
and pharmacogenetics

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Leadership
Competencies

1. Assumes complex and advanced
leadership roles to initiate and
guide change.

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to
improve health care.

3. Demonstrates leadership that uses
critical and reflective thinking.

4. Advocates for improved access,
quality and cost effective health
care.

5. Advances practice through the
development and implementation
of innovations incorporating
principles of change.

6. Communicates practice knowledge
effectively both orally and in
writing.

7. Participates in professional
organizations and activities that
influence advanced practice
nursing and/or health outcomes of
a population focus.

Advocates for unrestricted access to quality cost
effective care within health care agencies for
children and families.

Vulnerable children in nontraditional settings
such as:
 Incarcerated youth
 Infants and children of incarcerated

parents
 Children in foster care
 Homeless children
 Children of migrant workers
 International adoptees

Global pediatric health issues

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety
and their influence on health care.

Recognizes the importance of collaborating with
local, state and national child organizations to
foster best practices and child safety.

Child safety policies

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

3. Evaluates how organizational
structure, care processes,
financing, marketing and policy
decisions impact the quality of
health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice
and is proactive in implementing
interventions to ensure quality.

Practice Inquiry
Competencies

1. Provides leadership in the
translation of new knowledge into
practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills
to improve health outcomes.

4. Leads practice inquiry, individually
or in partnership with others.

5. Disseminates evidence from
inquiry to diverse audiences using
multiple modalities.

6. Analyze clinical guidelines for
individualized application into
practice

1. Ensures pediatric assent and consent,
and/or parental permission when conducting
clinical inquiry.

2. Promotes research that is child-centered and
contributes to positive change in the health
of or the health care delivered to children.

Quality research for children.

Product design and development with pediatric
user/consumer in mind.

Barriers to quality research in the pediatric
population.

Technology and
Information
Literacy

1. Integrates appropriate technologies
for knowledge management to
improve health care.

1. Promotes development of information
systems to assure inclusion of data
appropriate to pediatric patients, including

Tailoring information to the child’s
developmental and cognitive level.

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Competencies

2. Translates technical and scientific
health information appropriate for
various users’ needs.
2.a Assesses the patient’s and

caregiver’s educational needs
to provide effective,
personalized health care.

2.b Coaches the patient and
caregiver for positive
behavioral change.

3. Demonstrates information literacy
skills in complex decision making.

4. Contributes to the design of clinical
information systems that promote
safe, quality and cost effective
care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

developmental and physiologic norms.
2. Considers developmental level of child and

the family when translating health
information to support positive health
outcomes.

3. Uses pediatric focused simulation based
learning to improve practice.

Design and implementation of the electronic
health/medical record for compatibility with
health and illness of the child.

Information systems to assure inclusion of data
appropriate to pediatric clients, including
developmental and physiologic norms.

Advising and counseling families whose
members may have a genetic disorder.

Age appropriate concepts and the
development of education tools for the
pediatric patient and family.

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality,
and cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

5. Analyzes the implications of health

1. Advocates for local, state, and national
policies to address the unique needs of
children and families.

2. Uses relevant policy specific to children to
direct appropriate patient care, and to
advocate against financial and legislative
restrictions that limit access or opportunity.

Child safety policies

Poverty initiatives

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

policy across disciplines.
6. Evaluates the impact of

globalization on health care policy
development.

Health Delivery
System
Competencies

1. Applies knowledge of
organizational practices and
complex systems to improve health
care delivery.

2. Effects health care change using
broad based skills including
negotiating, consensus-building,
and partnering.

3. Minimizes risk to patients and
providers at the individual and
systems level.

4. Facilitates the development of
health care systems that address
the needs of culturally diverse
populations, providers, and other
stakeholders.

5. Evaluates the impact of health care
delivery on patients, providers,
other stakeholders, and the
environment.

6. Analyzes organizational structure,
functions and resources to improve
the delivery of care.

7. Collaborates in planning for
transitions across the continuum of
care.

1. Optimizes outcomes for children and their
families by facilitating access to other health
care services (e.g. mental health) or to
community and educational settings.

2. Facilitates parent-child shared management
and transition to adult care as
developmentally appropriate.

3. Applies knowledge of family, child
development, healthy work environment
standards and organizational theories and
systems to support safe, high quality, and
cost effective care within health care delivery
systems.

4. Facilitates transitions across settings
including health care, mental health,
community and educational services to
optimize outcomes.

Transitions and linkages across health and
mental service, community, and educational
settings to optimize outcomes

Early intervention programs and committee
special education.

Advocacy for effective models of health care
delivery for alternative families.

Development of systems of care across health
and mental services, social and educational
institutions.

Integration of mental health into primary care
for children.

Navigation and promotion of health care
access for children and adolescents.

Collaboration in planning for transition to adult
health care.

Collaboration in palliative and end of life care.

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Ethics
Competencies

5. Integrates ethical principles in
decision making.

6. Evaluates the ethical
consequences of decisions.

7. 3. Applies ethically sound solutions
to complex issues related to
individuals, populations and
systems of care.

Knowledge of the unique challenge and
process with ethical dilemmas concerning
children and families.

Long term outcomes of ethical decisions
(chemo).

Principles of legal and ethical decision making.

Independent
Practice
Competencies

1. Functions as a licensed
independent practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing
previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to include
health promotion, disease
prevention, health protection,
anticipatory guidance,
counseling, disease
management, palliative, and
end of life care.

3.b Uses advanced health
assessment skills to
differentiate between normal,
variations of normal and
abnormal findings.

3.c Employs screening and
diagnostic strategies in the
development of diagnoses.

1. Conducts age appropriate comprehensive
advanced physical, mental and
developmental assessment across pediatric
life span.

2. Assesses growth, development and
mental/behavioral health status across the
pediatric life span.

3. Assesses for evidence of physical, emotional
or verbal abuse, neglect and the effects of
violence on the child and adolescent.

4. Analyzes the family system (i.e. family
structure, cultural influences etc.) to identify
contributing factors that might influence the
health of the child/adolescent and/or family

5. Assesses patient’s, family’s or caregiver’s
knowledge and behavior regarding age-
appropriate health indicators and health
risks.

6. Performs age appropriate comprehensive
and problem-focused physical exams.

7. Performs a systematic review of normal and
abnormal findings resulting in a differential
diagnoses encompassing anatomical,
physiological, motor, cognitive,

Refer to resource list for most up to date
guidelines:
 Bright Futures
 AAP well child visits
 ACIP Immunization schedule

Pediatric health risks and health indicators

Genetic (3 generational), developmental,
behavioral, psychosocial, cognitive screening
and family history.

Age-appropriate and condition specific
screening tools, tests, laboratory test, and
diagnostic procedures .

Age appropriate anticipatory guidance.

Etiology, natural history, developmental
considerations, pathogenesis, and clinical
manifestations of common disease processes
in children.

Principles of health education and counseling
for growth and development, health promotion,
health status, illnesses, illness management.

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

3.d Prescribes medications within
scope of practice.

3.e Manages the health/illness
status of patients and families
over time.

4. Provides patient-centered care
recognizing cultural diversity and
the patient or designee as a full
partner in decision-making.
4.a Works to establish a

relationship with the patient
characterized by mutual
respect, empathy, and
collaboration.

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy,
comfort, emotional support,
mutual trust, and respect.

4.c Incorporates the patient’s
cultural and spiritual
preferences, values, and
beliefs into health care.

4.d Preserves the patient’s control
over decision making by
negotiating a mutually
acceptable plan of care.

developmental, psychological, and social
behavior across the pediatric lifespan.

8. Identifies nutritional conditions and
behavioral feeding issues and implements
appropriate educational, dietary or medical
treatments/interventions.

9. Interprets age-appropriate, developmental
and condition-specific screening and
diagnostic studies to diagnosis and manage
the well, minor acute, or chronic conditions in
the pediatric scope of practice.

10. Promotes healthy nutritional and physical
activity practices.

11. Provides health maintenance and health
promotion services across the pediatric
lifespan.

12. Activates child protection services, and
recommends/incorporates other resources
on behalf of children or families at risk.

13. Partners with families to coordinate family
centered community and health care
services as needed for specialty care and
family support.

14. Incorporates health objectives and
recommendations for accommodations, as
appropriate, into educational plans (IEP)

15. Assists the parent/child in coping with
developmental behaviors and facilitates the
child’s developmental potential.

16. Recognizes and integrates the perspectives
of intradisciplinary collaboration in
developing and implementing the plan of
care.

Anticipatory guidance

Breast feeding promotion and management.

Nutritional programs, and nutritional intake
considering food preferences and avoidance of
food sensitivities.

Coordination of care .with Early Intervention
and special education

Newborn screening and appropriate follow up.

Exposure to and knowledgeable about the
following procedures:
 Fluorescein staining
 Removal of foreign body from eye-cotton

tip applicator
 Ear foreign body and cerumen removal-

curette and irrigation method
 Nasal foreign body removal
 Nasal packing for epistaxis
 Tooth evulsion- stabilization
 Pulse oximetry
 CPR
 Nasogastric tube insertion
 Urethral catheterization
 Removal of vaginal foreign body
 Skin scraping
 Wound immigration and drainage
 Wound closure- suture insertion; staple

insertion; butterfly/steri-strip, tissue
adhesive

 Splinting

Competency Area

NP Core Competencies Primary Care Pediatric
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

17. Understands the complexity and interaction
of nonpharmacologic and pharmacologic
therapies required in the care of children.

 Reduction of radial head subluxation
 Spirometry
 Nebulizer treatment
 Spacers devices
 Incheck dial for assessing inhaler

technique
 Pelvic exams with collection of cultures
 Diagnostic testing

 Proper strep test
 RSV collection of specimen
 Influenza A/B collection

Psychiatric-Mental Health Nurse Practitioner Competencies
These are entry-level competencies for the psychiatric-mental health nurse practitioner (PMHNP) and supplement
the core competencies for all nurse practitioners.

The PMHNP focuses on individuals across the lifespan (infancy through old age), families, and populations
across the lifespan at risk for developing and/or having a diagnosis of psychiatric disorders or mental health
problems. The PHMNP provides primary mental health care to patients seeking mental health services in a wide
range of settings. Primary mental health care provided by the PMHNP involves relationship-based, continuous
and comprehensive services, necessary for the promotion of optimal mental health, prevention, and treatment of
psychiatric disorders and health maintenance. This includes assessment, diagnosis, and management of mental
health and psychiatric disorders across the lifespan.

See the “Introduction” for how to use this document and to identify other critical resources to supplement these
competencies.

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and
evidence for improving advanced
nursing practice.

2. Integrates knowledge from the
humanities and sciences within
the context of nursing science.

3. Translates research and other
forms of knowledge to improve
practice processes and outcomes.

4. Develops new practice
approaches based on the
integration of research, theory,

Neurobiology

Advanced Pathophysiology, Advanced
Pharmacotherapeutics, Advanced Health
Assessment

Psychotherapy theories

Genomics

Developmental neuroscience

Interpersonal neurobiology

Recovery and resiliency

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

and practice knowledge

Trauma informed care

Toxic stress

Adverse Childhood Events Studies (ACES)
Studies

Allopathic stress

Advanced Practice and Interprofessional
psychiatric theoretical frameworks

Theories of change in individuals, systems

Stigma issues

Role of the PMHNP in changing policies

Aging Science

Caregiver stress

Leadership
Competencies

1. Assumes complex and advanced
leadership roles to initiate and
guide change.

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to
improve health care.

3. Demonstrates leadership that
uses critical and reflective
thinking.

4. Advocates for improved access,
quality and cost effective health
care.

1. Participates in community and population-
focused programs that promote mental
health and prevent or reduce risk of mental
health problems and psychiatric disorders.

2. Advocates for complex patient and family
medicolegal rights and issues.

3. Collaborates with interprofessional
colleagues about advocacy and policy issues
at the local, state, and national related to
reducing health disparities and improving
clinical outcomes for populations with mental
health problems and psychiatric disorders.

Interprofessional practice competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

5. Advances practice through the
development and implementation
of innovations incorporating
principles of change.

6. Communicates practice
knowledge effectively both orally
and in writing.

7. Participates in professional
organizations and activities that
influence advanced practice
nursing and/or health outcomes of
a population focus.

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety
and their influence on health care.

3. Evaluates how organizational
structure, care processes,
financing, marketing and policy
decisions impact the quality of
health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice
and is proactive in implementing
interventions to ensure quality.

Evaluates the appropriate uses of seclusion and
restraints in care processes.

QSEN competencies

Reflective Practice

Self-awareness and self-care

QI process in measuring outcomes of care

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Practice Inquiry
Competencies

1. Provides leadership in the
translation of new knowledge into
practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills
to improve health outcomes.

4. Leads practice inquiry, individually
or in partnership with others.

5. Disseminates evidence from
inquiry to diverse audiences using
multiple modalities

6. Analyze clinical guidelines for
individualized application into
practice

Research knowledge of:
 Research utilization
 Research process

Skill in use of EBP:
 Evaluating outcomes

 Integrating results into practice

Technology and
Information Literacy
Competencies

1. Integrates appropriate
technologies for knowledge
management to improve health
care.

2. Translates technical and scientific
health information appropriate for
various users’ needs.
2.a Assesses the patient’s and

caregiver’s educational needs
to provide effective,
personalized health care.

2.b Coaches the patient and
caregiver for positive
behavioral change.

3. Demonstrates information literacy

Electronic medical records

Electronic prescriptions

Virtual patient care

Distance linked services
(Telemedicine/Telepsychiatry)

Social networking

Laws for technology

Cultural and Linguistic literacy

Data banks and quality assurance findings
matched by evidence based best practices in
Web-based, tele-, written, oral and electronic

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

skills in complex decision making.
4. Contributes to the design of

clinical information systems that
promote safe, quality and cost
effective care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

communications to enhance care.

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality,
and cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

5. Analyzes the implications of health
policy across disciplines.

6. Evaluates the impact of
globalization on health care policy
development.

Employs opportunities to influence health policy
to reduce the impact of stigma on services for
prevention and treatment of mental health
problems and psychiatric disorders.

Healthcare/public policy knowledge of:
 Laws and regulations (e.g., Health

Insurance Portability and Accountability
Act [HIPAA], Center for Medicare and
Medicaid Services [CMS], The Joint
Commission, Accreditation Healthcare
Organizations, documentation,
coding/reimbursement, American with
Disabilities Act, mental health parity),

 Principles of advocacy to influence socially
responsible policy, including consumer
focused care .

 Laws, procedures for seclusion and
restraint for hospitals/psychiatric units,
long term care (LTC is inclusive of nursing
homes)

Health Delivery
System
Competencies

1. Applies knowledge of
organizational practices and
complex systems to improve
health care delivery.

2. Effects health care change using

Interprofessional practice competencies

Scope of practice knowledge of:
 Scope and Standards of Practice
 Legal/ethical issues

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

broad based skills including
negotiating, consensus-building,
and partnering.

3. Minimizes risk to patients and
providers at the individual and
systems level.

4. Facilitates the development of
health care systems that address
the needs of culturally diverse
populations, providers, and other
stakeholders.

5. Evaluates the impact of health
care delivery on patients,
providers, other stakeholders, and
the environment.

6. Analyzes organizational structure,
functions and resources to
improve the delivery of care.

7. Collaborates in planning for
transitions across the continuum
of care.

 Regulatory agencies

Coordination of services knowledge of
available resources (e.g., consultation
resources, evidence based practice,
community resources, government funded
studies/grants, school resources)

Models of integrative care skill in:
 Obtaining and utilizing appropriate

collateral information
 Providing and utilizing consultations and

referrals
 Communicating with other health care

providers

Ethics
Competencies

1. Integrates ethical principles in
decision making.

2. Evaluates the ethical
consequences of decisions.

3. Applies ethically sound solutions
to complex issues related to
individuals, populations and
systems of care.

Boundaries, duty to report, duty to warn,
confidentiality, reporting abuse, seeks
consultation, knowing scope of practice,
knowing personal limits, safety

State mental health laws

State laws related to involuntary
hospitalization and commitment

Influence on policy by monitoring of policy and

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

active communication to appropriate parties to
affect policy for optimal healthcare.

Independent
Practice
Competencies

1. Functions as a licensed
independent practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing
previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to
include health promotion,
disease prevention, health
protection, anticipatory
guidance, counseling, disease
management, palliative, and
end of life care.

3.b Uses advanced health
assessment skills to
differentiate between normal,
variations of normal and
abnormal findings.

3.c Employs screening and
diagnostic strategies in the
development of diagnoses.

3.d Prescribes medications within
scope of practice.

3.e Manages the health/illness
status of patients and families
over time.

1. Develops an age-appropriate treatment plan
for mental health problems and psychiatric
disorders based on biopsychosocial theories,
evidence-based standards of care, and
practice guidelines.

2. Includes differential diagnosis for mental
health problems and psychiatric disorders.

3. Assess impact of acute and chronic medical
problems on psychiatric treatment.

4. Conducts individual and group
psychotherapy.

5. Applies supportive, psychodynamic
principles, cognitive-behavioral and other
evidence based psychotherapy/-ies to both
brief and long term individual practice.

6. Applies recovery oriented principles and
trauma focused care to individuals.

7. Demonstrates best practices of family
approaches to care.

8. Plans care to minimize the development of
complications and promote function and
quality of life.

9. Treats acute and chronic psychiatric
disorders and mental health problems.

10. Safely prescribes pharmacologic agents for
patients with mental health problems and
psychiatric disorders.

11. Ensures patient safety through the
appropriate prescription and management of

Age Specific Psychiatric Disorders for:
 Aging adult (65 years and older)
 Adult (18-64 years)
 Adolescent (13-17 years)
 Pre-Adolescent (10-12 years)
 Child (3-9 years)
 Infant (Prebirth-2 years)

Evaluation:
 History and Physical Exam
 Psychiatric Evaluation
 Mental Status Exam Concepts related to

screening instruments (e.g., specificity and
sensitivity, reliability and validity)

Type of screening instruments (e.g.,
depression screening, Mini Mental Status
Exam (MMSE), alcohol screening, ADHD
screening, anxiety screening, drug screening,
serum screening)

Clinical guidelines

Screening tools

Clinical evaluation tools

Medical co-morbidities and differentials

Theoretical foundations of individual, group
and family approaches

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

4. Provides patient-centered care
recognizing cultural diversity and
the patient or designee as a full
partner in decision-making.
4.a Works to establish a

relationship with the patient
characterized by mutual
respect, empathy, and
collaboration.

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy,
comfort, emotional support,
mutual trust, and respect.

4.c Incorporates the patient’s
cultural and spiritual
preferences, values, and
beliefs into health care.

4.d Preserves the patient’s
control over decision making
by negotiating a mutually
acceptable plan of care.

pharmacologic and non-pharmacologic
interventions.

12. Explain the risks and benefits of treatment to
the patient and their family.

13. Identifies the role of PMHNP in risk-mitigation
strategies in the areas of opiate use and
substance abuse clients.

14. Seeks consultation when appropriate to
enhance one’s own practice.

15. Uses self-reflective practice to improve care.
16. Provides consultation to health care

providers and others to enhance quality and
cost- effective services.

17. Guides the patient in evaluating the
appropriate use of complementary and
alternative therapies.

18. Uses individualized outcome measure to
evaluate psychiatric care.

19. Manages psychiatric emergencies across all
settings.

20. Refers patient appropriately.
21. Facilitates the transition of patients across

levels of care.
22. Uses outcomes to evaluate care.
23. Attends to the patient- nurse practitioner

relationship as a vehicle for therapeutic
change.

24. Maintains a therapeutic relationship over time
with individuals, groups, and families to
promote positive clinical outcomes.

25. 25. Therapeutically concludes the nurse-
patient relationship transitioning the patient to
other levels of care, when appropriate.

Theoretical foundations of trauma-focused
care and recovery models of care

Gender differences and equality

Foster care, caregiver stress

Simulation of crisis intervention, risk
assessment, other pertinent areas

Epidemiology/risk analysis knowledge of:
 Prevalence of disorders or behaviors in

diverse populations across the life span
 Contributing risk factors and potential

barriers to health promotion and disease
prevention (e.g., 
socioeconomic,
biological, environmental, community
specific variables)

Epidemiology/risk analysis skill in:
 Risk assessment (e.g., violence, abuse,

neglect, suicide, psychopathology)

Health Promotion and Disease Prevention

Health behavior knowledge of:
 Health behavior guidelines (e.g., gender-

based recommendations, exercise,
lifestyle, familial factors that predisposes
one to disease, cultural and societal
influences/stigmas)


Health behavior skills in:
 Selecting and implementing appropriate

health behavior guidelines to specific
situations based on individual patient

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

26. Demonstrates ability to address
sexual/physical abuse, substance abuse,
sexuality, and spiritual conflict across the
lifespan.

27. Applies therapeutic relationship strategies
based on theories and research evidence to
reduce emotional distress, facilitate cognitive
and behavioral change, and foster personal
growth

28. Apply principles of self-efficacy/
empowerment and other self-management
theories in promoting relationship
development and behavior change.

29. Identifies and maintains professional
boundaries to preserve the integrity of the
therapeutic process.

30. Teaches patients, families and groups about
treatment options with respect to
developmental, physiological, cognitive,
cultural ability and readiness.

31. Provides psychoeducation to individuals,
families, and groups regarding mental health
problems and psychiatric disorders.

32. Modifies treatment approaches based on the
ability and readiness to learn.

33. Considers motivation and readiness to
improve self-care and healthy behavior when
teaching individuals, families and groups of
patients.

34. Demonstrates knowledge of appropriate use
of seclusion and restraints.

35. Documents appropriate use of seclusion and
restraints.

variances

Growth and development across the lifespan
knowledge of:
 Growth and development theories and

concepts (including spiritual, cultural,
cognitive, emotional, psychosexual,
physical abilities)

 Variances

Growth and development across the lifespan
skill in:
 Developmental assessment

Screening instruments (including invasive and
noninvasive screenings) skill in:
 Selecting and implementing appropriate

screening instrument(s), interpreting
results, and making recommendations and
referrals

Prevention activities knowledge of:
 Primary, Secondary and Tertiary

Prevention activities (e.g., health
promotion, immunizations, anticipatory
guidance, parenting skills, lifestyle
modifications, psychosocial rehabilitation
activities, in- home family treatments, risk
reduction, pharmacology, CAM, self-care)

 Access to care to underserved populations

Prevention activities skill in:
 Guidance, teaching, coaching,

collaborating (with patient, family, and
community)

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 Assessing readiness and capacity (e.g.,
change, learning, health literacy)

 Implementing early intervention activities

Assessment of Acute and Chronic Illness

Anatomy, physiology, development and
pathophysiology across the lifespan
knowledge of:
 Normal anatomy and physiology (including

genetics, normal aging)
 Pathophysiology

Comprehensive psychiatric evaluation
knowledge of:
 Psychopathology (including DSM V signs

and symptoms and neurobiology)

Comprehensive psychiatric evaluation skills in:
 Recognizing clinical signs and symptoms

of psychiatric illness
 Differentiating between pathophysiological

and psychopathological conditions
 Performing and interpreting a

comprehensive and/or interval history and
physical examination 
(including
laboratory and diagnostic studies)

 Performing and interpreting a mental
status examination

 Performing and interpreting a psychosocial
assessment and family psychiatric history

 Performing and interpreting a functional
assessment (activities of daily living,
occupational, social, 
leisure, educational,

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

coping skills)

Diagnostic reasoning knowledge of:
 Diagnostic reasoning process
 Diagnostic criteria (e.g., DSM V current

International Classification of Disease)

Diagnostic reasoning skill in:
 Developing and prioritizing a differential

diagnoses list
 Formulating diagnoses according to DSM

V based on assessment data
 Differentiating between normal/abnormal

age related physiological and
psychological symptoms/changes

The Nurse Practitioner and Patient
Relationship

Therapeutic communication knowledge of:
 Therapeutic communication principles,

techniques and ethics (e.g., boundaries,
phases of the therapeutic relationship,
conflict of interest, self-awareness,
negotiation and collaboration)

 Principles of family dynamics and social
support systems

 Cultural competency (e.g., language,
ethnicity, race, religious, spiritual,
biopsychosocial, urban/rural, 
homeless,
migrant, Gay-Bisexual-Lesbian-
Transgender/Transexual orientation,
corrections/forensic, uninsured and
underinsured, health disparities)

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Therapeutic communication skill in:
 Initiating a therapeutic relationship with

patient and family/support system (e.g.,
developing 
therapeutic alliances,
assessing literacy, health literacy, spiritual
needs, and barriers to communication)

 Maintaining a therapeutic relationship with
patient and family/support system (e.g.,
encouraging 
adherence and clinical
engagement, maintaining therapeutic
boundaries)

 Terminating a therapeutic relationship with
patient and family/support system (e.g.,
evaluating the 
effectiveness of a
therapeutic relationship, appropriate
closure and transitioning)

Legal/business/ethical issues knowledge of:
 Ethical principles and issues (e.g.,

termination, risk/benefit of disclosure,
professional boundaries, patient
autonomy, advocacy, consent/assent to
treatment, consumer focused care)

 Legal principles and issues (e.g., conflict
of interest, patient rights and
responsibilities, Health Information
Portability and Accountability Act [HIPAA],
professional obligations, duty to warn)

 Business principles and issues (e.g.,
financial agreements, contracts for
services)

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Clinical Management

Pharmacotherapuetic knowledge of:
 Current pharmacological concepts (e.g.,

pharmacodynamics, pharmacokinetics,
interactions, Complementary/Alternative
medicines [CAM])

 Standards of practice and clinical
guidelines, evidenced-based practice

 Safety and continuous quality
improvement

Pharmacotherapuetic skills in:
 Selecting appropriate medication plan

(e.g., risk/benefit, patient preference,
developmental 
considerations, financial,
the process of informed consent, symptom
management)

 Evaluating patient response and modify
plan as necessary

 Documenting (e.g., adverse reaction,
patient response, changes to plan of care)

Psychotherapy, psychoeducation,
complementary/alternative medicine
knowledge of:
 Theories of treatment modalities (models

and practices)
 Standards of practice and clinical

guidelines, evidenced-based practice
 Safety and continuous quality

improvement

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Psychotherapy, psychoeducation,
complementary/alternative medicine skill in:
 Selecting appropriate therapeutic plan

(e.g., risk/benefit, patient preferences,
developmental 
considerations, financial,
the process of informed consent)

 Implementing appropriate therapeutic plan
 Evaluating patient response and modify

plan as necessary
 Documenting (e.g., adverse reaction,

patient response, changes to plan of care)

Crisis management (e.g., chemical and
physical restraints, seclusion, reporting abuse
and neglect, involuntary hospitalization, safety
assessment, duty to warn, end of life,
institutionalization, residential treatment, foster
care, military service)
knowledge of:
 Theories and concepts associated with

crisis management (e.g., intervention risk
vs. benefit, level of risk, safety, lethality
assessment, stress adaptation, crisis
theories, disaster response)

 Standards of practice and clinical
guidelines, evidenced-based practice

 Safety, continuous quality improvement,
and patient rights

Crisis management skill in:
 Selecting appropriate intervention (e.g.,

risk/benefit, patient preference,
developmental 
considerations, the

Competency Area

NP Core Competencies Psychiatric-Mental Health
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

process of informed consent, least
restrictive environment/invasive treatment)

 Implementing appropriate intervention
 Evaluating patient response and modify

plan as necessary
 Documenting (e.g., adverse reaction,

patient response, changes to plan of care)
 Seclusion & restraint

Neurobiology and genetics of mental illnesses

Theories and application of behavior change

Women’s Health/Gender-Related NP Competencies
These are entry level competencies for the women’s health/gender-related nurse practitioner and supplement the
core competencies for all nurse practitioners.

The women’s health nurse practitioner provides primary care to women across the life cycle with emphasis on
conditions unique to women from menarche through the remainder of their life cycle within the context of socio-
cultural environments – interpersonal, family, and community. In providing care, the women’s health nurse
practitioner considers the inter-relationship of gender, social class, culture, ethnicity, sexual orientation, economic
status, and socio-political power differentials.

See the “Introduction” for how to use this document and to identify other critical resources that supplement these
competencies.

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Scientific
Foundation
Competencies

1. Critically analyzes data and evidence
for improving advanced nursing
practice.

2. Integrates knowledge from the
humanities and sciences within the
context of nursing science.

3. Translates research and other forms
of knowledge to improve practice
processes and outcomes.

4. Develops new practice approaches
based on the integration of research,
theory, and practice knowledge

1. Integrates research, theory, and evidence-
based practice knowledge to develop clinical
approaches that address women’s responses
to physical and mental health and illness
across the lifespan.

2. Integrates best evidence into practice
incorporating client values and clinical
judgment

Hormonal therapy (contraception, HRT,
infertility/fertility treatments)

In-depth knowledge of reproductive
endocrinology

Advanced assessment of female breast and
genitourinary systems

Genomics

Advanced practice and interprofessional role
development

Gender discrimination

Sexual Assault

Gender-unique disease presentations

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Leadership
Competencies

1. Assumes complex and advanced
leadership roles to initiate and guide
change.

2. Provides leadership to foster
collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to improve
health care.

3. Demonstrates leadership that uses
critical and reflective thinking.

4. Advocates for improved access,
quality and cost effective health care.

5. Advances practice through the
development and implementation of
innovations incorporating principles of
change.

6. Communicates practice knowledge
effectively both orally and in writing.

7. Participates in professional
organizations and activities that
influence advanced practice nursing
and/or health outcomes of a
population focus.

Quality
Competencies

1. Uses best available evidence to
continuously improve quality of
clinical practice.

2. Evaluates the relationships among
access, cost, quality, and safety and
their influence on health care.

3. Evaluates how organizational
structure, care processes, financing,

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

marketing and policy decisions impact
the quality of health care.

4. Applies skills in peer review to
promote a culture of excellence.

5. Anticipates variations in practice and
is proactive in implementing
interventions to ensure quality.

Practice Inquiry
Competencies

1. Provides leadership in the translation
of new knowledge into practice.

2. Generates knowledge from clinical
practice to improve practice and
patient outcomes.

3. Applies clinical investigative skills to
improve health outcomes.

4. Leads practice inquiry, individually or
in partnership with others.

5. Disseminates evidence from inquiry
to diverse audiences using multiple
modalities.

6. Analyzes clinical guidelines for
individualized application into practice

1. Evaluates gender-specific interventions and
outcomes.

2. Integrates of gender-specific evidence into
practice

Review of literature to distinguish unique
aspects of gender-specific health for
application of appropriate findings to patient
care.

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

Technology and
Information
Literacy
Competencies

1. Integrates appropriate technologies
for knowledge management to
improve health care.

2. Translates technical and scientific
health information appropriate for
various users’ needs.
2.a Assesses the patient’s and

caregiver’s educational needs to
provide effective, personalized
health care.

2.b Coaches the patient and
caregiver for positive behavioral
change.

3. Demonstrates information literacy
skills in complex decision making.

4. Contributes to the design of clinical
information systems that promote
safe, quality and cost effective care.

5. Uses technology systems that
capture data on variables for the
evaluation of nursing care.

Uses health information and technology tools in
providing care for women across the lifespan to
communicate, manage knowledge, improve
access, mitigate error, and to support clinical
decision making locally and globally.

Use of electronic datasets to evaluate practice
and improve quality, cost, and efficiency

Distance-linked services
 Telewomen’s health
 Social networking

Technology laws affecting women and families

Use of electronic communications to enhance
care processes
 Use of simulation to enhance clinical skills

in the care of women
 gynececologic urologic teaching

associates (GOTA)
 task trainers (e.g., IUD insertion, Leopold

maneuvers)
 standardized patient encounters focusing

on issues more prevalent in women such
as, but not limited to, domestic violence
and prenatal counseling

Policy
Competencies

1. Demonstrates an understanding of
the interdependence of policy and
practice.

2. Advocates for ethical policies that
promote access, equity, quality, and
cost.

3. Analyzes ethical, legal, and social
factors influencing policy
development.

4. Contributes in the development of
health policy.

Advocates for health care policies and research
that support accessible, equitable, affordable, safe
and effective health care for women both locally
and globally.

Principles of advocacy to influence socially
responsible policy for women and their
families.

Promotion of gender-specific health concerns
such as, but not limited to:
 undernourishment with body dysmorphism
 obesity epidemic
 female genital cutting

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

5. Analyzes the implications of health
policy across disciplines.

6. Evaluates the impact of globalization
on health care policy development.

Health Delivery
System
Competencies

1. Applies knowledge of organizational
practices and complex systems to
improve health care delivery.

2. Effects health care change using
broad based skills including
negotiating, consensus-building, and
partnering.

3. Minimizes risk to patients and
providers at the individual and
systems level.

4. Facilitates the development of health
care systems that address the needs
of culturally diverse populations,
providers, and other stakeholders.

5. Evaluates the impact of health care
delivery on patients, providers, other
stakeholders, and the environment.

6. Analyzes organizational structure,
functions and resources to improve
the delivery of care.

7. Collaborates in planning for
transitions across the continuum of
care.

Demonstrates knowledge of legal/ethical issues
and regulatory agencies relevant to gender-
specific issues

Consent forms such as, but not limited to:
 minors
 tubul ligation
 IUD insertion

Variation of policies specific to women among
state and federal regulatory agencies

Ethics
Competencies

1. Integrates ethical principles in
decision making.

2. Evaluates the ethical consequences

1. Recognizes the unique ethical dilemmas in
women’s health care.

2. Recognize the global ethical challenges in

Activities that raise awareness of issues that
influence women’s health such as, but not
limited to:

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

of decisions.
3. Applies ethically sound solutions to

complex issues related to individuals,
populations and systems of care.

women’s health care.
3. Develops ethically sound solutions to

complex global issues related to women.

 ageism
 racism,
 sexism,
 religious beliefs
 cultural variations
 health belief systems
 violence against women
 homophobia
 gender roles
 poverty

Independent
Practice
Competencies

1. Functions as a licensed independent
practitioner.

2. Demonstrates the highest level of
accountability for professional
practice.

3. Practices independently managing
previously diagnosed and
undiagnosed patients.
3.a Provides the full spectrum of

health care services to include
health promotion, disease
prevention, health protection,
anticipatory guidance,
counseling, disease
management, palliative, and end
of life care.

3.b Uses advanced health
assessment skills to differentiate
between normal, variations of
normal and abnormal findings.

3.c Employs screening and
diagnostic strategies in the

1. Provides culturally appropriate reproductive
and primary care for women of all ages.

2. Approaches gender-specific developmental
events, such as menarche, pregnancy,
menopause and senescence, as normative
transitions not disease states.

3. Recognizes unique health care needs of
marginalized women, including victims of
violence and transgendered female clients.

4. Recognizes disease manifestations unique to
women.

5. Manages disease manifestations unique to
women.

6. Provides infertility and sexually transmitted
disease services to sexual partners of female
patients.

7. Supports a woman’s right to make her own
decisions regarding her health and

Age-appropriate care
 women across the lifespan
 gynecologic
 obstetric

Normal vs. abnormal
 development of the female
 obstetrics
 gynecology
 age-related changes

Male conditions related to reproductive and
urologic systems

Selection and implementation of appropriate
clinical guidelines and standards

Using clinical decision support tools

Epidemiology/risk analysis, including
knowledge of:
 Prevalence of gynecologic and obstetric

disorders in diverse populations across the

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

development of diagnoses.
3.d Prescribes medications within

scope of practice.
3.e Manages the health/illness status

of patients and families over
time.

4. Provides patient-centered care
recognizing cultural diversity and the
patient or designee as a full partner in
decision-making.
4.a Works to establish a relationship

with the patient characterized by
mutual respect, empathy, and
collaboration.

4.b Creates a climate of patient-
centered care to include
confidentiality, privacy, comfort,
emotional support, mutual trust,
and respect.

4.c Incorporates the patient’s cultural
and spiritual preferences, values,
and beliefs into health care.

4.d Preserves the patient’s control
over decision making by
negotiating a mutually acceptable
plan of care.

reproductive choices within the context of her
belief system.

8. Assesses genetic, social, environmental,
physical, and mental health risks through
collection of family, social, environmental, and
health data.

9. Provides counseling, management, and/or
referral based on identified healthcare risk
factors.

life span
 Contributing risk factors and potential

barriers to health promotion and disease
prevention (e.g., socioeconomic,
biological, environmental, community-
specific variables)

Gender-based recommendations, exercise,
lifestyle, familial factors that predisposes one
to disease, cultural, and societal
influences/stigmas.

Growth and development theories and
concepts (spiritual, cultural, cognitive,
emotional, psychosexual, physical abilities) &
variances

Principles of family dynamics and social
support systems.

Cultural differences impacting health such as,
but not limited to:
 language
 ethnicity
 race
 religious
 spiritual
 biopsychosocial
 urban/rural
 homeless
 migrant
 lesbian-gay-bisexual-

transgender/transsexual (LGBT)
orientation

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 corrections/forensic
 uninsured and underinsured
 health disparities
 health literacy

Complementary/alternative medicine therapies
used across the lifespan in women’s health

Crisis management
 sexual assault
 violence (such as, but not limited to,

intimate partner and elder abuse)
 divorce
 caregiver burden

Female genital health, including, but not limited
to:
 vulvodynia
 vulvar vestibulitis
 chronic pelvic pain
 vulvovaginal dermatalogic conditions

Common urological disorders in women,
including, not limited to:
 urinary Incontinence
 urinary frequency
 interstitial cystitis

Skill in the procedures such as, but not limited
to:
 IUD insertion
 punch biopsies
 endometrial biopsies
 basic ultrasound

Competency Area

NP Core Competencies Women’s Health / Gender-Related
NP Competencies

Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only
suggested content specific to the population

 pessary use

Prenatal and postpartum management,
including, but not limited to:
 supervision of high-risk pregnancy
 breastfeeding
 contraception counseling

Glossary of Terms
Care processes: Actions or changes that occur during the delivery of health care.

Clinical investigative skills: Those skills needed to conduct inquiry of practice questions/therapies, evaluate
discovered evidence, and then translate it into practice.

Cultural diversity: Common beliefs, values, practices and behaviors shared by multiple subgroups or individuals.

Culture of excellence: The environment developed through the internalization of core values and a shared
commitment in which the highest standards of personal integrity, professionalism, and clinical expertise are
upheld.

Developmental neuroscience: The study of the differentiation and organization of neurons into an integrated,
functioning nervous system.

Evidence-based practice: The “conscientious, explicit and judicious use of current best evidence in making
decisions about the care of individual patients. Individual clinical expertise is integrated with the best available
external evidence from systematic research.” (Modified from Sackett, 1996).

Globalization: The interrelated influence of actions, resources, cultures, and economies across nations.

Health policy: The set of decisions pertaining to health whether made at local, state, national, and global levels
that influences health resource allocation.

Independent practice: Recognizes independent licensure of nurse practitioners who provide autonomous care
and promote implementation of the full scope of practice.

Independently: Having the educational preparation and authority to make clinical decisions without the need or
requirement for supervision by others.

Information literacy: The use of digital technology, communications tools, and/or networks to access, manage,
integrate, evaluate, create, and effectively communicate information.

Interpersonal neurobiology: The study of developmental neuroscience with the study of human experience,
particularly to understand how the brain gives rise to mental processes and is directly shaped by interpersonal
experiences (Siegel 1999).

Interprofessional education: When two or more professions learn about, from and with each other to enable
effective collaboration and improve health outcomes.

Interprofessional practice: Occurs when multiple health workers from different professional backgrounds work
together with patients, families, and communities to deliver the highest quality of care.

Knowledge management: Strategies that identify, create, represent, distribute, and enable the efficient use of all
types of information.

Licensed independent practitioner: An individual with a recognized scientific knowledge base that is permitted
by law to provide care and services without direction or supervision.

Quality care: The degree to which health services to individuals and populations increase the desired health
outcomes consistent with professional knowledge and standards. Quality care also means avoiding underuse,
overuse, and misuse of health care services.

Patient centered care: Care based on a partnership between the patient and health care provider that is focused
on the patient’s values, preferences, and needs.

Peer review: Evaluation of the processes and/or outcomes of care by professionals with similar knowledge, skills
and abilities.