© 2021 American Association of Colleges of Nursing. All rights reserved.

Making nursing education equitable and inclusive requires actively combating structural
racism, discrimination, systemic inequity, exclusion, and bias. Holistic admission reviews are
recommended to enhance the admission of a more diverse student population to the profession
(AACN, 2020). Additionally, an equitable and inclusive learning environment will support the
recruitment, retention, and graduation of nursing students from disadvantaged and diverse
backgrounds. Diverse and inclusive environments allow examination of any implicit or explicit
biases, which can undermine efforts to enhance diversity, equity, and inclusion. When diversity
is integrated within inclusive educational environments with equitable systems in place, biases
are examined, assumptions are challenged, critical conversations are engaged, perspectives
are broadened, civil readiness and engagement are enhanced, and socialization occurs. These
environments recognize the value of and need for diversity, equity, and inclusion to achieve
excellence in teaching, learning, research, scholarship, service, and practice.
Academic nursing must address structural racism, systemic inequity, and discrimination in
how nurses are prepared. Nurse educators are called to critically evaluate policies, processes,
curricula, and structures for homogeneity, classism, color-blindness, and non-inclusive
environments. Evidence-based, institution-wide approaches focused on equity in student
learning and catalyzing culture shifts in the academy are fundamental to eliminating structural
racism in higher education (Barber et al., 2020). Only through deconstructive processes
can academic nursing prepare graduates who provide high quality, equitable, and culturally
competent health care.
Finally, nurses should learn to engage in ongoing personal development towards understanding
their own conscious and unconscious biases. Then, acting as stewards of the profession, they
can fulfill their responsibility to influence both nursing and societal attitudes and behaviors
toward eradicating structural/systemic racism and discrimination and promoting social justice.
Four Spheres of Care
Historically, nursing education has emphasized clinical education in acute care. Looking at
current and future needs, it is becoming increasingly evident that the future of healthcare
delivery will occur within four spheres of care: 1) disease prevention/promotion of health and
well-being, which includes the promotion of physical and mental health in all patients as well
as management of minor acute and intermittent care needs of generally healthy patients;
2) chronic disease care, which includes management of chronic diseases and prevention of
negative sequelae; 3) regenerative or restorative care, which includes critical/trauma care,
complex acute care, acute exacerbations of chronic conditions, and treatment of physiologically
unstable patients that generally requires care in a mega-acute care institution; and 4) hospice/
palliative/supportive care, which includes end-of-life care as well as palliative and supportive
care for individuals requiring extended care, those with complex, chronic disease states, or
those requiring rehabilitative care (Lipstein et al., 2016; AACN, 2019).
Entry-level professional nursing education ensures that graduates demonstrate competencies
through practice experiences with individuals, families, communities, and populations across
the lifespan and within each of these four spheres of care. The workforce of the future needs
to attract and retain registered nurses who choose to practice in diverse settings, including
community settings to sustain the nation’s health. Expanding primary care into communities
will enable our healthcare delivery systems to achieve the Quadruple Aim of improving patient
6

THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION