Four pillars of nursing

The standards developed alongside each definition (enhanced, advanced and consultant level) are aligned to the four pillars of nursing. Find out more about how the integration of all capabilities across these pillars is key to the nursing workforce.

Key principles

• The four pillars of nursing apply irrespective of where nursing staff work.
• The core capabilities listed under each pillar can be set out according to the level of nursing. 
• Additional capabilities can be described that reflect the role and responsibilities of a nurse according to the primary focus of the context in which they work. For example, nurse researchers will have additional capabilities under the research pillar that reflect the expectations of their scope of practice. 

When the term 'practice' is used in nursing, there is often an assumption that this refers solely to nurses working in a clinical setting providing direct patient care. A limitation of this perspective is that it does not make it clear that while clinical knowledge and skills are important, nurses also use their knowledge and skills in education, research, and leadership to provide safe, high-quality, person-centred care. Together these aspects are described as the ‘four pillars of practice’ and mark the importance of these key elements.

The concept of the four pillars is referred to across nursing publications by respective departments of health in the UK and other health care professionals (Health Education and Improvement Wales 2021; Department of Health NI 2018; Health Education England 2017; NHS Education for Scotland 2021). The order of the pillars and terms for each vary, but all have the essence of Clinical Practice, Education, Research and Leadership. 

Understanding the relationship of the four pillars 

Previously, the four pillars of nursing — clinical practice, education, research, and leadership — have often been illustrated as separate pillars with no visual articulation between one another. This has led to perceptions that nurses will always only be using one pillar at a time within their job. It may also insinuate that some of the pillars are less important or unnecessary for distinct roles.  

There are several benefits to the combined application of four pillars and their associated capabilities. For example, an advanced level registered nurse working in a clinical-facing role can use the knowledge and skills of the pillars to function in a far more efficient manner across often complex and unpredictable contexts. This also applies to advanced level registered nurses working in education, research and leadership roles.