Educating nurses to communicate with all persons: Development and psychometric exploration of the CARES communication rubric

The 2026 American Association of Colleges of Nursing Essentials update emphasized access, connection, and engagement, in addition to communication, as core nursing competencies and embedded health equity throughout domains. To work toward this standard, competency-based education requires valid assessment tools to measure learner progression. To address this need, we used a theoretically grounded six-step development process to develop the Culturally Aware, Reflective, and Equitable Communication in Simulation (CARES) Communication Rubric to assess nurse practitioner learner performance in equity-focused communication. Rater response processes were explored through three semi-structured focus groups using qualitative content analysis to explore rubric item interpretation and scoring decisions. Iterative revisions following each focus group improved alignment between rubric items and intended constructs. Inter-rater reliability was assessed by 10 raters who independently scored four simulation videos demonstrating varied learner performance levels. Inter-rater reliability testing established moderate agreement (ICC = 0.67, 95% CI 0.55–0.79, p < 0.0001). The final 8-item CARES C ommunication R ubric was designed to measure equity-focused communication behaviors across five theoretically grounded domains. Findings support intended response processes and moderate inter-rater reliability. The CARES C ommunication Rubric offers faculty an assessment rubric to evaluate learner progression of updated nursing competency standards.