Abstract There is strong evidence that a comprehensive model of sustained nurse home visiting (SNHV) in early childhood can improve child and family outcomes for vulnerable and at-risk families. There is also evidence that nurse home visitors experience challenges in delivering SNHV. This article aims to identify the nursing competencies needed for delivering a comprehensive model of SNHV and highlight the areas where further competency development is required. Qualitative analysis compared the content and language of published registered generalist and child and family nursing competency statements for Australian nurses with the work experiences of a team of community-based nurses delivering SNHV. Development of competencies is needed in the areas of (a) enhanced knowledge of child development, social determinants of health, and broader outcomes for individuals and populations; (b) advanced skills in fine observation, anticipatory guidance, negotiating, modelling and experimentation, holistic case management, and working in interdisciplinary teams; and (c) attitudinal competency for working “with” and supporting risk taking. The current published competencies for general and child and family nurses do not encompass the different and advanced competencies required for performing SNHV. Competency development and associated nurse training and support are needed for delivery of quality SHNV services.