Nurse Life Care Planning

Transcription

1 American Association of Nurse Life Care Planners Contributors Editor Nurse Life Care Planning Scope and Standards of Practice September 19, 2014 Wendie A. Howland, MN, RN-BC, CCRN, CCM, CNLCP, LNCC Members Lori Dickson MSN, RN, MSCC, CLCP, CNLCP Jacquelyn Godlove-Morris, RN, BSN, CRRN, CNLCP Liz Holakiewicz, BSN, RN, CCM, CNLCP Wendie A. Howland, MN, RN-BC, CCRN, CCM, CNLCP, LNCC Shelly Kinney, MSN, RN, CNLCP, CCM Kelly Lance, BSN, RN, CNLCP, LNCP-C Helen McDaniel, RN, LNCC, CNOR Peggie Nielson, RN, CNLCP April Pettengill, BSN, RN, CRRN, CDMS, CNLCP, MSCC Victoria Powell RN, CCM, LNCC, CNLCP, MSCC, CEAS, CBIS Patricia Rapson RN, CCM, CNLCP, CLCP, CBIS, MSCC Anne Sambucini, RN, CCM, CDMS, CNLCP, MSC-C Joan Schofield, MBA, BSN, RN, CNLCP Nancy Zangmeister RN, CRRN, CCM, CLCP, MSCC, CNLCP 1

2 Table of Contents Prologue 3 About the AANLCP 4 Introduction 5 The Origins of Nurse Life Care Planning, 1997 Foundation and Framework of the Scope and Standards, 2006 Audience for Scope and Standards Nurse Life Care Planning Scope of Practice 9 Overview and Evolution of Nurse Life Care Planning Nurse Life Care Planning in Context Who needs a life care plan? Body of Knowledge overview US healthcare cost trends How Nurse Life Care Planning Can Help How Other Nursing Disciplines See Nurse Life Care Planning Preparing for the Role and Maintaining Competence Role Preparation: Novice to expert, background experience, education Continuing education Professional Associations, Membership, Collaboration, and Certifications NLCP Functions and Roles 19 Overview AANLCP Role Delineation Study Essential Functions Nurse Life Care Planning Roles Advanced Skills Applied to Nurse Life Care Planning Practice Settings for Nurse Life Care Planners General Considerations for All Nurse Life Care Planner Settings Examples Values and Principles Guiding Nurse Life Care Planning 28 Ethics in Nurse Life Care Planning Practice: The AANLCP Code of Ethics and Conduct Current Issues and Trends Affecting Nurse Life Care Planning Practice 35 Overview Industry and Regulatory Issues Affecting the Future of the Specialty Costing transparency and accountability MSAs Tort reform Elder care Looking towards the future Nurse Life Care Planning Research 36 JNLCP Research committee goals and activities The Standards of Nurse Life Care Planning 39 Significance of the Standards Nurse Life Care Planning Standards of Practice...41 References 52 Appendix 2

3 Prologue The 2010 Nursing s Social Policy Statement: The Essence of the Profession (ANA, 2010, p.3) defines nursing in this way: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations. This definition is the foundation for understanding the scope of practice of Nurse Life Care Planners. The National League for Nursing defines critical thinking in nursing practice as a discipline-specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns (NLN, 2011). One such critical thinking process is called the nursing process. Nurse Life Care Planning is defined as the protection, promotion, and optimization of health and abilities for individuals and families affected by catastrophic injuries and chronic health conditions. Nurse Life Care Planners apply advocacy, judgment, and critical thinking skills using the nursing process, to develop long-term or life time plans of care, including the costs associated with all of a plan s components: Identified evaluations and interventions Health maintenance Health promotion Optimization of physical and psychological abilities for the life expectancy of the individual Care plan development is based on nursing assessment and collaboration with the affected individual, family, community and care providers. Other disciplines prepare life care plans, but nurses are unique in their abilities in leveraging and promoting quality metrics in Nurse Life Care Plans. Nurse Life Care Planners function in the registered nurse s scope of practice, and, when possible and applicable, incorporate opinions arrived by collaboration with various healthcare providers. While many registered nurses are prepared to develop short-term care plans and provide basic care coordination, Nurse Life Care Planners are distinguished by their advanced care planning for complex situations over an individual s lifetime. 3

4 About the American Association of Nurse Life Care Planners The American Association of Nurse Life Care Planners is a professional specialty organization founded in 1997 for registered nurses practicing life care planning. AANLCP promotes the professional practice that the Registered Nurse delivers to the life care planning process. The goals of the AANLCP are to promote education, collegiality, collaboration, research, and standards related to the practice of Nurse Life Care Planning. 4

5 Introduction Nurse Life Care Planning is defined as the protection, promotion, and optimization of health and abilities for individual and families affected by catastrophic injuries, and chronic and complex health conditions; Nurse Life Care Planners apply advocacy, judgment, and critical thinking skills using the nursing process to develop long-term or lifetime plans of care. These plans include the future cost of identified interventions and associated costs for health maintenance, health promotion, and optimization of physical and psychological abilities for the life expectancy of the individual. Nurse Life Care Planning: Scope and Standards of Practice addresses the scope of practice and defines the standards of practice and professional performance for all registered nurses identified as Nurse Life Care Planners. The Standards define, guide, and provide a theoretical foundation for Nurse Life Care Planning in all settings. Nurse Life Care Planners use a holistic framework, recognizing biological, psychological, social, and spiritual factors associated with and affected by disability and chronic health conditions. Life Care Planning begins with a strong nursing foundation. Nurse Life Care Planning is enriched, strengthened, and diversified by elements of case management, rehabilitation nursing, community health, public health, and legal nurse consulting. Nurse Life Care Planning requires a working knowledge of economic trends, healthcare policy, funding sources, medical coding, and reimbursement issues. Nurse Life Care Planners apply their expertise in many ways, expanding beyond litigation-based traditional life care planning practice into the following areas: Complex rehabilitation discharge planning Complex utilization review Independent nursing assessments Lien investigations Medical cost projections Medicare set-aside arrangements Reasonableness of past medical bills Setting insurance reserves 5

6 The Origin of Nurse Life Care Planning In 1997, Nurse Life Care Planning began as a distinct nursing entity when Kelly Lance, MSN, RN, CNLCP, LNCP-C, FNP-BC, recognized that a registered nurse s multidimensional healthcare education, combined with nursing s native professional standards and scope of practice, were an ideal preparatory foundation for life care planning. She identified the nursing process as the methodology often used by registered nurses who developed life care plans. Experienced nurses broad training and skills made them particularly well-suited and sought-after to assess patients needs and work collaboratively with all involved stakeholders whenever a lifetime plan of care was needed. Ms. Lance and a group of Nurse Life Care Planners founded the American Association of Nurse Life Care Planners (AANLCP) as a nonprofit, professional association for nurses who practiced life care planning. Ms. Lance developed a Nurse Life Care Planning curriculum with the nursing process methodology at its core, to teach and disseminate concepts and skills for Nurse Life Care Planning in the medical-legal arena. This included formal educational content on applying the nursing process and professional nursing scope and standards as the foundation for Nurse Life Care Planning practice. The AANLCP continues to represent and support all nurses engaged in or interested in life care planning. The American Association of Nurse Life Care Planners holds that the American Nurses Association (ANA) Scope and Standards of Practice is the defining conceptual base for Nurse Life Care Planning. Nurse Life Care Planners use the critical thinking skills of the nursing process to formulate a plan of care for an individual s lifetime, often involving decades of healthcare and other needs. The Nurse Life Care Planner develops the life care plan estimating the costs and resources necessary for future medical and nonmedical needs and expenses using the nursing process. Foundation and Framework of the Scope and Standards As a professional specialty nursing organization, AANLCP has a duty to its members and the public to develop and promulgate professional scope and standards of practice. In 2006, the AANLCP Executive Board realized the need to define a Nurse 6

7 Life Care Planner s scope of practice formally as a separate entity in its own right. In 2007, AANLCP developed the initial standards of practice. Also in 2007, the AANLCP established a preliminary work group to explore the development of the specialty practice of Nurse Life Care Planning with the ANA. In December 2010, this work group provided a draft of the Scope of Practice. A second work group completed defining the Nurse Life Care Planner s role and wrote the first Scope of Practice in This updated Scope of Practice describes a Nurse Life Care Planner s practice framework and responsibilities. The foundation and framework for NLCP specialty scope and standards are informed by three ANA documents: Nursing: Scope and Standards of Practice, Second Edition (ANA, 2010) as its template for the specialty practice of Nurse Life Care Planning because it applies to all registered nurses in every practice setting. Nursing s Social Policy Statement: The Essence of the Profession (ANA, 2010) The Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) Registered nurses developed Nurse Life Care Planning as a unique, synergistic specialty that draws strength and diversity from existing nursing specialties, such as community health, rehabilitation nursing, legal nurse consulting, and case management. Therefore, it was appropriate that other specialty scopes and standards of practice were consulted to help develop these, the AANLCP's Nurse Life Care Planning: Scope and Standards of Practice. Definitions and competencies are expanded, enriched, and customized to describe a competent level of Nurse Life Care Planning practice common to all Nurse Life Care Planners. The breadth and depth to which a particular Nurse Life Care Planner may engage in the total scope of Nurse Life Care Planning practice settings is a function of education, experience, role, and population served. The AANLCP placed the AANLCP Scope of Practice on the organization s website for public comment after informing the membership of its availability, then evaluated the comments and made appropriate revisions. The current AANLCP Code of Professional Ethics and Conduct, Scope of Practice, and Position Statements are available on the AANLCP website at along with other resources. The Standards 7

8 outlined here are authoritative statements, describing obligations that Nurse Life Care Planners are expected to meet, with the understanding that application of any standards must be considered in context. Specific clinical and practice settings, population served, and other factors, e.g., constraints imposed by the litigation process or funding sources, may affect the applicability of the standards at any given time. The competencies accompanying each standard serve as evidence of compliance with the corresponding standard. The list of standards is not to be regarded as exhaustive. Application and adherence to a specific standard or competency is dependent upon the situation. For example, collection and analysis of data may be limited by the availability of medical records and documents, access to the healthcare consumer and family, and scope of assignment. Implementation of the interventions outlined in the Nurse Life Care Plan may be delegated to or executed by others as circumstances warrant. The primary audience of this professional resource includes: Those who serve individuals who could benefit from life care planning Those who want to learn about life care planning as a specialty practice Those who want to learn about developing lifetime healthcare need and cost projections Registered nurses who are interested in pursuing the practice of nurse life care planning This scope and standards document also serves as a reference source for legislators, regulators, legal counsel, and the judicial system. Others who will find this a valuable reference and benefit from this information include: Persons with catastrophic injury, illness, complex care needs, and disability Families and legal guardians Human service agencies Healthcare organizations Nurse administrators Nurses working in other specialty areas Other professional colleagues, including those in the rehabilitation and case management fields 8

9 These groups are potential stakeholders who can use this document to better understand the role and responsibilities of registered nurses who practice life care planning. Nurse Life Care Planning Scope of Practice Overview of Nurse Life Care Planning The nurse s role in coordinating care and services began in the early 1900s with the appearance of privately funded home health nursing agencies for the poor. In the early 1900s, Lillian Wald promoted the term public health nurse, expanding nursing practice to encompass issues of employment, recreation, health education, and sanitation. Visiting nurses coordinated community-based resources; governmental funds for public health nursing expanded in the 1930s. By the 1940s, the insurance industry was using case management as a method of cost containment (CMSA, 2008), resulting in the beginnings of occupational health nursing, and industry during World War II used case management nurses to help maintain a healthy workforce for the war effort. Care planning in nursing advanced in 1961 with formal identification of the nursing process by Ida Jean Orlando. As care planning has evolved, so have its purpose and tools. Case management roles expanded as early as 1966, when nurses began adding budget planning to coordinating care and services. In the mid-1970s, Paul Deutsch first identified the term life care planning, referring to future needs, to describe a tool to project the costs of medical care. Case management and catastrophic disability research entered the litigation arena as a published resource in 1981 (Deutsch, 2011). Registered nurses in the insurance industry applied nursing expertise to project longterm healthcare needs and provide lifetime medical cost estimates. Management was directed toward serious conditions likely to require numerous providers and involve costly care. These early nurse life care planners assessed each case individually, identifying the treatments and care these individuals would require for their extremely resource-intensive conditions. Attorneys began engaging nurses to assist in litigation, using their nursing knowledge to develop expanded care plans projecting the future medical needs of individuals with complex injury or chronic illness. Nurses with an appreciation for legal issues were drawn to 9

10 this milieu. Life Care Plans were used in a variety of legal practice areas, including personal injury, medical malpractice, product liability, and toxic tort cases, and for setting budgets for high-cost medical claims in medical insurance and workers compensation cases. Early plans used checklists of assumptions about what injured persons might need. The nursing care plan has long been recognized as a product of the nursing process based on nursing theory and evidence-based best practices identified by nursing research. Registered nurses in all practice settings apply education and professional experience and use the nursing process to assess immediate and ongoing care needs for individuals and develop plans of care. As registered nurses, Nurse Life Care Planners apply the nursing process as a critical thinking model, knowledge, experience, and evidence-based research to their practice. Initially, Life Care Plans were developed by various professionals engaged in liability litigation, working largely from a vocational rehabilitation and disability management perspective to testify on this aspect of damages. Formal educational conferences with necessarily broad formats met the learning needs of these ancillary providers, still largely composed of vocational counselors with lesser numbers of nurses, educational consultants, social workers, therapists, psychologists, and others. Nurses who attended these early life care planning courses realized the methodology used to train ancillary providers in Life Care Planning was inherently different from registered nurses professional framework, the nursing process. In 1997, Kelly Lance, MSN, RN, CNLCP, LNCP-C, FNP-BC, recognized that registered nurses' multidimensional healthcare education and nursing s own professional standards and scope of practice were an ideal stand-alone methodology for Life Care Planning. Ms. Lance led a group of like-minded nurses to establish a nonprofit professional association for nurses who develop Life Care Plans, the American Association of Nurse Life Care Planners (AANLCP). She provided the first formal educational offerings on using the nursing process and professional nursing scope and standards of practice as the methodological basis for Nurse Life Care Planning. Nurse Life Care Planning emerged as a specialty practice as more nurses intuitively embraced this concept and wholly incorporated it into Life Care Planning practices. 10

11 Nurse Life Care Planning today is a unique hybrid of multiple nursing specialties. This means it has great opportunity to expand into more healthcare spaces in the coming decades. A Nurse Life Care Planner s skills and knowledge are excellent long-term planning resources for the growing elderly population and their families. As financial pressures constrain care provision for more survivors of spinal cord injury, multiple trauma, and brain injury, innovative approaches will be critical to maintain safe environments for them. The Nurse Life Care Planner s bundle of knowledge, incorporating elements of many different nursing specialties, legal systems, and healthcare economics, will be critical in changing the face of healthcare. Nurse Life Care Planners use their professional experience in case management, clinical settings, and rehabilitation to identify future medical and non-medical needs, and to research dollar amounts for future care for many different types of clients. A Nurse Life Care Planner performs a broad range of activities applying highly-specialized skills and advanced knowledge. In a typical day, it s quite possible for a Nurse Life Care Planner to research changing wheelchair needs over a person s lifetime, determine hours of care required for a particular level of spinal cord injury, and work with a contractor on an individual s specific accessible housing requirements and plans for home modification. Nurse Life Care Plans are formulated to smooth transitions throughout the healthcare system continuum and throughout the stages of life. Nurse Life Care Planners take into account the need for stewardship of available healthcare dollars and resources, setting forth safe transitions of care while staying focused on safety, quality of care and patient self-determination. Nurse Life Care Planning in Context Who Needs a Life Care Plan? Life Care Plans are most often developed for individuals with injuries or chronic conditions requiring complex longterm healthcare interventions and management. These documents must be dynamic, organized, concise plans of care for goods and services to meet estimated current and future, reasonable and necessary (and reasonably certain to be necessary) medical and non-medical needs and expenses, with associated costs. A life care plan outlines an individual s needs throughout the healthcare continuum, in multiple settings, and throughout life expectancy. Like any 11

12 nursing care plan, a Life Care Plan must be flexible, with provisions for periodic reevaluations and updates. Body of Knowledge Overview Nurse Life Care Planners possess a wide body of knowledge in: Care/case management principles Rehabilitation Changing care needs across the lifespan Epidemiology Morbidity and mortality Disability Healthcare trends Insurance and funding Legal issues This knowledge base informs Nurse Life Care Planners practice and bolsters their credibility and authority as advocates for positive changes in healthcare. Healthcare Costs and Trends Five percent of the U.S. population accounts for almost half of U.S. total expenditures for healthcare goods and services. The rapid growth of health maintenance organizations (HMOs) and other forms of managed care from the 1970s onward was intended to control costs. However, this change in U.S. health care delivery did not change the concentration of health care expenses. Moreover, studies reveal major differences in health care expenses by geographic area. These differences are due not to differences in prices, average acuity of illness, or socioeconomic status, but rather to the overall quantity of medical services provided and to the relatively higher proportions of internists and medical subspecialists in highcost regions (Agency for Healthcare Research and Quality, 2006). Nurse Life Care Planners services are targeted to and best serve individuals with high-dollar, highresource-utilization patterns. The plans of care are driven by evidenced based principles rather than geographic factors. How Nurse Life Care Planners Can Help AANLCP believes that adapting Nurse Life Care Planning to a broader population would create more informed healthcare consumers who could then change healthcare 12

13 utilization patterns via self-advocacy. Life Care Plans focus on nursing and medical diagnoses, and by their nature are: Action-oriented Attainable Evidence-based Fiscally responsible Interdisciplinary Time-specific Individuals with chronic, complex, and catastrophic conditions who understand their long-term needs as identified by a Nurse Life Care Planner are well-positioned to seek preventive and wellness-oriented interventions as recommended in the Nurse Life Care Plan to minimize the risk of secondary complications. As noted in the Institute of Medicine (IOM) report, nurses have the potential to play an influential role to ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes. The report recommended that nurses be full partners with physicians and other health care professionals to redesign health care in the United States (IOM, 2010). Nurse Life Care Planners unique knowledge base in clinical conditions, healthcare systems, regulatory, and healthcare spending makes them valuable contributors as the United States attempts to transform its health care system. Nurse Life Care Planners can and should play a fundamental role in this transformation. Embedding Nurse Life Care Planners within the healthcare system at the regulatory, insurance and care delivery levels could be achieved within the scopes of existing nurse practice acts. Healthcare spending pattern analyses shed important light on how best to focus efforts to help restrain rising health care costs. Recognizing that a relatively small group of individuals account for a large fraction of spending, regardless of payer, drives the need for smarter cost-containment strategies. AANLCP has a long-term goal of having a seat at the table for healthcare policy and strategy formation to design effective consumer-directed health plans and plans of care. Nurse Life Care Planners are particularly well-suited to assist all stakeholders -- government entities, policymakers, individuals, communities, and populations -- 13

14 develop and adopt strategies and tactics to address complex and chronic health issues such as spinal cord injury, acquired brain injury, diabetes, developmental disabilities, and chronic pain, among others. In litigation, the Nurse Life Care Planner may serve as testifying expert, providing testimony on disability and function, safety, nursing care, reasonable and necessary future care, and associated costs. In this role, the Nurse Life Care Planner educates the trier of fact (e.g., judge, jury, mediator, arbitrator) about identified needs, and provides evidence regarding the plan s foundation, contents, recommendations, methodology, and conclusions. How Other Nursing Specialties Value Nurse Life Care Planners Other specialties and nursing disciplines recognize the role of Nurse Life Care Planners. The certification examinations for Certified Case Managers (CCM) and Legal Nurse Consultants (LNCC) each allocate 5-7% of their examination questions to life care planning. Basic nursing textbooks, including Stanhope and Lancaster, (2012). Public Health Nursing Population-Centered Health Care in the Community (8th ed.)(2012), now describe the role and function of Nurse Life Care Planners; the authors are collaborating with the Journal of Nurse Life Care Planning editor on their next edition to provide more specifics. The Association of Rehabilitation Nurses includes the role and function of Nurse Life Care Planners in their Core Curriculum s upcoming revised edition. Nurse Life Care Planning: Preparing for the Role and Maintaining Competence Role Preparation The Nurse Life Care Planner role is independent, autonomous, and self-motivated. The specialty practice requires advanced nursing assessment, critical thinking, and communication skills. Additional qualifications include proficiency in research, literature and medical record reviews, technical writing, financial concepts, and medical coding. It is also critical to have a fundamental understanding of applicable laws and regulations, including the Nurse Practice Act. Registered nurses can prepare for this 14

15 role through experience, continuing education, and other formal and informal educational offerings. Benner's seminal novice-to-expert work is classically applied as a clinical ladder model, beginning with new graduates at a basic educational level caring for healthcare consumers with low-complexity needs who progress to expertise in higher-complexity situations in a continuum including further experience, learning, and mentorship. However, this cannot be wholly applied to nurse life care planning because, unlike many nursing specialties, Nurse Life Care Planning does not include a traditional or clinical patient care component. In contrast to new graduate nurses in clinical specialty areas, even novice Nurse Life Care Planners are typically experienced in many complex aspects of patient care, as reflected by the many contributory certifications they hold in nursing and other specialties, e.g., rehabilitation nursing, disability management, case management, brain injury, nursing education, utilization review, legal nursing, and others. Nurse Life Care Planners have experience in professional networking and research. The AANLCP Role Delineation Study in December 2013 (Manzetti, Bate, and Pettengill, 2014) found that 89% of Nurse Life Care Planners surveyed had held RN licensure for more than twenty years; 75% of respondents reported 30+ years of nursing experience. The AANLCP Role Delineation Study reported that 80% of responders held a bachelors degree, of whom 20% also have a master s degree in nursing and 80% held a master s degree in another field. Many CNLCPs obtain other certifications and degrees, such as Advanced Practice Registered Nurse or Master in Nursing. Some CNLCPs are pursuing doctoral degrees (e.g., PhD, DNSc, DNP) in nursing and performing evidence-based research in Nurse Life Care Planning. Continuing education As all nurses know, continuing education should never end. The AANLCP Scope and Standards of Practice and Code of Ethics and Conduct both address Nurse Life Care Planners responsibility to advance the profession through participating in and promoting mentorship, collegiality, education, and ongoing knowledge development in the field. Many Nurse Life Care Planners fulfill this responsibility by attending and 15

16 presenting at professional conferences for life care planners, case managers, rehabilitation nurses, legal nurses, and meetings of other allied professionals such as plaintiff and defense attorneys, structured-settlement providers, insurance claims managers, professional patient advocates, trust officers, and others. The commitment to lifelong learning after initial education is a Nurse Life Care Planning core value. The Nurse Life Care Planner seeks continuing education on, for example, regulatory issues, reimbursement, medical coding changes, adaptive technology, and research related to supplies and equipment for specific injuries or conditions. The AANLCP provides continuing education programs on current trends and research, especially related to catastrophic injuries or conditions, e.g., traumatic brain injury, spinal cord injury, amputation, burns, and chronic pain; disease states such as cancer, chronic illnesses, Guillain-Barré syndrome, psychiatric conditions, effects of toxic substances, and organ or other tissue transplant; and pediatric conditions such as autism, cerebral palsy, other developmental conditions, and muscular dystrophy. AANLCP also provides opportunities for lifelong learning through networking, participation in small group programs, self-study, reading nursing/medical journals, the JNLCP, other relevant literature, and collaboration with other organizations, e.g., the American Association of Legal Nurse Consultants. Annual AANLCP educational conferences include content on the nursing process and integrate it throughout conference programming. Conference topics include both entry level and advanced practice topics and subject matter. AANLCP also sponsors webinars on topics pertinent to the field of Nurse Life Care Planning. Continuing education opportunities exist throughout the country on related content such as catastrophic injury management, advances in rehabilitation, assistive technology for persons with disability, legal aspects of Life Care Planning, and trends in healthcare economics. 16

17 Nurse Life Care Planning: Professional Associations, Membership, and Certification AANLCP The American Association of Nurse Life Care Planners is a voluntary professional nursing specialty association established in 1997 for registered nurses practicing or with an interest in Nurse Life Care Planning. Members represent a multitude of professional practice backgrounds, including orthopedic, burn, trauma and rehabilitation nursing, case management, nursing education, insurance, physician and hospital administration, to name a few. Most AANLCP members practice Life Care Planning in the U.S., and there are an increasing number of international members. Leaders and members in the Association are also members of the ANA, NANDA-I, Case Management Society of America (CMSA), American Association of Legal Nurse Consultants (AALNC), National Association of Medicare Set-Aside Professionals (NAMSAP), and other nursing organizations. Activities and entities in which they serve and provide leadership include: Authoring, reviewing, and editing submissions for nursing periodicals Chairing and serving on standing and special committees Contributing to the next edition of a well-known nursing diagnosis handbook (Ackley, 11 th ed.) Preparing a textbook of Nurse Life Care Planning exemplars for publication Presenting continuing education topics at professional meetings and consortia Standards validation committees for certifying entities State Nurse Practice Advisory Panels Teaching and precepting nursing students Writing items for certification examinations The AANLCP seeks to promote excellence in Nurse Life Care Planning through education and research, and to unify the specialty practice by providing a common foundation for Nurse Life Care Planners. It also promotes the practice of Nurse Life Care Planning in healthcare, public, and legal communities; provides standards for quality of practice to protect the public who uses these services; and facilitates ethical practice. The AANLCP recognizes the expanded role of the registered nurse as separate and distinct from the physician, therapist, or counselor, and of equal value. 17

18 The Nurse Life Care Planner assesses individuals from a holistic and comprehensive perspective in homes, communities, and multiple care settings. AANLCP also collaborates with life care planning colleagues from other professional disciplines to share resources, discuss common issues, and to advance common agendas. AANLCP is an active member of the Nursing Alliance, a collaborative community of over 65 national nursing organizations. The Association provides the opportunity for nursing organizational leaders to network, exchange information, poll peer member organizations about association best practices, form partnerships and alliances on initiatives of mutual interest, and lobby for health care issues affecting member organizations. CNLCP Certification AANLCP assumed responsibility for developing and providing certification for the specialty, Certified Nurse Life Care Planner (CNLCP ). The CNLCP Certification Board has provided oversight of the CNLCP certification examination since Both AANLCP and the CNLCP Certification Board adhere to a Code of Professional Ethics Mission/Vision Statement. The CNLCP Certification Board meets and adheres to the Accreditation Board for Specialty Nursing Certification s standards and organizational criteria. The CNLCP certification examination is currently administered for the CNLCP Certification Board by Professional Testing Corporation (PTC). Details regarding credentialing may be found on the CNLCP website at There are now several courses that meet the educational prerequisite to take the CNLCP certification examination. Achieving a passing score on the certification exam entitles the RN to use the designation of Certified Nurse Life Care Planner (CNLCP). The current examination required for certification in Nurse Life Care Planning evaluates the core knowledge base specific to the specialty of Nurse Life Care Planning. This includes, but is not limited to, the nursing process, knowledge of rehabilitation and the lifetime needs of catastrophically injured and/or chronically ill individuals, and the ability to conduct appropriate and specific research related to an individual's specific current and future 18

19 needs. Please see the published Role Delineation Study, attached, for details on core knowledge (Manzetti, Bate, and Pettengill, 2014) A candidate for the CNLCP must meet the following criteria: Licensed as a Registered Nurse, or the equivalent in other countries, for at least the past five years. The license must be currently active, without any restrictions. A copy of the current license must be submitted with the Application. Have a minimum of two years of full time paid nurse life care planning and/or case management experience, personally coordinating client services along the continuum of care. Candidates meeting criteria A and B must also meet one of the following eligibility Routes pertaining to education and relevant experience: Route 1 A minimum of 120 continuing education units from a life care planning course within the past 5 years immediately preceding the application. (eligibility for examination) Route 2 Proof of two years of life care planning experience within the past five years immediately preceding the application. Experience must be verified on application by documentation from an employer or at least two referral sources. (eligibility for examination) Route 3 Reciprocity: Candidate for reciprocity must provide a copy of the current Life Care Planner Certification (CLCP), copy of current unrestricted RN license for a minimum of 5 years, and a minimum of two years of full time paid nurse life care planning and/or case management experience, and have personally coordinating client services along the continuum of care immediately preceding the submission of the application. If the criteria are met in Route 3, reciprocity will be granted, thereby eliminating the need to sit for the Certified Nurse Life Care Planner (CNLCP) examination (Source: CNLCP Certification Board, Nurse Life Care Planning Roles and Functions Overview Nurse Life Care Planner Functions During the Life Care Planning process, the Nurse Life Care Planner: Assesses and diagnoses the individual s current response to the disability or illness Anticipates the effects of disability or illness and future needs as the individual ages Collaborates with healthcare providers when possible and applicable 19

20 Considers risk minimization and the promotion of function over the lifetime Researches and documents the costs necessary to implement the care plan Identifies desired outcomes of plan elements Incorporates information and opinions from other providers May identify available community, public, and insurance funding and how to access those resources May initiate aspects of the life care plan during its development, educate the consumer and family/guardian on plan initiatives, or provide for the plan to be implemented by a nurse case manager (choice depends on jurisdiction) Updates the Life Care Plan based on the evaluation process The following tables with examples are excerpts from the Role Delineation Study cited. For further details on specific tasks related to Nurse Life Care Plan development, please refer to the complete Role Delineation Study, attached. Table 3 Rated high for Life Care Plan Development Tasks frequency of performance >3.5 Assess need for medications (e.g., pain medications) 3.9 Review post morbid medical records 3.8 Assess need for medical care evaluations/services 3.8 Assess need for therapeutic evaluations/services 3.8 Assess need for therapeutic evaluations/services 3.8 Assess need for diagnostic testing (e.g., medical labs, radiological studies, neuropsychological, etc.) 3.8 Assess need for wheelchair/mobility needs 3.8 Assess need for independent living ability 3.8 Assess need for home/attendant/facility care 3.8 Assess need for adaptive equipment 3.8 Assess need for therapeutic equipment 3.8 Assess need for orthotics and prosthetics (e.g., braces, ankle/foot orthotics) 3.8 Assess need for supplies (e.g., bowel/bladder supplies, oxygen, etc.) 3.8 Review expert reports 3.7 Assess need for assistive technology 3.7 Assess need for home furnishing and accessories (e.g., specialty bed, portable ramps, patient lifts) 3.7 Assess need for transportation (e.g., adapted/modified vehicle, etc.) 3.7 Assess the need for renovations for accessibility (e.g., widen doorways, installing wheelchair ramp, etc.) 3.7 Document pre- existing conditions utilizing a Medical Record Summary 3.6 Assess need for health, strength maintenance 3.6 Assess need for case management services 3.6 Assess need for architectural renovations (e.g., wheel- in shower, elevator, etc.)

21 Table 4 Cost Research Tasks Obtain costs for items and services in a Life Care Plan using provider/vendor contacts Other considerations used in determining Life Care Plan cost: Geographic location Obtain costs for items and services in a Life Care Plan using internet sources Rated high for frequency of performance > Essential Functions In 2013, the AANLCP performed a role delineation study of Nurse Life Care Planners. The result, A Survey of Nurse Life Care Planners: A Role Delineation Study in the United States, was published in the Journal of Nurse Life Care Planning in September 2014 (Manzetti, Bate, & Pettengill, 2013) The primary role of the nurse life care planner is to provide a life care plan, applying the nursing process: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. While specific individual practice environments, settings, and experience may differ, the nursing process methodology is common to all registered nurses. Respondents to the survey described the following functions for Nurse Life Care Planner practice. The Nurse Life Care Planner: Reviews available data, requesting additional records when needed as part of the assessment process for the LCP. Completes a comprehensive assessment of the injured or chronically ill person when able, using a comprehensive assessment tool that identifies current and probable future care needs, durable medical equipment, medical care providers, laboratory and diagnostic tests, personal care assistance, supplies, therapies, activity/exercise needs, educational/leisure/vocational needs, and environmental modifications as indicated. Collaborates as necessary with healthcare providers for current and probable future healthcare treatment plans. Uses critical thinking to analyze and categorize assessment data to identify the human responses to the injury or chronic illness; makes the nursing diagnoses for the life care plan. 21

22 Considers associated risks, benefits, costs, current scientific evidence, medical guidelines and literature, and cultural and ethical considerations, to achieve the identified outcomes. Plans for identified reasonable and essential needs, including frequency of caregiver follow-up and maintenance and replacement of equipment, including the annual cost of each item and possible alternatives. Considers promotion and restoration to health and injury/illness/disease prevention to achieve the desired outcome. Provides for implementation of the plan within an appropriate, reasonable timeline. Uses scientific evidence-based guidelines, nursing research, and other guidelines. Identifies community resources and systems; identifies and delegates the different sections of the life care plan to an appropriate provider to coordinate the care in the plan. Provides for health teaching and promotion and safety and prevention strategies from an appropriate, delegated provider. Provides life care plan consultation using analysis, summarization, research, evidencebased guidelines, and literature; communicates appropriate recommendations to the injured or chronically ill person to facilitate learning. Evaluates the life care plan to ensure a systematic approach for the completion of the LCP and the effectiveness of planned strategies. Completes an ongoing data assessment with appropriate revisions of the nursing diagnoses, outcomes, plan and implementation as needed. Demonstrates quality of practice, delivering life care planning consultation services as a NLCP and demonstrating the application of the nursing process in a responsible, accountable, and ethical manner. Testifies as an expert witness, educating the court including attorneys, jury, and judges, concerning facts regarding the identified care needs and costs pertaining to those needs within the life care plan. Practices following current statutes, rules, regulations and guidelines. Although there are areas of specialization in Nurse Life Care Planning, the specific ability to assess the catastrophically injured or chronically ill throughout the continuum of health care in multiple settings over the lifetime remains constant. With this assessment, the Nurse Life Care Planner creates a plan that addresses health care, basic protection, and safety needs for the person and caregivers. Nurse Life Care Planners who serve as testifying experts must be familiar and comfortable with the various rules and procedures inherent to this role, as well as knowledgeable about their 22

23 own special knowledge, experience, skill, education, and foundations of nursing practice, and able to communicate these clearly to triers of fact, i.e., magistrate, administrative law panel, judge, or jury. Each Nurse Life Care Planner maintains a current nursing license and adheres to a professional registered nurse scope and standard of practice as specified by a state, province, or territory nurse practice act. Individual nurse practice acts may or may not specifically address every component of nursing process: assessing, nursing diagnosis, outcome identification, planning, implementing, and evaluating. Each Nurse Life Care Planner must know the applicable nurse practice act when testifying as an expert. Nurse Life Care Planning Roles Nurse Life Care Planners regard the ANA Scope and Standards of practice as the definitive conceptual framework for care planning. Nurse Life Care Planners use the nursing process to develop a plan of care for the lifetime of an individual in ways that parallel but are not equivalent to traditional nursing roles. Many nurses are attracted to the field of life care planning because they enjoy challenges. They want to develop advanced nursing skills to deliver safe, cost effective, quality care, and provide related education to individuals, families, and providers in nontraditional settings. The Robert Wood Johnson Foundation described this well: Nurse Life Care Planners create healthcare roadmaps. These nurses help patients who have suffered catastrophic injuries and illnesses, advocate for them, and plan out their care. Nurse Life Care Planners work with a patient's family, insurance company, attorneys, and others to develop a life care plan, determining the future needs, services, and costs of care for the patient over their lifetime. Many Nurse Life Care Planners work independently from the hospital system, acting as a consultant for businesses, families, or courts of law. Because of life care plans, patients caregivers know how often they need to schedule appointments, what to expect in terms of rehabilitation, and what the course of medical care will look like. Nurse Life Care Planners: Design Nurse Life Care Plans for patients Advocate for patients, who often cannot express their own needs Teach patients families about the illness and treatment A Nurse Life Care Planner s practice is: 23

24 Multifaceted Structured Patient-facing Managerial Research-oriented Independent (Robert Wood Johnson Foundation, 2013) Nurse Life Care Planners have the knowledge and skill to plan care for multiple disease states and complicated conditions. They are well-equipped to apply their skills to today s healthcare challenges, e.g., the increasing awareness of autism-spectrum conditions and developmental disability, improved survival after very premature birth and after catastrophic trauma, and in the growing aged population with dementia. Nurse Life Care Plans foster patient and family engagement and partnering in the planning process. Practice examples include: Parents may need a Life Care Plan for a disabled child s changing needs as the child grows to adulthood. The Nurse Life Care Planner will provide education regarding choices for long term care options, e.g., remaining at home with support services, specialized group home, or assisted living, and plan care respecting their individual values, needs, and preferences. An attorney or court may ask for a Life Care Plan to address lifetime needs of the individual with catastrophic injury, e.g., burn, spinal cord injury, traumatic brain injury, amputation. A trust officer may need help administering funds for an elder or disabled adult, respecting the individual s preferences for palliative care or hospice at end of life. These and many other situations require thorough and comprehensive care plans that address all needs, including safety, for a lifetime of care. Meeting such challenges by applying one s wealth of knowledge and previous experience as a nurse case manager or clinician in an expanded role is invigorating. Advanced Skills Applied in Nurse Life Care Planning All nurses should be familiar with evidence-based practice and apply it in clinical practice. Nursing care typically involves assessment, planning, goal identification, and care coordination related to data and outcomes for a discrete admission or episode of care. The specialty practice of Nurse Life Care Planning requires the nurse to consider a 24

25 much larger picture, and apply a much broader range of resources to an individual s plan of care. Nurse Life Care Planners may review years of prior treatment, educational, vocational, and other records to evaluate prior hospitalization causes, frequency, and resource utilization to determine what secondary factors will most likely contribute to future resource demands over an entire life expectancy, commonly involving decades of care needs. Nurse Life Care Planners apply knowledge of statistics and other researchbased findings at an advanced level to understand probable prognoses, trajectory of care, and to project resources and associated costs. For example, to plan care for an individual with spinal cord injury (SCI) or traumatic brain injury (TBI), Nurse Life Care Planners will consult US Model Systems data bases to research the frequency of complications and likelihood of rehospitalization. The Nurse Life Care Planner will connect these data (i.e., age of the individual at the time of injury, years post injury, and comorbidities) to individual assessments to extrapolate outcomes. Other research will be necessary for comorbidities common in catastrophic conditions (e.g., renal failure, psychiatric disability, amputation, and burns). The Nurse Life Care Planner will examine the literature for current, high-quality, reliable, and applicable studies regarding possible complications and probability of occurrence. The Nurse Life Care Planner will apply current standards of practice and cost data from Medicare and other payor sources. The Nurse Life Care Planner will apply knowledge of rehabilitation nursing and healthcare finance to identify likely diagnosis codes for future care and search associated Healthcare Cost and Utilization Project (HCUP) data from the US Government s Agency for Healthcare Research and Quality (AHRQ) to project those costs over the life expectancy. Durable medical equipment with associated repairs, maintenance, warranty periods and replacement intervals for life expectancy require similar study. Planning care for life expectancy also means looking at levels of home care, level of assistance, respite care, counseling, assisted living, custodial care, therapies, medications, supplies, safety, adaptive technology, and other aspects of care, all with the same level of attention to 25

26 detail and resources. Applying this level of expertise exceeds the expectations of general nursing care planning. As nursing evolves, so does Nurse Life Care Planning. The market for Nurse Life Care Plans has expanded to many areas outside of litigation: medical care planning, liability insurance, special needs trusts (elders, children, disabled), and MSA. Due to the value of their extensive nursing knowledge and expertise, Nurse Life Care Planning specialists are seeing growing demand for their services. Nurse Life Care Planners have become sought-after consultants. The courts recognize Nurse Life Care Planners as experts in a variety of relate fields for our unique combination of experience and knowledge. The federal government specifically uses nurses for their knowledge when responding to National Vaccine Fund cases. Some litigation calls for expert Nurse Life Care Planners to critique plaintiff plans for defense of liability suits. Nurse Life Care Planning expertise is applied in Social Security Disability cases, in medical malpractice, worker s compensation, toxic tort liability, even in divorce cases when a child s or spouse s future care needs must be considered. Practice Settings for Nurse Life Care Planners Nurse Life Care Planners practice in a variety of settings for diverse entities, such as legal practices, government agencies, insurance companies, banks, private companies, or, most commonly, in private practice as self-employed consultants (65% of respondents in the AANLCP Role Delineation Study) (Manzetti, Bate, & Pettengill, 2014). In each of these settings, Nurse Life Care Planners may interact with injured or chronically ill persons and their associated support systems, legal representatives, healthcare providers, insurance companies, employers, Centers for Medicare/Medicaid Services, other public or private agencies, and the community at large. See also Nurse Life Care Planning Functions and Roles for more information about the AANLCP Role Delineation Study.) General Considerations for All Nurse Life Care Planner Settings Nurse Life Care Planners must follow the applicable law when handling, using, transmitting, and communicating personal information in the process of preparing the LCP. 26

27 The Health Insurance Portability and Accountability Act Privacy Rule (HIPAA) addresses how protected health information (PHI) must be safeguarded. While many settings in which the Nurse Life Care Planner practices do not require HIPAA-level PHI protection, the Nurse Life Care Planner protects all medical and confidential records to the extent required in the individual case, and destroys these materials when the case has been completed. These rules continue to evolve. The full text of HIPAA, summaries, and FAQs are available at the Office of Civil Rights (OCR) website at The Family Educational Rights and Privacy Act (FERPA, the Buckley Amendment) applies to access to data about student enrollment, grades, behavioral issues, and other school information, at all levels of institutions and agencies that receive US Department of Education funding. It also applies to states transmitting information to federal agencies. General information on the legislation and policies can be found at Health Information Technology for Economic and Clinical Health Act (HITECH) is concerned with, among other provisions, information technology and the electronic health record. It also extends the privacy and security provisions of HIPAA to business associates of covered entities, some of which may apply to the Nurse Life Care Planner. These rules also continue to evolve. Information on this can be obtained at entifr.html Nurse Life Care Planners should carry malpractice insurance. A Nurse Life Care Planner in independent practice may also want to consider other specific business insurance, such as errors and omissions, loss of business, and premises coverage. Examples of Nurse Life Care Planner Specialty Practice Areas Testifying Expert Witness Nurse Life Care Planners who are retained as consultants by attorneys may be considered testifying experts to testify at trial or deposition in litigation. They must be able to articulate their own specialized and distinct body of knowledge clearly. They must also have a clear and accurate understanding of the licensed scope of nursing 27

28 practice as defined and authorized by the state, commonwealth, or territory. The qualifications and credibility of the Nurse Life Care Planner in this role are of great value to the triers of fact. In other situations, Nurse Life Care Planners may be engaged by attorneys to provide behind-the-scenes advice as a consulting expert, reviewing and offering opinions on a testifying expert's or opposing party s plan. In this role, opinions are considered attorney work product and the Nurse Life Care Planner will not be disclosed as a testifying expert. Each testifying Nurse Life Care Planner must be knowledgeable about current federal and state laws pertaining to giving testimony in the jurisdiction. If a case will require trial or deposition testimony, the Nurse Life Care Planner should consult with the retaining attorney for advice and specifics. However, the prudent testifying Nurse Life Care Planner is familiar with Rule 702 in the Federal Rules of Evidence, concerning testimony by experts, outlining the requirements for a person to be qualified as an expert for the purposes of testimony; and Rule 703, bases of opinion testimony by experts. These Rules may be reviewed at the Cornell Law School website, Special Needs Trusts A Nurse Life Care Planner may be asked to assist an attorney, financial planner, and parent or guardian to develop a Life Care Plan to meet the person s needs through adulthood to end of life. The goal is to ensure safety and protection of the disabled person while addressing healthcare and other supplemental needs to maintain the person s current lifestyle as closely as possible. A trust officer may oversee the fiduciary responsibilities of the plan, while a case manager may be engaged to implement its components. The Nurse Life Care Planner working in this area should be knowledgeable about types of varied trusts, Social Security programs (Supplemental and Disability), the Association of Retarded Citizens (ARC), and CMS guidelines in addition to specialty resource knowledge for the specific disability. Nurse Life Care Planners may work with children with special needs, families, communities, and medical providers. These Nurse Life Care Planners outline current 28

29 and future medical, social, psychological, and recreational needs for the child s growing years. Continued planning for adulthood includes consideration of a living environment that maximizes safety and independence. The Nurse Life Care Planner collaborates with financial professionals regarding funding, medical insurance, and community resources to include in the LCP. At the request of the parents, guardians, or trust officer, a Nurse Life Care Planner may evaluate and revise the Plan as the child s needs change into adulthood. Worker s Compensation Insurance Nurse Life Care Planners may be company employees or independent consultants who receive worker s compensation cases from insurance adjusters to develop medical cost projections, medical record reviews, or MSAs for injured workers (see below). The plans may assist the insurance company to either settle cases and/or set financial reserves for ongoing care of the injured worker, depending on jurisdiction. A Nurse Life Care Planner working in this area should be knowledgeable about applicable state and federal worker s compensation laws, rules, and regulations and reimbursement schedules. Medicare Set-aside Arrangements Some Nurse Life Care Planners have pursued specialized training in the intricacies of MSAs. A Workers Compensation Medicare Set-aside Arrangement (WCMSA) is a financial agreement that allocates a portion of a workers compensation settlement to pay for future medical services related to the workers compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers compensation injury, illness, or disease (Centers for Medicare and Medicaid Services (CMS), 2014). MSAs are completed to protect Medicare's interests when resolving cases that include future medical expenses. These Nurse Life Care Planners must be knowledgeable about CMS guidelines for MSAs, ICD 9 & 10 codes, and pharmaceutical and other reimbursement structures used by CMS. The Nurse Life Care Planner must constantly seek and apply updated information, due to the complexity of ever-changing federal and state laws and guidelines, including those for worker s compensation, third-party liability, automobile, and self-employee insurance. 29

30 Federal Case/National Vaccine Fund These complex plans are mandated by the National Childhood Vaccine Injury Act of 1986 (Public Law ). This federal law protects the vaccine-injured person and provides reasonably necessary medical care deemed related to the injury. Guidelines are outlined and followed in developing the Life Care Plan. These Life Care Plans are different from civil Life Care Plans because the plaintiff s insurance benefits (except state-funded insurance plans) are considered as partial payment for future related medical needs. The Nurse Life Care Planner must be able to interpret insurance benefit language to identify and offset (take into consideration) these insurance benefits. Nurse Life Care Planners are retained by either the petitioner s attorney or the Department of Justice attorney. These Nurse Life Care Planners must have expanded knowledge about applicable federal law, receive special training, and are referred to as Petitioner Life Care Planners and Respondent Life Care Planners. Health and Disability Insurance Nurse Life Care Planners who work for health and disability insurance carriers help claims personnel set annual reserves on high-cost members, applying the nursing process to determine future medical care needs and costs. This information may then be provided to an actuary, who calculates reserves to be set aside according to state or federal requirements to pay for the following year s healthcare needs. This position also requires working knowledge of insurance terminology, regulations, and applicable laws. Senior Care Nurse Life Care Planners may work with senior individuals, families, and trust officers or attorneys. This includes reviewing current and anticipated health needs, supplemental insurance coverage options, educating about and reviewing options for care in independent and assisted living, and planning for expected transitions through the healthcare continuum with aging. These Nurse Life Care Plans are generally not involved in litigation. Case Management (CM) Some Nurse Life Care Planners practice as nurse case managers as well as Nurse Life Care Planners. The Nurse Life Care Planner may provide care coordination during plan 30

31 development if needed to complete the assessment process and develop opinions on expected needs over the life expectancy. The Life Care Plan may make provisions for CM. Unless circumstances clearly do not present the potential for conflict of interest, the Nurse Life Care Planner or Nurse Life Care Planning/CM company generally will not provide Nurse Life Care Planning services on the same case. However, if the referral source requests CM services after a LCP has been completed and wants continuation of services, the Nurse Life Care Planner may see no conflict of interest and provide CM services. Legal advice may be helpful if this situation arises. Values and Principles Guiding the Nurse Life Care Planning Practice Nurse Life Care Planners embrace the following values and principles which are reflected in the AANLCP Ethics Statement. Competence: Nurse Life Care Planners recognize that continual professional growth, particularly in knowledge and skill, requires a commitment to lifelong learning. Such learning includes, but is not limited to, continuing education, networking with professional colleagues, self-study, professional reading, certification, and seeking advanced degrees. Integrity: For Nurse Life Care Planners, integrity is the foundation of practice and demonstrates wholeness of character which is realized through congruence of thoughts, words and actions. As one of the core values, integrity means being truthful, honest, reliable, and authentic in all personal and professional matters. Accountability: Nurse Life Care Planners are personally accountable for judgments, decisions, and actions they make in their practice, regardless of the policies or directives of others. Objectivity: Nurse Life Care Planners remain impartial and approach all aspects of the Life Care Planning process without individual bias, interpretations, or feelings. Respect for human dignity: In all professional relationships, Nurse Life Care Planners practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Ethics in Nurse Life Care Planning: The AANLCP Code of Ethics and Conduct Ethical concerns in nurse life care planning practice are often complex and multidimensional, and may or may not be addressed in laws and professional ethics codes. Codes of ethical practice educate and inform professionals about sound ethical 31

32 behavior, while mandating a minimal standard of practice. The ANA Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) provides the framework for ethical Nurse Life Care Planning practice. The Code includes explanations and specific examples are provided for each of its nine provisions. Code of Ethics for Nurses with Interpretive Statements affirms that all nurses, including Nurse Life Care Planners, have an ethical obligation to practice with integrity, competence and accountability. The AANLCP Code of Ethics and Conduct was created by a group of Nurse Life Care Planners as an additional guide to core values and obligations of Nurse Life Care Planning. 1. The Nurse Life Care Planner does not discriminate against any person based on age, gender, sexual orientation, ethnic background, religious beliefs or practices, social or economic status, lifestyle choices, functional status, health status, or disability. Nurse Life Care Planning explanation: An individual's differences or beliefs are respected. Personal attitudes do not influence or interfere with professional performance. Each individual's inherent worth, dignity and human rights are respected by the Nurse Life Care Planner without prejudice, regardless of whether the nurse agrees with or condones certain individual choices. The Nurse Life Care Planner performs in a nonjudgmental and nondiscriminatory manner. Nurse Life Care Planning example: A Nurse Life Care Planner whose religious beliefs prohibit her from accepting blood transfusions includes plans for platelet and red blood cells transfusions for an individual with chronic malignancy. 2. The Nurse Life Care Planner maintains competency in nursing practice and Nurse Life Care Planning practice. Nurse Life Care Planning explanation: The Nurse Life Care Planner pursues professional growth through personal study, attendance at educational programs, national nursing conferences, seminars, professional meetings, reading the AANLCP Journal and other relevant professional journal articles, and collegial collaboration. The Nurse Life Care Planner maintains an active registered nurse license in good standing. 32

33 The Nurse Life Care Planner practices according to the Nurse Practice Act and AANLCP scope of practice. Nurse Life Care Planning example: A CNLCP earned credits towards recertification by attending the AANLCP annual conference and a continuing education seminar on spinal cord injury, and by presenting an offering on Nurse Life Care Planning to other nurses. 3. The Nurse Life Care Planner demonstrates high standards of professional conduct in delivering Nurse Life Care Planning services. Nurse Life Care Planning explanation: The Nurse Life Care Planner demonstrates honesty, integrity, responsibility, accountability, timeliness, and respect for human dignity. The Nurse Life Care Planner practices ethically and lawfully. The Nurse Life Care Planner accurately represents professional background and credentials. The Nurse Life Care Planner does not promote personal interests for personal gain. The Nurse Life Care Planner remains objective and does not impose individual values on others. Nurse Life Care Planning examples: The Nurse Life Care Planner positively exemplifies nursing to individuals, community, legal field, and media. The Nurse Life Care Planner seeks consultation as necessary. The Nurse Life Care Planner remains respectful and open in the exchange of views with all individuals with relevant interests. 4. The Nurse Life Care Planner safeguards privacy rights. Nurse Life Care Planning explanation: The Nurse Life Care Planner exercises responsibility, discretion and respect in handling and use of all protected or sensitive information and materials. The Nurse Life Care Planner considers that the rights, well-being, and safety of the individual should be the primary factors in arriving at any professional judgment concerning the disposition of confidential information. Nurse Life Care Planning examples: The Nurse Life Care Planner shares relevant data only with those with a need to know. 33

34 The Nurse Life Care Planner is aware of and complies with local, state and federal privacy and security regulations. The Nurse Life Care Planner recognizes that in some circumstances private information must be disclosed in compliance with federal or state law or regulations. The Nurse Life Care Planner uses appropriate technology to maintain data security with electronic communication. 5. The Nurse Life Care Planner assumes responsibility and accountability for professional action, opinions, recommendations, and commitments. Nurse Life Care Planning explanation: The Nurse Life Care Planner assumes accountability for Life Care Plan and actions, opinions, and decisions. The Nurse Life Care Planner accepts, declines, or refers out cases on good faith based upon personal competence, education, experience, and capabilities. The Nurse Life Care Planner's professional services are delivered in a competent, concise, and timely manner. Nurse Life Care Planning examples: The Nurse Life Care Planner accepts responsibility for initiating consultation with other health care providers when necessary. The Nurse Life Care Planner questions incorrect or inappropriate collaborative suggestions. The Nurse Life Care Planner seeks opportunities for improvement based on feedback from clients and colleagues on professional work. 6. The Nurse Life Care Planner provides professional services with objectivity. Nurse Life Care Planning explanation: The Nurse Life Care Planner demonstrates critical thinking in decisions, recommendations, and opinions. The Nurse Life Care Planner actively seeks to eliminate personal opinion, prejudice, conflict of interest, consideration, or appearance of any of these that could interfere with objectivity, performance, or outcome or tend to create the appearance of bias. Nurse Life Care Planning examples: The Nurse Life Care Planner applies standards of nursing practice (the nursing process) consistently in all Life Care Plans, thereby not confusing bias with advocacy. The NCLP identifies and resolves any potential conflict of interest as soon as possible. 34

35 7. The Nurse Life Care Planner participates in the advancement of the profession through participating in and promoting mentorship, collegiality, education, and ongoing knowledge development. Nurse Life Care Planning explanation The Nurse Life Care Planner maintains active involvement in the professional association's ongoing development and revisions of standards, policies, and guidelines for nursing and Nurse Life Care Planning. The Nurse Life Care Planner collaborates with mentors, peers, colleagues, and others. The Nurse Life Care Planner shares materials and information designed to advance the practice of nursing and Nurse Life Care Planning with peers, colleagues, clients, and others. Nurse Life Care Planning examples: The Nurse Life Care Planner stays current on trends and decisions regarding healthcare delivery dynamics and expanding scopes of practice at the local, state and national levels. The Nurse Life Care Planner maintains an active membership in a national nursing organization. The Nurse Life Care Planner collaborates with members of other professional organizations at international, national, state and community levels. The Nurse Life Care Planner facilitates and participates in critical self-reflection and evaluation in the profession. The Nurse Life Care Planner serves as a leader, mentor, or committee member in the professional association. Current Issues and Trends Affecting Nurse Life Care Planning Overview AANLCP supports the policy advocacy role outlined in Role of Professional Organizations in Advocating for the Nursing Profession (OJIN, 2012). This includes activities such as advocating for greater nursing presence in the current Patient Protection and Affordable Care Act (P.L , March 2010) (ANA, 2011a; Gallagher, 2010). The AANLCP s goals include greater nurse involvement in providing access to care, influencing the cost and quality of care, determining the scope and authority of practice, and increasing and improving the healthcare workforce. 35

36 Case management was initially developed by the defense industry during World War II to improve return-to-work rates after injury to support the war effort. After the war, workers compensation insurance carriers continued case management as the positive effect of such services on clinical outcomes became apparent in return-to-work data: care coordination activities and utilization review emphasis on evidenced-based clinical decision-making led to cost savings. Today, case managers are an integral part of the healthcare system in all settings. Nurse case managers are in high demand. AANLCP foresees increased demand for Nurse Life Care Planning. Nurse Life Care Planning has its historical roots in the day-to-day, month-to-month, and year-to-year nursing plans created, implemented, evaluated, and maintained by visiting nurses and home care nurses. Case management nurses and rehabilitation nurses were likely among the first Nurse Life Care Planners, especially those involved in litigation. Nurse Life Care Planning has evolved as a nursing specialty in ways these earliest practitioners could not have imagined. Future need for Nurse Life Care Planners probably far outweighs the number of nurses currently practicing in the specialty. Healthcare Industry and Regulatory Issues Affecting the Future of the Specialty Costing Accountability and Transparency Nurse Life Care Planners expertise in researching costs, applying data regarding prognosis of medical conditions, and projecting future care needs will become more important. Legislative calls for more statutory requirements for pricing accountability and transparency in all aspects of healthcare grows louder with each budget year. Nurse Life Care Planners will become increasingly valuable as their expertise assists stakeholders to make meaningful use of published cost data. Medicare Set-aside Arrangements The Medicare Modernization Act (2003) requires that Medicare remain the secondary payor whenever possible. As a result, Nurse Life Care Planners with an expertise in Medicare guidelines are in high demand to assess expected care needs in worker s compensation and develop plans that protect Medicare s interest, called Medicare setaside arrangements, in settlements. CMS has expanded the requirements for MSAs to 36

37 include civil litigated case settlements. This is resulting in increased demand for Nurse Life Care Planner expertise. Tort Reform The potential for across-the-board tort reform could lead to damage caps in medical malpractice, liability, and personal injury cases. Tort reform involving drug and device product liability is another area where the need for Nurse Life Care Planners will increase. In turn, this will increase the demand for Nurse Life Care Planner assessment and care planning to provide direction about the injured person needs so that cases can be resolved appropriately. Elder Care The baby boomer generation has created the largest population of elders in US history. This will pose a challenge for Medicare and Medicaid that can foreseeably lead to tighter controls on healthcare funding. The Nurse Life Care Planner can assist the Medicare system and the baby boomers plan for their healthcare needs; more nurses are pursuing this specialty area of Nurse Life Care Planning as a result. Looking to the Future Nurse Life Care Planners typically have clinical experience in settings throughout the health care system, not only in hospitals but in home health, public health, primary care, and long-term care. They know what happens when the system works for patients -- and when it doesn t. This, combined with their rich understanding of evidencedbased care and focus on outcomes and costs, positions them for leadership roles in any healthcare system redesign. They will be valuable contributors to transform and improve care for persons with catastrophic and complex care needs at all stages of life. Healthcare costs and healthcare reforms continue to make headlines. The full effect of the Affordable Care Act on Nurse Life Care Planning remains to be seen; speculation on this topic is becoming more common in professional journals and meetings. As ANA states, "Registered nurses must proactively deal with constant change and must be prepared for an evolving healthcare environment... (Nursing: Scope and Standards of Practice, 2010). We believe that Nurse Life Care Planning is, by its nature, well-positioned for addressing the above issues and trends in the future. 37

38 Nurse Life Care Planning and Research Journal of Nurse Life Care Planning The Journal of Nurse Life Care Planning (JNLCP) is recognized by nurses who practice in the field of Life Care Planning and other specialty areas as a source for education. Initially published in 1998, this journal began as a few articles shared by AANLCP members to help address educational needs of their peers as determined by AANLCP s annual needs assessment. It is now the AANLCP s sole journal, peerreviewed, and published quarterly. The JNLCP has been published electronically since 2009 and is indexed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL). According to annual readership surveys, readers include members of many professions. More than 80% of all readers share individual articles or entire themed issues with colleagues and clients more than twice a year. Research Committee The AANLCP collects research data from Nurse Life Care Planners to identify evolving practice patterns. The AANLCP promotes research led by doctorally-prepared Nurse Life Care Planners wherever possible by publicizing and supporting data collection from members and other activities as they arise. This is congruent with AANLCP s goal to support evidence-based research concerning Nurse Life Care Planning. AANLCP established the Research Committee in early 2014 to expand the body of knowledge and theory specific to nursing practice and life care planning through research supporting evidence based practice. The Research Committee represents the association s research interest, activities, and relationships to support, design, conduct, disseminate, and integrate research specific to the specialty practice. The Research Committee has several activities and responsibilities including: Initiating, facilitating, integrating and supporting nursing-focused research projects Developing an Institutional Review Board (IRB) process to safeguard the interests of human subjects who participate in research projects conducted by Nurse Life Care Planners Carefully considering research budgets, timelines, outcomes, and usefulness for the specialty Developing resources for funding research projects 38

39 Developing and carrying out research plans consistent with the AANLCP strategic plan and the objectives and budget of the committee Mentoring novice researchers Publishing the resulting research findings in the AANLCP Journal of Nurse Life Care Planning and website Standards of Nurse Life Care Planning Significance of the Standards The Standards of Professional Nursing Practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. The Standards may serve as evidence of the standard of care, with the understanding that their application depends on context. The Standards are subject to change with the dynamics of the nursing profession, as new patterns of professional practice develop and are accepted by the nursing profession and the public. Specific conditions and clinical circumstances may also affect the application of the standards at a given time (e.g., civil unrest, natural disaster). The Standards are subject to formal, periodic review and revision. The competencies that accompany each standard provide evidence for compliance with the corresponding standard. The list of competencies is not exhaustive. Whether a particular standard or competency applies depends upon the circumstances. For example, a nurse preparing a Life Care Plan for litigation may have limited access to the individual due to court constraints; an in-home or in-person assessment may not be permitted. The Standards of Practice recapitulate the steps of the nursing process. The nursing process includes six singular and integrated actions of assessment: diagnosis, outcomes identification, planning, implementation, and evaluation. The bidirectional interactions between each component in Figure 1 convey that the process is not linear. That is, the nursing process is cyclical and dynamic. Each action (assessment, diagnosis, identification of outcomes planning, implementation, and evaluation) encompasses significant actions taken by registered nurses and forms the foundation of the nurse s decision making. 39

40 The standards may be applied at the individual, family, community, and/or population level. Figure 1. The Nursing Process and Standards of Professional Nursing Practice (ANA, 2010) 40

41 Nurse Life Care Planning Standards of Practice The following standards of practice and performance are adapted from the American Nurses Association 2010 Nursing: Scope and Standards of Practice, Second Edition. Standard 1. Assessment The Nurse Life Care Planner performs comprehensive data collection pertinent to the healthcare consumer s health and unique situation. Competencies: The Nurse Life Care Planner: Collects comprehensive data including but not limited to physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual/transpersonal, and economic assessments in a systematic and ongoing process while honoring the uniqueness of the person. Assesses any existing plan of care. Analyzes current plan of care for adherence to current standards and clinical guidelines. Elicits the healthcare consumer s values, preferences, expressed needs, and knowledge of the healthcare situation when possible and as appropriate. Includes the healthcare consumer, family, and healthcare providers in data collection when possible and as appropriate. Identifies barriers (e.g., psychosocial, literacy, financial, cultural) to effective communication and makes appropriate adaptations. Identifies unwarranted or unwanted treatment and causes of healthcare consumer suffering in the current plan of care. Recognizes the impact of personal attitudes, values, and beliefs. Assesses family dynamics and impact on healthcare consumer health and wellness. Prioritizes data collection based on the healthcare consumer s history, current condition and anticipated needs or situation. Uses appropriate evidence-based assessment techniques, instruments, and tools. Analyzes data and information to prescribe necessary system and community support measures, e.g., home modifications, nursing care, counseling. Synthesizes available data, information, and knowledge relevant to the situation to identify patterns and variances. Applies ethical, legal, and privacy guidelines and policies to the collection, maintenance, use, and dissemination of data and information. Recognizes healthcare consumers as unique sources of information on their own 41

42 health. Documents relevant data in a retrievable format. Standard 2. Diagnosis The Nurse Life Care Planner analyzes assessment data to determine diagnoses and issues. Competencies: The Nurse Life Care Planner: Derives diagnoses and issues based on assessment data Validates the diagnoses or issues with the healthcare consumer, family, and other healthcare providers when possible and appropriate. Identifies actual and potential risks to the healthcare consumer s health, safety, and barriers to health, including but not limited to interpersonal, systematic, and environmental circumstances. Uses standardized classification systems and clinical decision support tools, when available, in identifying diagnoses. Documents diagnoses and issues in a way that makes it possible to identify expected outcomes, establish priorities, and develop the Life Care Plan. Standard 3. Outcomes Identification The Nurse Life Care Planner identifies expected outcomes for a Life Care Plan individualized to the healthcare consumer or situation. Competencies: The Nurse Life Care Planner: Involves the individual, family, healthcare providers, and others, when possible and appropriate, in formulating expected outcomes. Develops culturally appropriate outcomes. For example, referrals to providers with similar language and culture whenever possible. Considers the healthcare consumer s age, developmental stage, values and culture, ethical considerations, and environment when formulating expected outcomes. For example, a child with life-long needs receives age-appropriate occupational therapy in the home, community, or facility appropriate setting Derives realistic outcomes for potential functional, emotional, and developmental capabilities. For example, the plan prescribes appropriate nursing care configuration based on functional potential over life expectancy. 42

43 Considers associated risks, benefits, costs, current scientific evidence, expected trajectory for the condition, and clinical expertise. For example, the patient/family voices understanding of the plan for long-term health maintenance needs, including follow up and treatment with specialists and therapists. Includes realistic timeframe estimates for attainment of expected outcomes. Derives expected outcomes that provide direction for continuity of care. The plan includes a long-term health maintenance plan that emphasizes continuity of care over life expectancy. Modifies expected outcomes according to changes in the status of the healthcare consumer or evaluation of the situation. Documents expected outcomes as measurable goals. Standard 4. Planning The Nurse Life Care Planner develops a plan that prescribes strategies, interventions, and alternatives to attain projected outcomes. Competencies: The Nurse Life Care Planner develops a plan that: Provides direction to the healthcare team and consumer. Reflects current statutes, standards, rules, and regulations. Considers the individual s characteristics and situation, including, but not limited to, values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture and environment, and available technology. Explores suggested, potential, and alternative options and establishes the plan s priorities with the healthcare consumer, health care providers, and others as possible and appropriate. Integrates traditional and complementary health care practices as appropriate. Includes strategies that address each identified diagnosis or issue across the lifespan, e.g., probable future needs; strategies for health promotion and/or restoration; illness, injury, and disease prevention; alleviation of suffering; supportive care for end of life. Provides for continuity. Incorporates an implementation pathway or timeline, i.e., frequency of need. Includes an analysis of the economic effect on the healthcare consumer, family, caregivers, or other affected parties. Integrates current scientific evidence, trends and research. Provides alternatives, associated costs, and benefits. 43

44 Can be modified according to ongoing assessment of response and other outcome indicators as indicated. Documents the plan that uses standardized language or recognized terminology. Standard 5. Implementation The Nurse Life Care Planner provides for implementation of the plan. Competencies: The Nurse Life Care Planner: Recognizes and uses technology, community resources, and systems as appropriate. Recommends evidence-based interventions, treatments, and strategies specific to diagnoses and issues. Consults with others as appropriate. Recommends implementation methods and manner. Modifies the plan if indicated. Provides for holistic care that addresses the needs of diverse populations across the lifespan. Provides for health care that is sensitive to individual needs, with particular emphasis on the needs of diverse populations. Applies appropriate knowledge of major health problems and cultural diversity in providing for the plan of care. Provides for available healthcare technologies to maximize access and optimize outcomes for healthcare consumers. Standard 5A. Coordination of Care The Nurse Life Care Planner provides for coordination of the planned care and services throughout the lifespan. Competencies: The Nurse Life Care Planner: Organizes the components of the plan. Recommends a nurse case manager and/or qualified other(s) to implement the plan, manage transitions of care delivery, and provide for dignified and humane care by the interprofessional team. Assists the healthcare consumer in identifying options for alternative care. Incorporates services that maximize safety, independence, and quality of life. 44

45 Advocates for the delivery of dignified and humane care by the interprofessional team. Documents decisions and actions related to coordination of care. Standard 5B. Health Teaching and Health Promotion The Nurse Life Care Planner employs strategies to promote health and safety. Competencies: The Nurse Life Care Planner: Addresses health and safety issues using data collected in the assessment, diagnosis, and planning processes. Provides for health teaching to address such topics as healthy lifestyles, risk-reducing behaviors, developmental needs, activities of daily living, restorative measures, intended effects and potential adverse effects of proposed therapies, and preventive care. Provides for health teaching methods taking into account values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status. Provides for health promotion and maintenance, for example, weight loss, smoking cessation, support group participation, or exercise programs. Provides for education about informed decision-making related to plan options Standard 5C. Consultation The Nurse Life Care Planner provides consultation to evaluate, develop, and influence the plan of care, enhance others ability, and effect change. Competencies: The Nurse Life Care Planner: Synthesizes data, information, research, and evidence to summarize and share with others. Communicates recommendations in a way that facilitates understanding. Facilitates the effectiveness of a consultation by involving the healthcare consumers and stakeholders in decision-making. Standard 6. Evaluation The Nurse Life Care Planner evaluates progress toward plan outcomes. 45

46 Competencies: The Nurse Life Care Planner: Incorporates a systematic and evidence-based process for outcomes evaluation in the Life Care Plan. Collaborates with the healthcare consumer and other involved persons in the evaluation process when possible and appropriate. Uses evaluation findings to revise the nursing diagnoses, outcomes, Life Care Plan, and implementation as needed. Communicates the Life Care Plan results to the healthcare consumer and other involved persons as reasonable and appropriate, in accordance with state and federal law and regulations. Reviews the Life Care Plan for responsible and appropriate interventions to minimize unwarranted or unwanted treatment and healthcare consumer suffering. Documents the results of the evaluation. Standard 7. Ethics The Nurse Life Care Planner practices ethically. Competencies: The Nurse Life Care Planner: Uses the current ANA Code of Ethics for Nurses with Interpretive Statements and AANLCP Code of Professional Ethics and Conduct for Nurse Life Care Planners with Interpretive Statements to guide practice. Practices in a manner that preserves and protects healthcare consumer autonomy, dignity, rights, values, and beliefs Recognizes the centrality of the healthcare consumer and family as core members of any healthcare team. Maintains patient confidentiality within legal and regulatory parameters. Assists healthcare consumers in self-determination and informed decision-making. Provides information on the risks, benefits, and outcomes of healthcare regimens to allow informed decision-making by the healthcare consumer, including informed consent and informed refusal. Contributes to resolving ethical issues involving healthcare consumers, colleagues, community groups, systems, and other stakeholders. Takes appropriate action to address illegal, unethical, inappropriate behavior, or unsafe practices that can endanger or jeopardize the best interests of the healthcare consumer. Promotes healthcare consumers self-determination and informed decision-making. 46

47 Maintains professional relationships in the healthcare, community and legal environments. Participates in continuing education that addresses ethical issues. Advocates for equitable healthcare consumer care. Standard 8. Education The Nurse Life Care Planner attains knowledge and competence that reflects current nursing practice Competencies: The Nurse Life Care Planner: Participates as learner and teacher in formal and informal educational activities related to appropriate knowledge and professional issues. Demonstrates an ongoing commitment to learning through self-reflection and inquiry to identify learning needs. Pursues learning activities to develop and maintain skills, abilities, knowledge, and competence. Uses current healthcare research findings and other evidence to expand Nurse Life Care Planning knowledge, skills, and judgment. Consults with nursing and other healthcare professionals to develop and maintain skills, abilities, and knowledge. Shares educational findings, experiences, and ideas with peers. Maintains professional records that provide evidence of competence and lifelong learning. Obtains and maintains professional certification in Life Care Planning and other applicable content areas as appropriate. Standard 9. Evidence Based Practice and Research The Nurse Life Care Planner integrates research findings and evidence into practice. Competencies: The Nurse Life Care Planner: Uses critical thinking skills and current scientific evidence to guide Nurse Life Care Planning practice. Actively participates in research activities, such as: Participating in a formal research committee, program, or study. Critically analyzing and interpreting research for application to Nurse Life 47

48 Care Planning practice. Formally disseminating research findings through presentations, publications, or consultations. Shares findings with peers, colleagues, individuals, families, nurses entering the field of Nurse Life Care Planning, and others. Standard 10. Quality of Practice The Nurse Life Care Planner contributes to quality nursing and Nurse Life Care Planning practice. Competencies: The Nurse Life Care Planner: Applies the nursing process responsibly, accountably, and ethically when developing a Life Care Plan. Provides leadership in the design and implementation of quality improvements. Uses the results of quality improvement to initiate changes in nursing practice and the healthcare delivery system. Participates in quality improvement activities. These may include, for example: Identifying problems that occur in day-to-day work routines to correct process inefficiencies. Seeks healthcare consumer feedback to identify opportunities for improving practice. Formulating recommendations to improve practice or outcomes. Implementing activities to enhance the quality of practice. Maintaining familiarity with current standards of practice. Active participation in a professional organization relating to the practice of Nurse Life Care Planning. Participating in and/or leading efforts to minimize costs and unnecessary duplication. Standard 11. Communication The Nurse Life Care Planner communicates effectively in a variety of formats in all areas of practice. Competencies: The Nurse Life Care Planner: Assesses communication format preferences of healthcare consumers, families, and 48

49 colleagues. Self-assesses communication skills in formal and informal professional interpersonal encounters. Seeks continuous improvement of own communication and conflict-resolution skills. Conveys information accurately. Questions the rationale supporting processes and decisions that do not appear to be in the best interest of the healthcare consumer. Discloses observations or concerns related to hazards and errors in care, practice environment, or individual circumstances to the appropriate level. Provides for communication between providers using case managers or qualified others to minimize risks associated with transfers and transition in care delivery. Contributes professional perspective in formal and informal inter- and intraprofessional discussions. Standard 12. Leadership The Nurse Life Care Planner provides demonstrates leadership in the professional practice setting and the profession. Competencies: The Nurse Life Care Planner: Provides direction to enhance effectiveness of interprofessional team. Educates the public about the Nurse Life Care Planning profession. Fosters a supportive environment for nurses entering Nurse Life Care Planning practice. Communicates effectively. Defines a clear vision, measurable associated goals, and a plan for achievement. Models expert practice to interprofessional team members and healthcare consumers. Uses best practices in the development of policies, procedures and standards of Nurse Life Care Planning practice. Demonstrates a commitment to lifelong learning and education for self and others. Promotes professional development through mentoring of colleagues for the advancement of nursing practice, the profession, and quality health care. Treats colleagues with respect, trust, and dignity. Facilitates successful conflict resolution through effective communication. Advocates for advancing nursing autonomy and accountability. Participates in professional organizations. 49

50 Promotes the specialty and nursing profession through writing, publishing, and formal and informal presentations. Works to influence decision-making bodies to improve healthcare services and policies. Standard 13. Collaboration The Nurse Life Care Planner collaborates with healthcare consumers, healthcare providers, and others, in the conduct of practice. Competencies: The Nurse Life Care Planner: Partners with others to effect change and produce positive outcomes through the sharing of knowledge of the healthcare consumer and/or situation. Communicates the Nurse Life Care Planner s role to all involved parties. Promotes conflict management and engagement. Adheres to standards and applicable codes of conduct that govern behavior among peers and colleagues to create a work environment that promotes cooperation, respect, and trust. Creates a documented plan and other work product focused on outcomes and decisions related to care and service delivery that reflects communication and collaboration with all involved parties. Documents communications, rationales for plan changes, and collaborative discussions as appropriate. Cooperates in creating a documented plan focused on outcomes and decisions related to care and delivery of services that indicates communication with healthcare consumers, families, and others. Engages in teamwork and team-building processes. Standard 14. Professional Practice Evaluation The Nurse Life Care Planner self-evaluates nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. Competencies: The Nurse Life Care Planner: Analyzes one s Life Care Plans for age-appropriate and developmentally appropriate care in a culturally and ethnically sensitive manner. Engages in self-evaluation of practice on a regular basis, identifying areas of 50

51 strength, as well as areas for professional development Seeks feedback regarding one s own practice from healthcare consumers, peers, professional colleagues, and appropriate others. Interacts with peers and colleagues to enhance her or his own professional nursing practice or role performance. Takes action to achieve goals identified as a result of self-evaluation, e.g., revising report format, preparing for deposition or trial, improving presentation skills. Considers new and emerging technology and tools for improving work flow and products. Provides the evidence for practice decisions and actions as part of the informal and formal evaluation processes. Interacts with peers and colleagues to enhance her or his own professional nursing practice or role performance. Provides peers with formal or informal constructive feedback regarding their practice or role performance. Standard 15. Resource Utilization The Nurse Life Care Planner recommends appropriate resources for safe, effective, and financially-responsible healthcare services. Competencies: The Nurse Life Care Planner: Assesses the healthcare consumer s needs and resources available to address needs and achieve desired outcomes. Recommends appropriate levels of care based on complexity and the needs of the individual. Identifies healthcare consumer needs when making resource recommendations. Evaluates factors such as safety, effectiveness, availability, cost/benefits, technology, evidence, and efficiencies when considering Life Care Plan component options with the same expected outcome. Considers new and emerging technology for inclusion in the plan. Provides for delegation of elements of care in the plan to appropriate persons and healthcare workers in accordance with applicable legal, regulatory, or policy parameters. Assists the healthcare consumer and other relevant parties to understand costs, risks, and benefits of treatment, care, and other elements of the nurse Life Care Plan. 51

52 Standard 16. Environmental Health The Nurse Life Care Planner practices in an environmentally safe and healthy manner. Competencies: The Nurse Life Care Planner: Attains knowledge of environmental health concepts, such as implementation of environmental health strategies. Promotes practice and care environments that reduce environmental health risks. Assesses how environmental factors such as sound, odor, noise, and light affect health. Advocates for the judicious and appropriate use of products in health care. Communicates environmental health risks and exposure reduction strategies to healthcare consumers, families, colleagues, communities, and others as appropriate. Evaluates scientific evidence to determine if a product or treatment is an environmental threat. Participates in strategies to promote healthy communities. References Agency for Healthcare Research and Quality (2006) The High Concentration of U.S. Health Care Expenditures: Research in Action, Issue 19. June 2006, Rockville, MD. American Association of Nurse Life Care Planners (AANLCP ). (2008) Nurse Life Care Planners standards of practice with interpretive statements. Membership Guide. AANLCP. Salt Lake City UT. Position statement on the definition of the nurse Life Care Planning. (2008) Membership Guide. AANLCP. Salt Lake City UT Code of professional ethics and conduct for nurse Life Care Planners with interpretive statements. (2008) Membership Guide. AANLCP. Salt Lake City UT American Nurses Association (ANA). (2001) Code of ethics for nurses with interpretive statements. Washington, DC: American Nurses Publishing.. (2010) Nursing s social policy statement: The essence of the profession. 2nd edition. Silver Spring MD: Nursesbooks.org.. (2010) Scope and standards of practice, Nursing, 2nd edition. Silver Spring MD: Nursesbooks.org 52

53 Brock, P. From Clinical Nurse to Entrepreneur: Becoming a Life Care Planner. American Journal of Nurse Life Care Planning. Winter 2010; X, (4): Available at, December. Centers for Medicare and Medicaid: Workers Compensation Medicare Set-aside Arrangements (WCMSAs) Deutsch. P. M. Life Care Planning. (2011) Retrieved from: Federal Rules of Evidence. Article VII, Opinions and Expert Testimony (Rule ) Herdman TH (2012) (Ed.). NANDA International Nursing Diagnosis: Definitions and Classification, Oxford: Wiley-Blackwell Howland WA (2010) Nursing Diagnosis, Definitions and Classifications, NANDA I. Journal of Nurse Life Care Planning. Winter 2010; X, (4): Available at December. Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health; October 5, 2010 LaGasse, N., McDaniel, H., American Association of Legal Nurse Consulting, Legal Nurse Consulting Practices, 3rd Edition, "The Life Care Planning Expert," Volume II, Chapter 13, (pp ), CRC Press, Taylor & Francis Group, Boca Raton, FL. (2010) Manzetti C, Bate BT & Pettengill A, A survey of nurse life care planners: a role delineation study in the United States. JNLCP XIV.3, Fall 2014, p.694 ff National League of Nursing. Critical Thinking in Clinical Nursing Practice/RN Examination. June Available at Online Journal of Issues in Nursing (2012) Role of professional organizations in advocating for the nursing profession. Vol. 17, No. 1, Manuscript 3, January Contents/Vol /No1-Jan-2012/Professional-Organizations-and-Advocating.html Retrieved 8/24/2014 Robert Wood Johnson Foundation (2013) Discover nursing: nurse life care planning Retrieved 9/16/2014 The ARC. For people with intellectual and development disabilities. (2011) Appendix: Role Delineation Study 53