American Assisted Living Nurses AssociationOFFICIAL SECTION OF THE OFFICIAL SECTION OF THE

American Assisted Living Nurses Association

Assisted Living NurseCompetenciesJosh Allen, RN, C-AL

In the last edition of the AALNA section in Geri-

atric Nursing, we shared the Scope and Stan-dards of Assisted Living Nursing Practice,1

originally developed by AALNA in 2007. In fol-low-up to that, we are sharing below the AALNAAssisted Living Nurse Competencies for bothRegistered Nurses and Licensed Practical/Voca-tional Nurses practicing in assisted living.

Both theCompetencies and theScope andStan-dards are core components of promoting effectivenursing practice in assisted living, defining therole of nurses in assisted living, and crafting theAssisted Living Nurse Certification Exam.

We welcome input and comments from nursesand assisted living professionals on the AssistedLiving Nurse Competencies outlined below.Please visit www.alnursing.org or send yourcomments directly to jallen@alnursing.org.

Competencies Necessary for Nursesto Provide High-Quality Care toOlder Adults in Assisted Living

Residences

(Adapted from: Older Adults: RecommendedBaccalaureate Competencies and CurricularGuidelines for Geriatric Nursing Care. AmericanAssn of Colleges of Nursing and the John A Hart-ford Foundation Institute for Geriatric Nursing.July 2000)

1. Recognize one’s own and others’ attitudes,values, and expectations about aging andtheir impact on care of older adults and theirfamilies.

2. Adopt the concept of individualized (person-centered and directed) care as the standardof practice with older adults.

3. Communicate effectively, respectfully, ethi-cally, and compassionately.

4. Recognize that sensation and perception inolder adults are mediated by functional,

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physical, cognitive, psychological, and socialchanges common in old age.

5. Incorporate into daily practice valid and reli-able tools to assess the functional, physical,cognitive, psychological, social, and spiritualstatus of older adults.

6. Prevent or reduce common risk factors thatcontribute to functional decline, impairedquality of life, and excess disability in olderadults.

7. Recognize and report elder mistreatment.8. Recognize and manage geriatric syndromes

common to older adults.9. Recognize the complex interaction of acute

and chronic comorbid conditions and the al-tered presentation of illness common to olderadults.

10. Use technology to enhance older adults’ func-tion, independence, and safety.

11. Facilitate communication and appropriate in-formation transfer among the assisted livingresidence, other health care settings, andthe older adult’s private residence.

12. Assist older adults, families, and caregiversto understand and balance autonomous deci-sion making and safety interests in everydayactivities of life of the older adult and to ad-vance quality of life.

13. Apply ethical principles in practice.14. Appreciate the influence of culture, attitude,

role, language, race, religion, gender, and life-style in the provision of care to older adults.

15. Evaluate the influence of payer systems onaccess to health care.

16. Recognize the benefits and utilize the exper-tise of the interdisciplinary team.

17. Evaluate the utility of complementary and in-tegrative health care practices on health pro-motion and symptom management for olderadults.

18. Facilitate older adults’ active participation inall aspects of their own health care.

19. Involve, educate, and supervise assistivestaff (ands family/friends, as appropriate) inimplementing best practices for older adults.

20. Promote older adults’ right to quality care atthe end of life.

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Assisted Living Nurse Competencies:Registered Nurse

Continuum of Long-Term Care/

Assisted Living

1. Describe the philosophy of assisted living(AL).

2. Describe the service or program characteris-tics of AL that differentiate AL from a nursinghome, skilled nursing or independent livingenvironment, per the regulations in yourstate.

3. Describe the in-house services and/or transferarrangements available in the event of:a. resident accidentb. change in conditionc. significant/critical illness post hospital cared. end-of-life care

4. Describe the allowed use of advance direc-tives in the state, including community-baseddo not resuscitate orders (DNRs), prescribedlocation of same, and the role of surrogate de-cision makers.

Clinical: Assessment

1. Accurately conduct and analyze physical andmental assessment data, including but not lim-ited to:a. activities of daily living (ADL) measure

(e.g., Katz)b. instrumental ADL measure (e.g., Lawton)c. mental status examination measure (e.g.,

Mini-Mental State Exam [MMSE])d. depression measuree. falls-at-risk measuref. weight monitoringg. self-medication abilityh. decision-making capacityi. pain assessment

2. Describe admission, retention, and dischargecriteria.

3. Identify abnormal lab data and reporting pro-cedures for abnormal results.

4. Identify potential adverse effects of certainclasses of medication, such as:a. cardiac and respiratory medicationsb. anticoagulantsc. psychotropics, including anxiolyticsd. sleeping aids

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e. nonsteroidal anti-inflammatory drugs(NSAIDs), opioid, and other pain manage-ment interventions

f. over-the-counter medications (OTCs) thatare managed by the individual resident

g. commonly used herbal remediesh. likelihood of polypharmacy associated

with resident having several medical pro-viders (e.g., ophthalmic, cardiac, rheuma-tologist, etc.)

5. Demonstrate knowledge of key geriatricsyndromesdsigns and symptomsdas wellas onset of acute illness such as: cardiore-spiratory, infection, peripheral vascular dis-ease exacerbation, diabetic instability,delirium.

6. Verbalize the relationship with and/or expec-tations of a hospice provider to a resident re-ceiving end-of-life care in the residence,including the clarifications of roles andresponsibilities.

Clinical: Planning

1. Develop a plan of care that reflects strengths aswell as areas of risk (and the signs and symp-toms to look for) for the resident.

2. Provide evidence of a plan of care review andupdate, frequency as determined by state li-censing requirements, primary provider, ALnurse and other clinicians, resident/family,and others, as relevant.

3. Demonstrate appropriate documentation perstate regulations

Dementia Care

1. Identify the unique care requirements of per-sons with dementia, including:a. Alzheimer’s diseaseb. multi-infarct/vascular dementiac. Parkinson’s-related dementiad. Lewy body diseasee. transient dementia

2. Describe delirium and contrast to dementia.a. Identify appropriate nursing actions to as-

sist with an appropriate diagnosis and sub-sequent interventions.

3. Demonstrate a knowledge of appropriate pro-gramming interventions for persons withdementia.

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4. Identify nursing actions for dementia-relatedcomplications, including swallowing prob-lems, incontinence, risk for dehydration.

5. Describe nursing actions essential to workingwith psychotropic medications, including:a. monitoring for unwanted effectsb. avoiding inappropriate use/nonmedication

interventions6. Demonstrateknowledgeofdementia-appropriate

interventions for special care issues,including:a. sundowningb. agitationc. aggressiond. exit seekinge. impaired communicationf. isolationg. inappropriate sexual behaviors

Managerial

1. Direct, supervise, and monitor unlicensedstaff with regard to:a. medication administration and assistanceb. personal care assistancec. meal assistanced. unskilled treatment assistance

2. Document staff performance using a valid/re-liable measure (i.e., one promulgated by theprofessional organization).

3. Describe the criteria that would be associ-ated with a disciplinary report or action.

4. Describe the steps in delegation, per state reg-ulations and nurse practice act and what mayor may not be delegated to unlicensed staff.

5. Describe the medication management sys-tem in the residence, approved by state regu-lations, that includes:a. telephone orders: renewal, newb. fax ordersc. STAT ordersd. change of dose, etc.e. pharmacy provider communication and

oversight (if any)6. Describe the primary provider notification

system in the event of resident change ofcondition.

7. Describe the family notification system in theevent of resident change of condition.

8. Identify the information required by a hospi-tal or nursing home to which a resident mightbe transferred.

Geriatric Nursing, Volume 32, Number 5

9. Describe basic conflict-resolution skills tomanage disputes between residents, betweenstaff and resident, and between staff.

10. Demonstrate the ability to understand anduse a budget, including spend-down reports.

11. Describe the process for vendor selection, in-cluding selecting and building a workingrelationship.

12. Describe the kind of information necessaryto construct an accident/incident report re-lated to physical injury or event (e.g., fallwithout evidence of bruise), medication er-ror, resident-resident altercation, etc.

Professional Nursing

1. Describe the collegial relationship of the ALnurse to physician, social worker, residenceowner/administrator, etc.

2. Provide evidence of annual continuing educa-tion unit courses taken or other formal learn-ing initiatives, per state regulations.

3. Maintain membership in a professional nurs-ing organization.

4. Provide evidence of the receipt of or access toprofessional nursing journals.

5. Identify professional learning needs; assesscompetencies.

Assisted Living Nurse Competencies:Licensed Practical Nurse

Continuum of Long-Term Care/Assisted

Living

1. Describe the philosophy of AL.2. Describe the service or program characteris-

tics of AL that differentiate it from a nursinghome, skilled nursing, or independent livingenvironment, per the regulations in your state.

3. Understand/describe the in-house servicesand/or transfer arrangements available in theevent of:a. resident accidentb. change in conditionc. significant/critical illness post hospital cared. end-of-life care

4. Understand/describe the alloweduse of advancedirectives in the state, including community-based DNRs, prescribed location of same, andthe role of surrogate decision makers.

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Clinical: Assessment

1. Contribute to the assessment of the residentby the use of resident data, including but notlimited to:a. ADL measure (e.g., Katz)b. instrumental ADL measure (e.g., Lawton)c. mental status examination measure (e.g.,

MMSE)d. depression measuree. falls-at-risk measuref. weight monitoringg. self-medication abilityh. decision-making capacityi. pain assessment

2. Describe admission, retention, and dischargecriteria.

3. Participate in the identification of abnormallab data and reporting procedures for abnor-mal results.

4. Understand the potential adverse effects ofcertain classes of medication, such as:a. cardiac and respiratory medsb. anticoagulantsc. psychotropics, including anxiolyticsd. sleeping aidse. NSAIDS, opioid, and other pain manage-

ment interventionsf. OTCs that are managed by the individual

residentg. commonly used herbal remediesh. likelihood of polypharmacy associated

with resident having several medical pro-viders (e.g., ophthalmic, cardiac, rheuma-tologist, etc.)

5. Knowledge of key geriatric syndromesdsignsand symptomsdas well as onset of acute ill-ness such as cardiorespiratory, infection, pe-ripheral vascular disease exacerbation,diabetic instability, delirium.

6. Maintain aworking relationshipwith a hospiceprovider to a resident receiving end-of-lifecare in the residence, including the clarifica-tions of roles and responsibilities.

Clinical: Planning

1. Participate in the plan of care that reflectsstrengths as well as areas of risk (and the signsand symptoms to look for) for the resident.The plan of care must have measurable goals.

2. Maintain evidence of a plan of care review andupdate, frequency as determined by state li-

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censing requirements, primary provider, ALnurse and other clinicians, resident/family,and others, as relevant.

3. Appropriate documentation per stateregulations

Dementia Care

1. Understand the unique care requirements ofpersons with dementia, including:a. Alzheimer’s diseaseb. multi-infarct dementiac. Parkinson’s-related dementiad. Lewey body diseasee. transient dementia

2. Describe delirium and contrast it to dementia.a. Identify appropriate nursing actions to as-

sist with an appropriate diagnosis and sub-sequent interventions as appropriate to thescope of practice for a licensed practicalnurse.

3. Demonstrate a knowledge of appropriate pro-gramming interventions for persons withdementia.

4. Contribute to identifying nursing actions fordementia-related complications and risk fac-tors such as weight loss, swallowing prob-lems, incontinence, and risk for dehydration.

5. Describe nursing actions essential to workingwith psychotropic medications including:a. participating in observing for unwanted

effectsb. identifyingnonmedication-related interventions

6. Knowledge of dementia appropriate interven-tions for special care issues such as:a. sundowningb. agitationc. aggressiond. exit seekinge. impaired communicationf. isolationg. inappropriate sexual behaviors

Managerial

1. Monitor unlicensed staff with regard to:a. medication administration and assistanceb. personal care assistancec. meal assistanced. unskilled treatment assistance

2. Documentation of staff performance usinga valid/reliable measure (i.e., one promul-gated by the professional organization).

Geriatric Nursing, Volume 32, Number 5

3. Describe the criteria that would be associ-ated with a disciplinary report or action.

4. Describe/understand the medication man-agement system in the residence, approvedby state regulations, that includes:a. telephone orders: renewal, newb. fax ordersc. STAT ordersd. change of dose, etc.e. pharmacy provider communication and

oversight (if any)5. Describe/understand the primary provider

notification system in the event of residentchange of condition.

6. Describe/understand the family notificationsystem in the event of resident change ofcondition.

7. Identify the information required by a hospi-tal or nursing home to which a resident mightbe transferred.

8. Describe basic conflict-resolution skills tomanage disputes between residents, betweenstaff and resident, and between staff.

9. Demonstrate the ability to understand anduse a budget, including spend-down reports

10. Describe the process for vendor selection, in-cluding selecting and building a workingrelationship.

11. Describe the kind of information necessaryto construct an accident/incident reportrelated to physical injury or event (e.g., fallwithout evidence of bruise), medication er-ror, resident-resident altercation, etc.

Professional Nursing

1. Describe the collegial relationship of the li-censed practical nurse to registered nurse to

Geriatric Nursing, Volume 32, Number 5

physician, social worker, residence owner/ad-ministrator, etc.

2. Provide evidence of annual continuing educa-tion courses taken or other formal learning ini-tiatives, per state regulations.

3. Maintain membership in a professional nurs-ing organization.

4. Provide evidence of the receipt of or access toprofessional nursing journals.

5. Identify professional learning needs; assesscompetencies.

About AALNA

The American Assisted Living Nurses Associa-tion is the only national nonprofit associationdedicated exclusively to nursing in assisted liv-ing. Operated by nurses, for nurses. The missionof AALNA is to promote effective nursing prac-tices in assisted living such that nurses as wellas residents benefit. Learn more about AALNAat www.alnursing.org.

Reference

1. Scope and Standards of Assisted Living Nursing Practice.

(2007). Retrieved from http://www.alnursing.org/

alnursecert/SCOPE_AND_STANDARDS_FINAL2_

09-19-06.pdf.

JOSH ALLEN, RN, C-AL, is the President of the American

Assisted Living Nurses Association, Napa, CA. Josh is

a registered nurse with over 17 years of experience in as-

sisted living and residential care.

0197-4572/$ - see front matter

� 2011 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2011.07.010

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