; (B) is developed in coordination with the patient, the patient’s family, or other representatives when appropriate, and staff of other disciplines involved in the care of the patient; (C) reflects all elements of the nursing process; and (D) recommends the number and skill mix of additional licensed and unlicensed direct care staff needed to fully implement the nursing care plan. (9) Professional judgment The term professional judgment means, in accordance with State nursing laws and regulations of the State in which the direct nursing care is being performed, the direct care registered nurse’s application of knowledge, expertise, and experience in conducting a comprehensive nursing assessment of each patient and in making independent decisions about patient care including the need for additional staff. (10) Staffing plan The term staffing plan means a staffing plan required under section 3401. (11) State of emergency The term state of emergency — (A) means a state of emergency that is an unpredictable or unavoidable occurrence at an unscheduled or unpredictable interval, relating to health care delivery and requiring immediate medical interventions and care