Is a Career in Palliative Care and Hospice for You?

January 26th, 2012

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By , BSN, RN

Palliative care and hospice nursing have been the focus of several articles this week on Notes from the Nurses’ Station. Caring for the chronically or seriously ill and nursing care for people at the end of life is a very special area that takes a certain amount of special education. There are nursing programs and courses that focus on palliative care, there is a certification and a professional organization for nurses who find their passion in nursing these unique patients.

The baby boomer generation is quickly moving into old age. Many of this generation are sandwiched between caring for their children and grandchildren while also being responsible for their elderly parents. Palliative and hospice nursing is growth industry. Even the American Association of Colleges of Nursing (AACN) has addressed the issue of end-of-life nursing care and developing competencies for educators and nurses to meet as this specialty area grows in need. 

Palliative Care Nursing

According to the Hospice and Palliative Nurses Association (HPNA) the goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, and helping with decision-making and providing opportunities for personal growth.

To become a palliative care nurse most providers require RNs to have at least one year of acute care experience, excellent assessment skills, and clear and concise communications skills. Since both palliative and hospice care are provided by a team approach there is a lot of dependence on the nurse since it is the nursing providers who will see the patient most often. The interdisciplinary team will rely on the nurse’s assessment to make decisions for the plan of care and both the care team and the client’s family will need information that is timely, accurate, and, particularly for the family, easy to understand.

Any level of RN can work as and be certified as a palliative care and hospice nurse. Hospice and palliative nurses are prepared at the associate- degree, baccalaureate-degree, and even the master’s-degree level. A small percentage of hospice and palliative nurses hold a doctoral degree.

Palliative care can be offered anywhere patients are seen in any stage of illness. Palliative care programs are seen most often in hospitals, though there are programs that are found in outpatient care and other areas.

Hospice Nursing

Hospice care, a part of palliative care, is provided to patients during the end stages of their disease process and is defined by Medicare regulations stating that a patient is thought to be in their last six months of life. Hospice care is provided in the patient’s home regardless of whether this is a private home, a personal care home, a skilled nursing facility, correctional facility, group home, or hospice run residential facility. There are also inpatient hospice units in hospitals that are used most frequently to help control symptoms so that the patient can return to their home. Hospice care is focused on the patient and those who love them, wherever they reside.

No matter the setting, hospice care is given by an interdisciplinary team which typically includes RNs, LP/VNs, nursing assistants, a social worker, a chaplain, volunteers, and a medical director. The patient and family are also considered part of the team. Others like occupational or physical and speech therapists may also be part of the team. The entire team works toward meeting the goals of the patient and family.

Nurses who see patients outside of the hospital are responsible for assessing the patient, delivering care as needed, organizing and managing a patient’s plan of care; including scheduled visits for nursing and nursing assistants, referrals to additional services and volunteers, calls to insurances and physicians, and monitoring costs related to pharmacy, supplies, and durable medical equipment.

Hospice nurses work in a variety of settings, there can be extensive travel, care environments that may be threatening, unpredictable hours, and variable levels of reimbursement. Palliative care and hospice nurses earn salaries comparable to other registered nurses. If the nurse holds an advanced degree specialized in palliative or hospice care the salary is usually comparable to that of nurse practitioners.

Education

There is a distinct body of knowledge with direct application to the practice of hospice and palliative care nursing. This includes: pain and symptom management; end-stage disease processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations; communication skills; and awareness of community resources.

There are fewer than 20 universities that offer graduate level education programs with a focus on hospice and palliative care. Some of those schools merely offer a few courses, while others offer enough classroom and clinical experience to earn a certification, specialization, minor degree or post-graduate certification in hospice and palliative care. All these different programs fall under the auspices of masters level programs offering adult (ANP), pediatric (PNP) and doctoral (DNP) nurse practitioner education and training. There are currently two master’s degree programs that focus on specifically on hospice and palliative care – New York University (New York, NY) and Ursuline College (Pepper Pike, OH).

For nurses who are not working on a graduate degree but prefer to focus their time on their careers in palliative and hospice care nursing the HPNA offers continuing education courses and credits. There is also certification credentialing in this specialty for all levels of nursing (APN, RN, pediatric RN, LP/VN, nursing assistant) and administrator.

Finally, to be a palliative care or hospice nurse you must have the temperament and emotional stability for the job. It takes a lot of self-assessment to be sure you can handle the patients and the families you will be providing for. A hospice nurse must be very patient and compassionate. When people are critically ill or facing death they may not be easy to care for, their own fears, worries, and illness outweigh everything else. A palliative care or hospice nurse must be able to encourage and provide comfort to not only their immediate client but to the client’s family and friends as well.

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