Advocates Call on Nurses to Take Leading Role in Palliative Care

by: Robert Wood Johnson Foundation

(January 06, 2015)

s demand for palliative care grows, practicing nurses, nurse leaders and nurse researchers are needed.

First, the good news: More people in sor of nursing and pediatrics at Johns Hopkins
the United States are living longer. The not-so- University and an alumna of the Robert Wood
good news? Many are also living sicker, man- Johnson Foundation (RWJF) Executive Nurse
aging multiple chronic conditions, and creating Fellows program (2006-2009).
a growing need for palliative care, which fo-

Nursing, like palliative care, focuses on

cuses on symptom relief and optimizing quali- pain and symptom management, patient advoty of life at all stages of serious illness.
cacy and education of the patient and family.
The problem, advocates say, is that Both fields emphasize holistic care of the pathere is a shortage of palliative care provid- tients body, mind and spirit; serve family
ers. Nurses, they say, can help fill the void.

members and caregivers, rather than just the

Nurses are ideal providers of pallia- patient; and take patient wishes into account
tive care, according to a report on the future of when designing plans of care, according to

Hultman,
PhD,
APRN-BC,
nursing by a committee of nurses and other Todd
health experts that was released in 2010 by the ACHP. Hultman is a nurse practitioner in palInstitute of Medicine (IOM). Palliative care

liative care service at Massachusetts General

is a model that is consistent with basic nursing Hospital and past president of the Hospice and
values, which include caring for patients and Palliative Nurses Association.
their families regardless of their age, culture,

In palliative care, nurses are full part-

socioeconomic status, or diagnoses, and en- ners with providers from other disciplines and
gaging in caring relationships that transcend play central roles on care teams. Palliative care
time, location, and circumstances.

teams, by definition, must include a physician,

Leading nurses agree. The essence of a nurse and a social worker, and often include
palliative care is embodied in nursing care, spiritual leaders and professionals from other
said Cynda Rushton, PhD, RN, FAAN, profes- fields as well.

As such, palliative care is a model of vers patients who have serious health condiinterprofessional collaboration in health care, tions at all stages of life.
which has been linked to improved patient out-

Since then the field of palliative care

comes, more efficient use of resources, and has blossomed, and nurses have played a critiincreased retention of nurses, according to the cal role in its growth, Hultman said. They have

IOM report. As the delivery of care becomes conducted groundbreaking research in the
more complex across a wide range of settings, field, especially in the area of psycho-social
and the need to coordinate care among multiand spiritual care, which helps patients and
ple providers becomes ever more important, families cope with the emotional challenges of

developing well-functioning teams becomes a terminal and life-limited illnesses. Another key
crucial objective throughout the health care area of nurse research has been in self-care of
system, the report states.

Synchronicity Between Nursing and Palliative Care

The synchronicity between nursing and

palliative care is no accident. Palliative care
grew out of the hospice movement of the
1960s, which was led by Cicely Saunders, a
nurse and social worker in Great Britain who
later became a physician. Concerned about an
overall disregard for dying patients in traditional hospital settings, Saunders founded the

worlds first modern hospice in 1967, and

the clinician, which helps providers stave off

compassion fatigue.
Nurses have also helped develop a
newer branch of the field concerning pediatric
patients, and they have played a vital role advocating for public policies on behalf of their
patients. In the early 1980s, thanks in part to
the work of nursing advocates, the federal government granted Medicare beneficiaries the
right to non-curative medical and support services, Hultman said.

In 1996, RWJF launched a major initia-

drew on her nursing background in the pro- tive, investing more than $170 million over 10
years to improve care at the end of life. The

cess.
Meanwhile, Florence Wald, RN, MSN,
FAANthe then-dean of the Yale School of
Nursinglearned about and was inspired by
Saunders. She opened the first hospice in the
United States in 1971. Hospice care, which has
a strict focus on the end of life, contributed to
the development of palliative care, which co-

effort helped advance the field of palliative

care, according to a 2011report. Improvements
include an increasing focus on palliative care
in medical and nursing training programs and a
growing cadre of certified professionals in the

field. The Foundation has also supported nurse

scientists and leaders like Rushton to develop
the field.

Today, two-thirds of hospitals with cess to specialists, Rushton said.

more than 50 beds have palliative care pro-

Nurses also need to take on more lead-

grams, said Jay Horton, ACHPN, FNP-BC, ership roles in palliative care, many say. That
MPH, a palliative care nurse practitioner and is the goal of thePalliative Nursing Leadership
educator at the Mount Sinai School of Medi- Institute, a new program supported by the
cine and faculty with the Center to Advance Hospice and Palliative Nurses Association that
Palliative Care, which receives funding from cultivates emerging nurse leaders in the field.

RWJF.

There is a huge opportunity for nurses to step

Still, the field has a long way to go be- up, provide leadership and make clear

fore it is able to meet current and future de- nursings unique set of contributions to people
mands.

who need palliative care, Rushton said.

Advanced practice registered nurses

(APRNs), Horton said, are needed to fill a

huge gap between the supply of palliative
care providers and demand for their services.

APRNs educated and trained to carry out

many of the professional responsibilities associated with palliative care can be educated
more quickly, and at less expense, than physicians, he noted.
Fellowships, residencies, and federal
funding programs are needed to incentivize
more nurses to specialize in palliative care,

Hultman added. Theres no standard pathway

for nurses to enter the field. Unless an agency
is willing to train an untrained person from the
beginning, its hard for nurse practitioners to
make entry into the field.
Experts also say nurse education programs and licensure exams should include
more content on palliative care. Every single

nurse needs to have basic competencies in palliative care and to know when patients needs
have exceeded that [and the patient needs] ac-