PRIMARY VS. SPECIALIST
PALLIATIVE NURSING
ROLE OF APRNS IN HEALTH CARE
IN THE CHANGING LANDSCAPE OF HEALTHCARE, NURSING,
PARTICULARLY APRNS, HAVE BEEN IDENTIFIED AS AN ESSENTIAL
ELEMENT OF IMPROVING CARE AND ACCESS UNDER HEALTH CARE
REFORM.
APRNS ARE UNIQUELY QUALIFIED AND POSITIONED TO PROVIDE
PALLIATIVE SERVICES, PARTICULARLY IN THE RURAL AND COMMUNITY
SETTINGS.
INSTITUTE OF MEDICINE 2010
PATIENT PROTECTION AND AFFORDABLE CARE ACT 2010
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PALLIATIVE NURSING
PALLIATIVE NURSING FOCUSES ON: CARE DELIVERY TO INDIVIDUAL PATIENTS
AND FAMILIES; PATIENTS WITHIN SPECIFIC DISEASE POPULATIONS; AND
PALLIATIVE CARE ISSUES WITHIN HEALTHCARE AND SOCIETY AS A WHOLE
ENTITY.
PALLIATIVE NURSING EMBRACES AND REFLECTS A HOLISTIC PHILOSOPHY OF
CARE PROVIDED TO PATIENTS WITH SERIOUS OR LIFE-THREATENING ILLNESS
IN DIVERSE HEALTH SETTINGS, ACROSS THE LIFE SPAN.
PALLIATIVE NURSING: SCOPE AND STANDARDS
ANA AND HPNA 2014
DELINEATION OF PALLIATIVE NURSING
• ALL NURSES PRACTICE ASPECTS OF PRIMARY PALLIATIVE CARE.
• SPECIALTY PALLIATIVE NURSING
• REGISTERED NURSES EMPLOYED BY HOSPICES TO WORK ON HOSPICE UNITS, IN THE HOME, OR SKILLED
FACILITY SETTINGS.
• REGISTERED NURSES EMPLOYED BY PALLIATIVE CARE TEAMS TO WORK ON DEDICATED PALLIATIVE UNITS,
OUTPATIENT SETTINGS, OR IN THE HOME.
• TWO ADVANCED PRACTICE PALLIATIVE NURSING ROLES
• THE GRADUATE LEVEL PREPARED SPECIALTY NURSE WHO ADVANCES PALLIATIVE IN NON CLINICAL
AREAS SUCH AS EDUCATION, ADMINISTRATION, OR RESEARCH.
• THE ADVANCED PRACTICE REGISTERED NURSE (APRN) , USUALLY A NURSE PRACTITIONER OR CLINICAL
NURSE SPECIALIST WHO IS CLINICALLY FOCUSED.
PALLIATIVE NURSING: SCOPE AND STANDARDS
ANA AND HPNA 2014
PALLIATIVE NURSING ESSENTIALS
• KNOWLEDGE
• DISEASE STATE, PROGNOSIS, PHARMACOLOGY, EVIDENCE BASE TO PRACTICE
• COMMUNICATION
• ASSESSMENT (PERSPECTIVES, SYMPTOMS, BELIEFS, VALUES, CONCERNS,
COPING), GOALS OF CARE, RELATIONSHIPS, EDUCATION, COLLABORATION,
COORDINATION
• PRESENCE
• ACTIVE LISTENING, AVAILABILITY, ACKNOWLEDGEMENT
PRIMARY PALLIATIVE CARE
PROVIDED BY ALL HEALTH CARE PROFESSIONALS
• MANAGEMENT OF CHRONIC ILLNESS
• BASIC SYMPTOM MANAGEMENT
• COMMUNICATION
• ADVANCED DIRECTIVES
• RESOURCES/TRAINING:
• ELNEC (END OF LIFE NURSING EDUCATION CONSORTIUM
• EPERC (END OF LIFE/PALLIATIVE EDUCATION RESOURCE CENTER)
• CAPC (CENTER TO ADVANCE PALLIATIVE CARE)
• NHPCO (NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION)
SPECIALTY PALLIATIVE CARE
• RECOGNIZED AS SUBSPECIALTY IN NURSING, MEDICINE, SOCIAL
WORK, AND CHAPLAINCY
• PROVISION OF CARE THAT IS
• FOCUSED ON ALLEVIATING SUFFERING AND PROMOTING QUALITY OF LIFE
FOR PATIENTS AND FAMILIES WITH COMPLEX NEEDS WHO ARE LIVING
WITH A LIFE THREATENING ILLNESS OR SEVERE ADVANCED ILLNESS.
• INTERDISCIPLINARY
• PROVIDED BY PROFESSIONALS WITH SPECIALTY TRAINING/CERTIFICATION
IN PALLIATIVE CARE
CURRENT STATUS
OF
PALLIATIVE EDUCATION
FOR ADVANCED PRACTICE NURSES
• FEW GRADUATE PROGRAMS HAVE SPECIALTY PROGRAMS WITH DUAL EDUCATION
IN PARTICULAR POPULATION FOCI AND PALLIATIVE CARE
• EDUCATIONAL FORUMS BY NATIONAL ORGANIZATIONS REPRESENTING HOSPICE
AND PALLIATIVE CARE – HPNA, AAHPM, NHPCO
• REGIONAL EDUCATION – APRN ELNEC
• URBAN EDUCATION BY ACADEMIC SETTING
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RESOURCES FOR SPECIALTY APN PRACTICE
APRN FELLOWSHIPS IN PALLIATIVE CARE
ONLY 6 APN FELLOWSHIPS IN PALLIATIVE CARE
 5 FOR THE PALLIATIVE NP – ONE FOR PALLIATIVE CNS
 BY CONTRAST, THERE ARE 106 PHYSICIAN FELLOWSHIPS IN PALLIATIVE CARE.
 PROGRAMS HAVE 5 TRAINEES, AND CA HAS 10.
 RESULT – APPROXIMATELY 15 NPS ANNUALLY WHO RECEIVE SPECIALTY TRAINING
 HISTORICAL
 OCCUR AT ACADEMIC MEDICAL CENTERS – 5 EAST COAST AND 1 WEST COAST
 MOST ESTABLISHED - BI AND MSKCC – NYC
 NEWER – DFCI AND MGH - BOSTON
 RECENT CREATED – UVM AND CA PROGRAMS

MOST FELLOWSHIPS TRAIN APRNS AS FUTURE PALLIATIVE TEAM MEMBERS OF THEIR PROGRAM.

RESULT - APN FELLOWS STAY IN ACADEMIC MEDICAL CENTER POSITIONS
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PALLIATIVE NURSING:
SCOPE AND STANDARDS OF PRACTICE
5TH EDITION. 2014 ANA & HPNA
• THE REVISIONS REFLECT THE CURRENT PRINCIPLES AND PRACTICE OF PALLIATIVE NURSING,
WHICH INCLUDES BOTH HOSPICE AND PALLIATIVE NURSES, IN COLLABORATION WITH
INTERDISCIPLINARY TEAM MEMBERS ACROSS ALL SETTINGS.
• THE SCOPE AND STANDARDS REPRESENT THE NECESSARY KNOWLEDGE, SKILLS, AND ABILITIES
DEMONSTRATED BY THE REGISTERED NURSE, THE GRADUATE-LEVEL PREPARED SPECIALTY
NURSE, AND THE ADVANCED PRACTICE REGISTERED NURSE WHEN PROVIDING EVIDENCEBASED PHYSICAL, EMOTIONAL, PSYCHOSOCIAL, AND SPIRITUAL CARE.
COMPETENCIES FOR THE HOSPICE AND PALLIATIVE
ADVANCED PRACTICE NURSE
2ND EDITION. 2014 HPNA
• THESE HAVE BEEN COMPLETELY REVISED TO REFLECT THE CHANGES IN
PRACTICE OVER THE LAST 12 YEARS.
• THEY COMPLEMENT PALLIATIVE NURSING: SCOPE AND STANDARDS
• TO PROMOTE INCLUSION OF THE TWO ADVANCED PRACTICE ROLES
DELINEATED IN THE SCOPE AND STANDARDS OF PALLIATIVE NURSING, THE TITLE
DELIBERATELY INCLUDED APN RATHER THAN APRN
REQUIREMENTS FOR CERTIFICATION
• CURRENT, ACTIVE RN LICENSE THAT REFLECTS ADVANCED PRACTICE STATUS (CNS, NP, CRNA,
CNM)
• HOLD A MASTERS EDUCATION OR DOCTORAL EDUCATION FROM AN ACCREDITED GRADUATE
LEVEL NURSING PROGRAM AND
• COMPLETED SPECIFIC AREAS OF CLINICAL AND DIDACTIC COURSEWORK
• HEALTH ASSESSMENT
• PHARMACOLOGY
• PATHOPHYSIOLOGY
• AMERICAN NURSING CREDENTIALING CENTER (ANCC) WWW.NURSECREDENTIALING.ORG
• FAMILY, PEDIATRIC, FAMILY/PSYCHIATRIC/MENTAL HEALTH, ADULT–GERO ACUTE CARE OR PRIMARY CARE NP
• PEDIATRIC OR ADULT-GERO CNS
SPECIALTY CERTIFICATION IN
ADVANCED PRACTICE HOSPICE AND PALLIATIVE
• NATIONAL BOARD FOR CERTIFICATION OF HOSPICE AND PALLIATIVE NURSES
(NBCHPN) DELINEATES
• CERTIFICATION ELIGIBILITY
• EXAMINATION QUESTIONS
• RECERTIFICATION THROUGH A COMBINATION OF CE, PRESENTATIONS, WRITING,
PRECEPTORING, TEST QUESTION WRITING.
• 2013 RESULTS OF APRN CERTIFICATION
• 242 TOOK THE TEST
• 153 PASSED THE TEST
• TOTAL OF ACHPNS 905
• 2014 TESTING JUNE, SEPTEMBER, AND DECEMBER
PALLIATIVE NURSING RESOURCES
• OXFORD TEXTBOOK OF PALLIATIVE NURSING, 3RD EDITION. (2010). B.
FERRELL AND N. COYLE EDS. NEW YORK, NY: OXFORD UNIVERSITY PRESS.
• WITTENBERG-LYLES, E., GOLDSMITH, J., FERRELL, B., & RAGAN, S. (2013).
COMMUNICATION IN PALLIATIVE NURSING. NEW YORK, NY: OXFORD
UNIVERSITY PRESS.
• NATIONAL CONSENSUS PROJECT FOR QUALITY PALLIATIVE CARE. (2013).
CLINICAL PRACTICE GUIDELINES FOR QUALITY PALLIATIVE CARE, 3RD EDITION.
NATIONALCONSENSUSPROJECT.ORG
Competencies for Hospice and Palliative
Advanced Practice Nurse. 2014
Core Curriculum for the Advanced Practice Hospice
and Palliative Nurse 2nd edition. 2013
Position Statements:
Artificial Hydration and Nutrition in Advanced Illness
Assuring High Quality in Palliative Care
Legalization of Assisted Suicide
Palliative Sedation
Role of the Nurse when Hastened Death is Requested
The Ethics of Opiate Use Within Palliative Care
The Nurses Role in Advance Care Planning
Withholding and /or withdrawing Life Sustaining Therapies