Pioneering a Movement in Palliative Care Nursing
When Carmen Carrillo, RN, CHPN, interviewed for a palliative care nurse position in a Southern California hospital system, she had little idea she was about to become part of a new trend in end-of-life care.
“After I heard more about the position, I learned more about the palliative care movement and I wanted to be part of it,” says Carrillo, now a palliative care nurse at Citrus Valley Health Partners.
The goal of this evolution in end-of-life care is to better relieve suffering and promote the best quality of life for people with advanced chronic and life-limiting illnesses. To meet this goal, a growing number of hospitals are establishing palliative care teams trained to meet the physical and emotional needs of terminally ill patients.
The number of hospitals with palliative care programs increased 63 percent from 2000 to 2003, according to researchers from the American Hospital Association and Mount Sinai Medical Center.
“Just given the aging population, we know that there will be a large number of individuals who are going to require end-of-life care, and there is going to be a tremendous demand for this specialty,” says Judy Lentz, RN, MSN, NHA, CEO of the Hospice and Palliative Nurses Association (HPNA).
Helping Patients Navigate Their Options
Before she was hired as a palliative care nurse at Citrus Valley, Carrillo was a hospice nurse with the Visiting Nurse Association in Southern California for eight years. Although both roles have similarities, there are also distinct differences. As a hospice nurse, Carrillo treated patients in their final six months of life in their homes. Since they had already decided to discontinue life-saving treatments, Carrillo’s main job was to manage their pain.
As a palliative care nurse, Carrillo sees patients in their last few years of life when they are hospitalized. They may be in the hospital for a variety of reasons -- to be diagnosed, to receive treatment such as chemotherapy, or for pain and symptom management. Many need help navigating their options as far as how long to continue treatment, whether to choose hospice at some point and how to communicate their wishes to their family.
“Palliative care nurses help patients and families focus on the big picture,” says Patrick Coyne, MSN, APRN, FAAN, BC-PCM, clinical director of Thomas Palliative Care Unit at Virginia Commonwealth University’s Massey Cancer Center. “We help them make goals that are realistic. We may talk about the benefits of treatment versus the burdens it may put on the family. You need to have really good communication skills.”
In addition, palliative care nurses focus on pain and symptom management. They can make recommendations to nurses or physicians if they think a patient would benefit from a change in the dose or type of medication.
Path to Palliative Care
Ideal candidates for palliative care jobs are nurses with backgrounds in hospice, home health, case management or acute care, such as oncology or critical care. They may work in a palliative care unit or as part of a roving team that includes a social worker, chaplain, nurse and physician.
The field is so new that, in most cases, hospitals do not require specific palliative care experience. New hires can be sent to training classes to learn more about topics such as discussing goals and decisions with patients, pain and symptom management and caring for patients in the final hours.
Organizations that provide such training include the HPNA, End-of-Life Nursing Education Consortium and the Center to Advance Palliative Care.
Nurses seeking graduate-level training in palliative care can apply to one of the schools offering a degree or post-master’s certificate in the specialty.
Nurses can also be certified in palliative care by passing an exam given by the National Board for Certification of Hospice and Palliative Nurses. To apply to sit for the exam, applicants must meet several requirements, including a certain amount of palliative care experience. The requirements vary depending on whether the applicant is an advanced practice nurse, an RN, LPN/LVN or nursing assistant.
Comfort at the Very End
Although the palliative care movement is gaining momentum, Coyne acknowledges that pioneering a change in care requires perseverance. When he pitched the idea of creating a palliative care program at his hospital, some questioned the concept. But his diligence has paid off.
“When we started, nobody knew what we did,” he says. “Now we have an administrative system that has embraced what we do. Our message is that we can comfort you when we can’t fix you, because everybody is going to die. I get to be with patients and their families through a hard time, and this is really rewarding.”