The Integral Role of Nurses on a Hospital-Based Palliative Care Team

1. The Integral Role of Nurses on a Hospital-Based Palliative Care Team Speakers: Judy Lentz, RN, MSN, NHA Lyn Ceronsky, MS, APRN, BC Patrick J. Coyne, MSN, APRN, BC Sandra Muchka, RN, MS, APNP Sharol Herr, RN, MSEd, CHPN Sponsored by: The Center to Advance Palliative Care (CAPC)The Hospice and Palliative Nurses Association (HPNA) www.capc.orgwww.hpna.org

2. Presenter: Judy Lentz, RN, MSN, NHA Chief Executive Officer Hospice and Palliative Nurses Association One Penn Center West . Suite 229 . Pittsburgh, PA 15276-0100 . 412.787.9301 . www.hpna.org

3. Professional Development • C.E. teleconferences • Bimonthly professional journal • Resources and references • Networking • Local chapters • Special interest groups • Annual conferences • Recognition • Annual awards • Representation • Public policy • Board/committee participation www.hpna.org

4. Unique Nursing Specialty Certifications • Benefits • Enhances knowledge and skills • Validates competency • Recognizes professional commitment • Distinguishes the practitioner • Eligibility • APN • RN • LP/VN • NA • Administration • Twice a year www.nbchpn.org

5. Awards • Research • Professional writing • Poetry • Scholarships • Education • Certification • Grants • Chapter(s) • Individual(s) • Fellowship • Support for Foundation www.hpna.org/hpnf_home.asp All images courtesy of The John A. Hartford Foundation Institute for Geriatric Nursing, New York University, Steinhardt School of Education, Division of Nursing. Photography by James Schuck.

6. Presenter: Judy Lentz, RN, MSN, NHA Chief Executive Officer Hospice and Palliative Nurses Association One Penn Center West . Suite 229 . Pittsburgh, PA 15276-0100 . 412.787.9301 . www.hpna.org

7. The Role of the Advanced Practice Nurse in Palliative Care Patrick J. Coyne, MSN, APRN, FAAN Thomas Palliative Care Services of Massey Cancer Center at Virginia Commonwealth University Richmond VA.

8. The Evolution of the APN in Palliative Care Role is extremely varied depending on settings Requires highly evolved clinical and communication skills

9. The Signs of the Movement ELNEC course for APN’s Certification exams for APN in Palliative Care Job postings clearly increasing for these roles

10. Roles for APN’s • Education Staff development (not just nurses) Orientation Continuing education In services Community forums Authoring publications

11. Roles for APN’s (cont) • Research in palliative care is extremely limited, but opportunities exist. These can include insuring evidence based practice; initiating data bases, conducting research, developing quality assurance standards any many more interventions.

12. Roles for APN’s (cont) • Management Foster and develop appropriate clinical guidelines. Insuring appropriate staff competency Insuring that barriers to care in this population are addressed. Economic management of limited resources.

13. Roles for APN’s (cont) • Leadership Involves risk taking , advocacy and energy. This individual may (probably) will be the hub of any palliative care team. These activities may be extremely varied such as: legislative action, team development, role development within an institution and beyond.

14. Roles for APN’s (cont) • Consultation, typically the largest role. This can occur in a variety of settings. The role may include medication management, determining and obtaining appropriate information and referrals, patient/family support, conducting family and team meetings

15. APN’s as a further Resource Cost saving may be realized by institute. Compliance with mandates (i.e.. JCAHO) Improved pt/family satisfaction Improved satisfaction of other HCP’s

16. Issues facing APN’s Billing issues Role not yet embraced by many hospices Limited numbers of trained APN’s presently exist in palliative care.

17. My Role ref Coyne, P., J., "Evolution of the Advanced Practice Nurse within Palliative Care." Journal of Palliative Medicine. Vol. 6 No. 5, 2003, pp.767-768.

18. The Role of Nurses as Administrators in Palliative Care Lyn Ceronsky, MS, APRN System Director, Transitions and Life Choices Fairview Health Services Minneapolis, MN

19. Palliative Care Program:Administration • Nursing leadership in program development is critical • Nurses bring knowledge of clinical aspect and hospital operations • Administrative role may be part of a clinical role or a specific focus • Activities are dependent on resources in your setting

20. Accountabilities Lead program development Articulate the clinical case Develop strategic and business plans Design process and tools for inpatient team/unit Participate in staffing, marketing, identification of resources Develop systems to support coordination of care

21. Accountabilities Determine clinical and financial outcomes Select indicators Design data collection and analysis Develop communication process Dashboard Audience Link with local and national benchmarks and initiatives

22. Accountabilities Support clinical staff Problem solving Self care Continuing education Support for organization’s employees Develop grief resources Palliative care employee benefit

23. Innovation Recognize need for expanded services Inpatient unit Home care and hospice service capacity Outpatient clinic

24. Promotion of Palliative Care Work with philanthropy professionals Articulate the need Tell stories Nursing and interdisciplinary research Represent palliative care to community Advocate for education for health care professionals

25. The Role of the Palliative Care Nurse on a Physician-Led Program Sandra Muchka, RN, MS, APNP Clinical Nurse Specialist in Palliative Care Palliative Care Center Medical College of Wisconsin Milwaukee, WI

26. Nurse’s Role • Initial chart review • Interview with nursing/medical staff • Initial patient/family interview • Collaborative case planning with MD • Coordinate symptom management • Triage for ancillary services

27. Nurse’s Role (cont) • Case management • Psychological support to patient/family • Provide continuity of care across care sites

28. MD Role • Initial discussion of issues with medical team • Patient interview and exam • Communication with primary MD • Oversight of symptom management • Leadership for family meetings, when needed

29. MD Role (cont) • Prognostication • Collaborative case management with PC nurse

30. Working as a Team • PC Team communication/ Daily rounds • RN-to-MD communication • MD-to-MD communication

31. Education Opportunities inPalliative Care A Nursing Perspective Sharol Herr, RN, MSEd., CHPN Palliative Nurse Clinician & Education Coordinator Mt. Carmel Health System Columbus, OH

32. Perform EducationalNeeds Assessment

33. Establish Education Goals • Communicate with stakeholders • Provide resources and education to prepare direct care staff as care givers • Contribute to the organization’s quality and performance improvement initiatives • Establish a mechanism to support education of students and provide clinical experience

34. Routine Processes & Tools • Interdisciplinary team meeting & rounds • Team member roles & responsibilities • Clinical instrument • Routine orders & protocols • Establishing a palliative plan of care • On-call response of physician and team • How to make a referral/consult

35. Integrate Evidenced Based Practice • Core competencies • Bench marking data • Algorithms

36. Develop EducationTimeline • Start-up needs • Ongoing training • Mentoring and staff development • Certification • Integrate initiatives with system education

37. Palliative Education Resources

38. Texts • Oxford Textbook of Palliative Medicine, 3rd Ed 2004; Oxford (UK);2004 • Textbook of Palliative Nursing, Oxford 2001 • Principles and Practice of Palliative Care and Supportive Oncology; 2nd Ed, Lippincott; 2002 • End-of-Life Care: Clinical Practice Guidelines. WB Saunders; 2002

39. Journals • J Palliative Medicine (US); Official Journal of AAHPM • J Pain and Symptom Management (US) • American J of Hospice and Palliative Care (US) • Palliative and Supportive Care (US) • J of Pain and Palliative Care Pharmacotherapy (US)

40. Web Links • EPERC (End of Life/Palliative Education Resource Center). www.eperc.mcw.edu • Searchable database of ed. materials, articles, books, videos, web links, etc. • ELNEC (End of Life Nursing Education Consortium). www.aacn.nche.edu/elnec • Comprehensive, national education program to improve end-of-life care by nurses.

41. Web Links • Hospice and Palliative Care Nurses Association (HPNA) • www.hpna.org • City of Hope Pain/Palliative Care Resource Center. http://prc.coh.org • Clearinghouse for palliative care resources for individuals and institutions

42. Certification Resources • National Board for Certification of Hospice and Palliative Nurses (NBCHPN) • www.nbchpn.org • American Academy for Hospice and Palliative Medicine (AAHPM) • www.aahpm.org

43. Web Links • CAPC (Center to Advance Palliative Care) Tools. • Tools to assist in designing, strengthening, maintaining and defending Palliative Care programs .

44. Train at a Palliative Care Leadership Center • 2 days of intensive, hands-on training tailored to your own institution • Full year of mentoring • Train at any one of six Leadership Centers • An initiative of CAPC and RWJF • CME credits available • Nursing Accreditation Pending

45. Palliative Care Leadership Center Curriculum • Module 1: Systems Assessment & Mission Alignment • Module 2: Clinical Models & Staffing • Module 3: Financial Case & Sustainability • Module 4: Measurement • Module 5: Internal Marketing • Module 6: Community Partnerships • Module 7: Palliative Care Education • Module 8: Program Implementation To apply for training, visit www.capc.org