The Nurse Practitioner Role in Palliative Care

The Nurse Practitioner Role in Palliative Care

Ethan Perkins, MSN, AGACNP-BC, CCRN Ethan Perkins, MSN, AGACNP-BC, CCRN
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Most people have heard of palliative care, but do they fully understand all it entails? Helen Kennedy RN, FNP-BC, MS, ACHPN is a nurse practitioner at a large academic medical center in California, and she has offered to answer some of our burning questions. Helen works on the palliative care consult service where she provides clinical expertise to adult in-patient palliative care patients and their families. She further works in collaboration with a multidisciplinary team to provide advanced palliative care and education to patients and families experiencing life-limiting conditions. In her current role, she also acts as a resource person by providing education to residents, fellows, health care providers, and nursing staff. Prior to her current role on the palliative care team, she was a nurse practitioner and faculty member at an affiliated pain management clinic. Here’s what she had to share!

Could you please describe your role and responsibilities as a Nurse Practitioner for the Palliative Care Consult Service? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?

"As a nurse practitioner on the palliative care consult service, I assess, evaluate, and manage adult patients with various life limiting conditions including cancer, dementia, heart failure, kidney disease, COPD, and polytrauma. Important aspects of my role include aggressive symptom management to promote comfort/quality of life in addition to having goals of care discussions with patients and families to ensure their treatment choices reflect their wishes. The role of the palliative care NP definitely requires advanced communication skills!

Palliative care is a unique discipline that is provided in an interdisciplinary manner utilizing a team approach; thusly, I work in collaboration with other palliative team members including physicians, social workers, chaplains, and pharmacists. I also collaborate closely with various other health care team members including physical/occupational therapists, dieticians, speech therapists, and case managers to deliver optimal palliative care addressing patients’ and families’ physical, social, spiritual, and emotional needs.

Our palliative care consult service meets as a team twice weekly to review patient’s care needs and management plans. We provide consultative services to medical and surgical primary teams in our 600+ bed Level 1 trauma center, assisting in the management of patients requiring complex decision-making and management of refractory symptoms interfering with patients’ quality of life. Our team is also involved in goals of care discussions and advanced care planning with patients and families. As medical care has become more advanced and patients/family’s needs more complex, the role of palliative care has grown significantly. This growth has occurred because palliative care focuses on providing quality compassionate care for people facing life-limiting illnesses through expert medical care, pain management, and emotional/spiritual support expressly tailored to the patient’s unique needs and wishes."

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You also worked as a Nurse Practitioner in a private Pain Management Center. Could you please explain what your daily and long-term responsibilities were in this role?

"My prior role was very similar at Midwest Pain Management Center; however, it was a private clinic as opposed to an academic setting. The major difference between the settings was volume of patients seen and lack of learners (fellows and residents) in private practice. In this practice, I worked with six different anesthesiologists in addition to several nurses and another nurse practitioner. It was an extremely busy practice with a very dedicated, hard-working support staff which prepared me very well for my transition to the academic setting!"

Why did you decide to work in palliative care and pain management, and what academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?

"When I retrospectively look back upon my career pathway, it appears that my journey into palliative care was almost predestined! I was working in a hospital PACU as an RN, which led me to consider the pain management field. The anesthesiologists I worked with in PACU were doing nerve blocks for pain control and the pain management field was really growing at this time. I ended up working in pain management for 10+ years and was encouraged to continue my studies to become an NP by co-workers. My experiences working in pain management provided a smooth transition into palliative care. I found working with the cancer patient population especially rewarding and I also happened to have a close family member enter hospice at this time. I was greatly impressed with the overall philosophy of hospice care and its patient/family-centered focus. I felt drawn to palliative care and made the conscious decision to spend the rest of my career as a palliative care advanced practice nurse. I was very fortunate to be offered a NP position assisting with development of the palliative care consult service at my medical center approximately 7 years ago and have had the pleasure of seeing the service grow exponentially! I pursued certification as an Advanced Practice hospice and palliative nurse after I had accumulated the required clinical hours as I wanted to maximize my knowledge base and practice scope.

I truly believe that palliative care is an area where advanced practice nurses can thrive based upon their acquired skill set and training to provide total patient care focusing on mind, body and soul. I believe the terms nursing and palliative care are virtually synonymous! It is possible to find Acute Care NPs, FNPs, Pediatric NPs, and Geriatric NPs in the palliative care field depending upon the population served."

For current and prospective MSN students who are interested in working in palliative care nursing, what advice can you give them about optimally preparing for these fields while pursuing their degree?

"For the MSN student considering either the FNP or palliative care specialty, I whole-heartedly recommend seeking out potential mentors and experts in your desired field. Speak to these mentors and experts in depth about their roles and responsibilities to see if it aligns with your professional vision. Seek out as many educational opportunities as possible in your areas of interest. If hospice and palliative care is your desired area, I would also recommend volunteering for a hospice agency for further exposure and insight into this specialized field. Most importantly, follow your area of passion!"

About the Author:

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Ethan Perkins, MSN, AGACNP-BC, CCRN is a board-certified Adult/Gerontology Acute Care Nurse Practitioner. A Georgia native, he obtained his undergraduate degree from The University of Georgia before pursuing two graduate nursing degrees at Emory University in Atlanta. Ethan began his clinical career primarily working in pulmonology and critical care medicine. During this time, he developed a passion for patients with complex, often terminal illnesses and further focused his clinical expertise by practicing as a palliative and supportive care consultant. Ethan is an adjunct professor/lecturer at several Georgia universities and has also served in healthcare leadership and administration positions. In his free time, Ethan plays in a competitive tennis league and enjoys spending quality time with his two young daughters, Eden and Georgia.

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