The Role of the Nurse in Palliative Care

What is Palliative Care?

Palliative care is the medical specialty focused on people living with serious illnesses and providing relief from the symptoms and stress of a serious illness.

The goal of palliative care is to improve the quality of life for both the patient and the family, and is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Palliative care is appropriate for anyone suffering from a serious illness, such as:¹

• Cancer
• Cardiac disease
• Respiratory disease
• Kidney failure
• Alzheimer’s
• AIDS
• Amyotrophic lateral sclerosis (ALS)

Palliative care to patients can be initiated from the point of diagnosis and is not dependent on prognosis.

Nurses who work in palliative care are specially trained to deal with complex pain and symptoms, as well as communication about serious illness and treatment plans, supporting the patient in areas of:

• Pain
• Depression
• Anxiety
• Fatigue
• Shortness of breath
• Constipation
• Nausea
• Loss of appetite
• Difficulty sleeping

Nurses who work in palliative care work to improve a patient’s ability to tolerate medical treatments and allow the patient to have more control over their care by improving their understanding of treatment options and matching their goals to those options.  The Palliative Care Nurse also helps support family caregivers and provides practical support.

Training for Palliative Care Nursing

Palliative Care Nurses work in collaboration with other health providers, such as physicians, social workers, and chaplains, within the context of an interdisciplinary team.

Composed of highly qualified, specially trained professionals and volunteers, the team blends their strengths together to treat a variety of symptoms. Palliative care may be part of lifelong treatment, or it may be short-term in the case of a terminal illness.

In this instance, the care team will anticipate and meet the needs of the patient and family facing terminal illness and bereavement, which is why palliative care and hospice, or end-of-life care, often get grouped together.

Palliative Care Nurses can play a role in end-of-life care. To accomplish this, nurses collaborate in a cultural assessment of the patient and family and provide culturally sensitive care.

Although the majority of Palliative Care Nurses are “generalists,” some elect to sub-specialize in areas of oncology, pediatrics, or geriatrics and pursue advanced practice credentialing. Certification for nurses practicing in palliative care as a Certified Hospice and Palliative Nurse (CHPN) has been available since 1999, following the initial development of the Certified Nurse Hospice (CRNH) in 1994.

There is a distinct body of knowledge with direct application to the practice of palliative care nursing. In addition, there are particular career traits that are valuable in a palliative care nurse. This includes:

• Pain and symptom management
• End-stage disease processes
• Psychosocial
• Spiritual and culturally sensitive care of patients and their families
• Interdisciplinary collaborative practice
• Loss and grief issues
• Patient education and advocacy
• Bereavement care
• Ethical and legal considerations
• Communication skills
• Ability to handle stress
• Compassion and empathy
• Awareness of community resources

Palliative Care Nurses are registered nurses prepared at the associate degree, baccalaureate degree, and/or master’s-degree level. This can take 2 to 4 years, or longer. Let’s dive a little deeper into what a palliative care nurse actually does.

What Does a Palliative Nurses Do?

Palliative care nurses provide a wide range of general nursing tasks for patients. This can be either short-term or long-term care for critically ill individuals.

What a patient can receive from a palliative care nurse include:

Medication Administration

Under a doctor’s prescription, nurses give patients some medications. Medication dosages and delivery techniques, such as syringes or oral medications, call for a thorough understanding.

General Care

In addition to checking and documenting vital signs, nurses also provide basic care such as maintaining patient hygiene, helping patients with daily tasks like getting dressed or eating, and reporting to the patient’s primary care physician.

Offer Comfort

Nurses are able to provide a professional form of support and comfort. They can listen to the patient’s worries and concerns, help explain the patient’s condition or symptoms, and communicate with the patient’s family.

File Necessary Paperwork

Medical paperwork and documentation that patients may need assistance with include medical documents, prescriptions, and all physician orders.

Keep Families and Patient Informed

Nurses must keep a close relationship with the patient’s family and inform them of any changes in their health, their illness trajectory, along with existing treatment plans and care. Palliative nurses must also be available and knowledgeable regarding any questions the family may have.

Assist in Pain Releif

The ultimate goal is comfort and pain management for these patients. Nurses must carefully monitor pain levels and offer solutions to avoid discomfort. This can include physical pain, nausea, bed sores, anxiety, and difficulty breathing.

Where Do Palliative Nurses Typically Work?

There are three main locations where a palliative care nurse will typically work. That includes:

1. Home Care
2. Hospice
3. Hospital

Palliative Home Care

Private home palliative care nurses visit patients at their homes or temporarily occupy them to offer one-on-one care. Patient care may include administering medication, general nursing care, developing treatment plans, and more. Additional duties, such as meal preparation or simple daily tasks like taking out the garbage, may also be included.

Hospice Palliative Care

Hospice settings are intended for end-of-life care for patients that typically have 6 months or less to live. Therefore, nurses are not offering curative care and treatments. Instead, the high quality of care is intended to make patients with life expectancy of less than 6 months as comfortable and relaxed as possible and address emotional needs.

Palliative Nurse Care at Hospitals

These nurses work together with doctors, other nurses, and healthcare professionals as a part of the hospital’s medical team to offer curative treatment to seriously ill patients and comfort and support to terminally ill patients. This can be a long-term or acute care setting.

How Much do Palliative Nurses Make?

With the increasingly aging Baby Boomer generation, the need for palliative nurses is growing each year. This provides an excellent outlook for RNs looking to pursue palliative care services.

As of 2023, the average salary for an RN in the United States is about $93,500.

Stress on the Palliative Care Nurse

In general, nursing is recognized as an occupation that is associated with stress on both professional and personal levels.

Because of the nature of their patient’s advanced needs, health care providers may experience stressful situations related to death and dying—though they do not experience it as often as Hospice Care Nurses. However, the nursing literature suggests that stress and its effects can be moderated in these nurses through personal coping strategies and social support.⁴

In general, it has been found that the levels of stress and distress experienced by Palliative Care Nurses were no greater than those experienced by nurses from other specialties. In addition, nurses must stay updated on palliative care education.

Palliative Care Nurses who are well-trained and experienced may be at less risk of psychological distress and burnout than other nurses, because they may better utilize self-care strategies to reduce work-related stress which they have also taught to their patients and their families.

Because of the advanced training and experience required for Palliative Care Nursing, both clinical nursing skills and relationships with patients were seen as important, and these relationships has been found to reduce nurses’ experiences of stress.

Given the breadth of skills required to perform in this role, well-prepared Palliative Care Nurses may have ways of coping with the stress of their work environment that mitigate their stress levels.⁵  

One of the most common stress-reduction strategies used by Palliative Care Nurses includes informal gatherings of staff and weekly meetings that featured reflective discussions to help nurses in their professional development, allowing for both interaction of what they are dealing with and someone who understands can listen, advise, and console.⁶

Benefits of Palliative Care Nursing

In addition to the comfort, care, and support that the Palliative Care Nurse offers to a patient and his or her family, there are several health and economic benefits that have been found when Palliative Care is undertaken by a patient:

• Lung cancer patients receiving early palliative care had less depression, improved quality of life and survived 2.7 months longer⁷
• Patients with a Palliative Care Nurse demonstrated significant reductions in pharmacy, laboratory, and intensive care unit costs⁸
• Patients who died under Palliative Care Nursing Support for a specific illness have a cost savings of $4,908 per hospital admission when compared to patients for these same illnesses who did not receive Palliative Care Nursing support⁹
• Palliative care patients who were discharged alive had a net savings of $1,696 per admission, in comparison to matched cohorts of comparable patients who received usual care¹⁰

The Need for the Palliative Care Nurse

Palliative care is a model that is consistent with basic nursing values, which include caring for patients and their families regardless of their age, culture, socioeconomic status, or diagnoses, and engaging in caring relationships that transcend time, location, and circumstances.

Palliative Care Nurses address the complexity of patient and family needs and serve as cost-effective medical care coordinators for patients and families with both chronic and life-limiting illnesses, to reduce suffering and improve the quality of living and dying across the lifespan.¹¹

If you are looking for a private duty nurse for palliative care for yourself or a loved one, click here to learn more. Or, call (650) 462-1001 to speak with a Client Care Coordinator.

Want to Work with NurseRegistry in Palliative Care?

If you are an RN or LVN looking for opportunities in palliative care, apply online by clicking below.

References

¹ Meier, Diane, “Palliative Care Frequently Asked Questions,” Center To Advance Palliative Care, 2014.

² “Hospice/Palliative Care Nurses,” Nurses for a Healthier Tomorrow, 2016.

³ Flanagan NA, Flanagan TJ, “An analysis of the relationship between job satisfaction and job stress in correctional nurses,” Research in Nursing and Health, 2002, Volume 25, Issue 4, pp. 282–94.

⁴ Lim, J, “Stress and Coping in Australian Nurses: A Systematic Review,” International Nurse Review, Volume 57, Issue 1, pp. 22-31.

⁵ Barnard A, Hollingum C, Hartfiel B, “Going on a Journey: Understanding Palliative Care Nursing,” International Journal of Palliative Nursing, 2006, Volume 12, Number 1, pp. 6-12.

⁶McNamara, B., “Threats to the Good Death: The Cultural Context of Stress and Coping in Hospice Nurses,” Sociology of Health & Illness Journal, 1995, Volume 17, Number 2, pp. 222-244.

⁷ Meier, Diane, “CAPC Facts and Figures,” Center To Advance Palliative Care, 2014.

^8-10 Morrison, R. S., and Meier, D. E., “Clinical practice: Palliative Care,” New England Journal of Medicine, 2004, Volume 350, Issue 25, pp.2582-2590.

¹¹ Prevost, S., “Palliative and End-of-Life Care Transformation Models of Nursing Across Settings,” The Future of Nursing: Leading Change, Advancing Health, 2011, National Academies Press.