Nursing of any kind is popularly thought of as maternal, but whether or not an individual nurse has those comforting instincts doesn’t necessarily make him or her a better nurse. However, there are certainly aspects of nursing in which a nurturing, comforting personality can be essential and one of those specialties is hospice nursing. A hospice nurse practitioner works specifically with patients who have decided upon hospice care due to what is known as a life-limiting illness, though in popular parlance may be called a terminal illness. No one would argue that such a career is an easy one to choose, but those who do thrive in the field are able to find a great deal of reward in this difficult position.
Hospice care is certainly a type of medical care, but it is quite different than standard curative care because treatment provided is not intended to cure or prolong life. Instead, hospice care is a choice available to patients and their families who have been diagnosed with serious illnesses, such as cancer, dementia, or heart failure, that will end their lives within six months. As the National Hospice and Palliative Care Organization states, “hospice provides expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes.”
It is important to note that at times palliative care is used interchangeably with the term hospice, but they are not always the same thing. Palliative care also refers to comforting care and pain management, but may be offered alongside curative care, which is not the case with hospice (Center to Advance Palliative Care, 2012).
Generally speaking, those patients who have chosen to enter hospice care are expected to live no more than six months from the time they enter this phase of their treatment. This means that the majority of hospice patients are adults, and most are older, with more than 80% being older than 65 and just 0.4% being under 34 (NHPCO, 2012). Because of these statistics, it can be very helpful for hospice nurse practitioners to also have some experience working in gerontology, or even to be credentialed as gerontological nurse practitioners.
Hospice care can take place in any environment where curative treatment would take place, including a hospital, the patient’s home, or an assisted living facility. The most important part of hospice care is ensuring the patient is comfortable, which means that in many instances it is the patient, rather than a doctor or a nurse practitioner, who decides where he or she would prefer to spend the last days of his or her life. As of 2011, 66% of all hospice patients received hospice care in their home, which can refer to a private residence (41.6%), a nursing home (18.3%) or a residential facility (6.6%) (NHPCO, 2012). When offering home health care, there are different challenges for nurse practitioners and other caregivers, but in general it can be a very positive experience. Hospice nurse practitioners that serve patients in their home are often able to be more responsive, more flexible in terms of hours, and are able to form better relationships with patients and their families. In some cases, patients will have to be moved from their home to an acute care facility if their home is no longer suitable to provide the necessary palliative care. This may be a on a short term or a long term basis, depending on the circumstances.
As it is with most nurse practitioners, there is no single standard day for a hospice nurse practitioner. While many nurse practitioners work as part of some manner of care team, this team is perhaps even more important for hospice nurse practitioners. A hospice care team may consist of:
Every patient has different needs and wishes, so this list may not be comprehensive. family caregivers are also often a part of the hospice care equation.
On a typical day, a hospice nurse practitioners will work closely with these diverse treatment teams to ensure that patients are comfortable and having their needs met in a way that aligns with their wishes. The majority of hospice patients will take medication for pain, but may be on any other number of medications for various ailments, including their life-limiting illness. Hospice nurse practitioners must assess a patient’s status and ensure that these medications are not interacting in a way that causes discomfort.
Nurse practitioners are an integral part of hospice care because of their unique ability to see the patients from both a nursing and a medical perspective. Their advanced training in nursing, coupled with their foundation in the basic tenets of nursing care, means that they can play an essential role as a liaison between the doctors and nurses on a hospice care team.
One of the key assessments that nurse practitioners handle in the hospice setting is recertifications. Although the majority of hospice patients do die within 29 days of beginning hospice care, this is not true for all patients. Hospice nurse practitioners often take on the duty of assessing patients after 6 months to determine whether or not they still need to receive hospice care, then working with medical directors and physicians to determine a course of action.
Above all, compassion is the most essential skill for any hospice nurse practitioner to have. A life-limiting prognosis can have a major psychological and emotional impact on patients and their families. Every member of a hospice care team must be willing to handle these delicate situations in a professional but compassionate way. This includes assisting family with how to care for the patient as well as coming to a clear understanding of how the patient will progress along with how his or her care will progress over the course of their hospice.
The National Board for Certification of Hospice and Palliative Nurses (NBCHPN) offers certification for hospice and palliative nurses. Applicants for this certification must be either Clinical Nurse Specialists or Nurse Practitioners and have graduated from an accredited palliative nursing program with both didactic and clinical components, and either:
The requirement for certification is certainly not standard across employers. Many positions may only require proof of previous experience in hospice care for employment, but some students do find it worthwhile to pursue this recognized certification.
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