Call for Action: Nurses Lead and Transform Palliative Care

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Executive Summary

In January 2016, the American Nurses Association (ANA) and the Hospice and Palliative Nurses Association (HPNA) convened the Palliative and Hospice Nursing Professional Issues Panel (the Panel). The role of the Panel was to: (a) complete an environmental assessment, (b) examine palliative care nursing within today's healthcare system, and (c) identify steps and strategies for nurses to lead and transform palliative care. The Panel focused on identifying a future state for palliative care that promotes health equity and improves access, safety, and quality of palliative care.

The diverse palliative nursing experts on the Steering Committee identified five palliative care focus areas to examine. These areas were (1) practice, (2) education, (3) administration, (4) policy, and (5) research. A larger Advisory Group's contributions informed the work and development of the resultant recommendations for action. The draft Call for Action: Nurses Lead and Transform Palliative Care was broadly disseminated for public comment in September 2016. This examination yielded extensive feedback and excellent recommendations for additional resources and revisions, which were reviewed by the Steering Committee and integrated into the final document as warranted. The Steering Committee completed a final review and deemed the Call for Action ready for final examination and approval by members of ANA and HPNA Boards of Directors.

The conclusion of this Call for Action is that seriously ill and injured patients, families, and communities should receive quality palliative care in all care settings. This is achieved by the delivery of primary palliative nursing by every nurse, regardless of setting. The recommendations that follow support this conclusion.
 

Recommendations

  1. Adopt the End of Life Nursing Education Consortium (ELNEC) curricula (Core, Geriatric, Critical Care, Pediatric, Advanced Practice Registered Nurse [APRN], and Online for Undergraduate Nursing Students) as the standard for primary palliative nursing education for pre-licensure, graduate, doctoral, and continuing education for practicing registered, vocational, and practical nurses and advanced practice registered nurses.
  2. Petition the National Council for State Boards of Nursing to increase palliative care content on the pre-licensure NCLEX-RN and NCLEX-PN exams.
  3. Encourage state boards of nursing with continuing education re-licensure requirements to mandate inclusion of palliative care content.
  4. Advocate the use of the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines for Quality Palliative Care in the development, implementation, and evaluation of specialty, evidence-based palliative care services for all organizations.
  5. Recommend that all specialty nursing organizations review registered nurse (RN) and APRN practice standards to include primary palliative nursing care and develop resources and position papers to support and advance primary palliative nursing.
  6. Fund, develop, and evaluate innovative palliative care models to address workforce challenges and the needs of communities of color, underserved populations, and other vulnerable groups, such as Native Americans, persons with intellectual and developmental disabilities, and others in rural and urban areas.
  7. Convene a thought leader summit to address practice barriers and develop initiatives to implement primary palliative care.
  8. Incorporate primary palliative nursing as part of the American Nurses Credentialing Center Magnet Recognition Program® and Pathway to Excellence Program®, American Association of Critical Care Nurses Beacon Award for Excellence, Academy of Medical-Surgical Nurses Prism Award, and other organizational and unit-based credentialing and recognition programs.
  9. Conduct intervention studies testing strategies to alleviate compassion fatigue and moral distress to maintain a healthy workforce.
  10. Promote equitable reimbursement and reduction of barriers by all payers for RN and APRN services related to palliative and hospice care.
  11. Support the funding and development of palliative care services for communities with limited resources.
  12. Position nurses at decision-making and policy-setting venues, such as healthcare and regulatory boards, to address palliative care needs.
     

Contributors

ANA and HPNA extend a heartfelt thank you to the following persons who committed untold hours of personal and professional attention and thought to the development of this Call for Action:

Palliative and Hospice Professional Issues Panel Steering Committee Members

  • Harleah Buck, PhD, RN, FPCN, FAAN, Co-Chair
  • Mi-Kyung Song, PhD, RN, FAAN, Co-Chair
  • Lisa Albert, MSN, RN, CSN
  • Jason R. Bradley, MSEd, BSN, RN, CCRN, LPC
  • Jeannine M. Brant, PhD, APRN, AOCN, FAAN
  • Anabell Castro Thompson, MSN, RN, ANP-C
  • Patrick J. Coyne, MSN, ACHPN, ACNS-BC, FAAN, FPCN
  • Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN
  • Christine B. DeSantis, DNP, RN, APN
  • Candice J. Earney, MSN, RN-BC, CHPN
  • Patricia S. Fiske, BSN, RN, CT
  • Emily R. Frisch, MPA, RN, OCN
  • Marian Grant, DNP, CRNP, RN ACHPN, FPCN
  • Anne M. Hughes, PhD, FNP-BC, ACHPN, ACRN, FAAN
  • Mary J. Isaacson, PhD, RN, CHPN
  • Karen E. Nagel, BSN, RN
  • Patricia W. Nashimoto, DNS, MPH, RN, FAAN, FT
  • Eileen O’Shea, DNP, APRN, PCNS-BC, CHPPN
  • James C. Pace, PhD, MDiv, RN, FAANP, FAAN
  • Cynthia Wagner, MSN, CRNP, FNP-BC, FNP-BC, AGACNP-BC, ACHPN, CHPCA,
  • Clareen A. Wiencek, PhD, RN, ACNP, ACHPN

Additional Contributors

  • Linda Canonica, DNP, RN, CNE
  • Christine Denhup, PhD, APRN, CPNP
  • Judith Giffi, MSN, RN
  • Melissa Luther, BSN, RN
  • Carol M. Patton, DrPH, FNP-BC, CRNP, CNE
  • Vanessa Williams, MSN, APN-FNP-C
  • Janelle Williamson, NP-C, ACHPN
  • Other Advisory Group members

ANA Facilitators

  • Ruth Francis, MPH, MCHES
  • Carol J. Bickford, PhD, RN-BC, CPHIMS, FHIMSS, FAAN
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