What Does a Palliative Nurse Practitioner Do?

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palliative nursePalliative nurse practitioners are advanced practice nurses who treat patients with life threatening illnesses. They assess patient needs and diagnose health challenges. Palliative care nurse practitioners are skilled clinicians who are knowledgeable about a wide range of medical conditions. They provide emotional support to patients and family members facing devastating diagnoses. 

Palliative care nurse practitioners provide primary care services to patients who have terminal diagnoses. They work in a variety of settings. Palliative care nurse practitioners provide services in hospitals, medical offices, patient homes and, inpatient hospice facilities. They assess, and treat symptoms to promoting maximum level of wellness and independence for patients with terminal illnesses. They prescribe medications within the scope of practice for their jurisdiction. Specific roles vary with jurisdiction and workplace setting.

The majority of palliative care nurse practitioners work with adults. While palliative nurse practitioners may use their expertise to care for patients of all ages, they most commonly treat older adults and geriatric patients.

Medical illnesses that are commonly encountered by palliative care nurse practitioners include: cancer, advanced heart disease, neurological disorders and dementia. Palliative care nurse practitioners also encounter patients suffering from advanced liver, kidney, respiratory illnesses and serious injuries on a regular basis.

Palliative nurse practitioners develop treatment plans to relieve pain, nausea, and difficulty breathing. They treat people with seizures and serious wounds. Palliative care nurse practitioners arrange for comfort measures such as palliative radiation and palliative chemotherapy which are used to reduce pain and distress of patients with cancer. They employ multifaceted treatment plans which include mind, body, and spiritual interventions.

Palliative care nurse practitioners are advanced practice registered nurses who complete specialized course work at the Master’s or Doctoral degree level.  A proposal has been made which would require future a Doctorate of Nursing degree as the minimal entry level for nurse practitioners by 2015. Individual state governments must make rulings prior to that proposal being adopted.

Palliative care nurse practitioners order referrals for medical services, treatments, and diagnostic tests.  They prescribe diets, exercises, and therapies for patients suffering from serious illnesses.  Medication prescribing capacities vary depending upon individual state rules. In some jurisdictions, palliative care nurse practitioners have the option to work independently. However, in most areas palliative care nurse practitioners work collaboratively with physicians.

Palliative care nurse practitioners are certified by the National Board for Certification of Hospice and Palliative Nurses. Educational preparation to become certified as a Palliative Nurse Practitioner requires that the advanced practice nurse be a clinical nurse specialist or possess a nurse practitioner license in the state that he or she seeks certification in. A minimum of 500 hours of supervised masters or post masters clinical practice in palliative care must be documented prior to sitting for the certification exam

The Certification Examination for Hospice and Palliative Advanced Practice Registered Nurses consists of 175 questions, of which 150 are scored. It is a multiple choice test. Three and one half hours are allotted for taking the exam.

The certification exam addresses multiple areas that palliative care advanced practice nurses must be expert at. Areas include: clinical expertise, scientific knowledge, evidenced based practice, education, and communication skills. Professional issues such scope of practice, resource utilization, and ethics are tested.

Requirements for renewal of certification are obtained by providing proof of clinical hours and taking continuing education classes. 

Palliative care focuses on aiding patients with life threatening illnesses. Unlike hospice services , which are provided only when a patient has a life expectancy of six months or less, palliative care nurse  practitioners aid patients with life threatening illnesses from the time that they are diagnosed.

Palliative care nurse practitioners may make home visits to patients who are too ill to go to an office visit or serve as primary care providers within the community. They see patients in hospitals and specialized centers such as cancer clinics.

Palliative care nurse practitioners use the nursing process to assess, diagnose, plan, provide and evaluate care. They formulate and prioritize differential diagnoses of patients who have serious illnesses. Palliative care nurses actively determine patient prognosis and provide and address issues of grief of patients and families.

Palliative nurse practitioners conduct comprehensive physical examinations. They serve as patient and family advocates.  Palliative nurse practitioners advocate for health care changes which have potential to improve quality of life for terminally ill people.

In addition to advocating for individual patients, palliative nurse practitioners may be active within organizational and political arenas affecting health care policy change. Palliative nurse practitioners are part of multidisciplinary health care teams. They collaborate with other professionals and community members to ensure optimal wellness and comfort for patients.  

  • Hospice and Palliative Nurses Association (www.hpna.org)
  • National Board for Certification of Hospice and Palliative Nurses (www.nbchpn.org)
  • Center for Advance Palliative Care (www.capc.org)

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