Palliative Care Nursing Curriculum Could Impact Staff Shortages

A program designed to incorporate hospice and palliative care principles into undergraduate and graduate nursing education could help make a difference in ongoing staffing shortages in those fields.

The roots of this curriculum were planted five years ago when a group of hospice and palliative experts convened in Oregon to find strategies for improving and expanding education in their disciplines. A study published this month in the Journal of Continuing Education in Nursing indicated that the program is effective at advancing nursing students’ and graduates’ skills in palliative care, with many graduate participants (52%) indicating that the program had a significant impact on their clinical practice.

“We know there’s a huge gap. We hope that by teaching the nurses palliative care, we can alleviate that gap so that they could take care of patients that have common pain and symptom management issues, those patients with serious illness, or they could have basic conversations in terms of advanced care planning,” said Polly Mazanec, co-author of the study and research associate professor of nursing at Case Western Reserve University. “Then they wouldn’t have to tap into all the resources that are somewhat limited for our specialty providers. We’re hoping not only to get undergraduates excited about maybe going into hospice and palliative care, we’re hoping to prepare graduate nurses, practitioners, and advanced practice nurses to provide primary palliative care and alleviate the shortage that we certainly see is only increasing as the baby boomers age, and we see more and more serious illness.”

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Mazanec helped to develop the curriculum, working closely with Betty Ferrell, currently director and professor in the Division of Nursing Research and Education at City of Hope, a cancer institute in Duarte, Calif. Ferrell is the principal investigator for the End-of-Life Nursing Education Consortium (ELNEC).

Staffing shortages have been weighing heavily on the minds of hospice and palliative care organization leaders in recent years. More than 26% of 300 hospice-provider respondents to a Hospice News/Homecare Homebase survey indicated that staffing would be the greatest challenge hospice providers would face during 2020, compared to 18% who cited increased competition and another 18% who said new payment models were their biggest concern.

The survey was conducted early this year, prior to the COVID-19 pandemic.

The United States has 13.35 hospice and palliative care specialists for every 100,000 adults 65 and older, according to an April 2018 study. The research estimated that by 2040 the patient population will need 10,640 to 24,000 specialists; supply is expected to range between 8,100 and 19,000.

Hospice and palliative care providers also experience shortages in non-physician disciplines, including chaplains, nurses, and social workers. As far back as 2008, the U.S. Centers for Medicare & Medicaid Service (CMS) began allowing hospice providers to use contracted nursing staff because not enough nurses were available to fill permanent positions.

The palliative care curriculum, originally developed using funds from the Cambia Health Foundation, consists of six modules that students can complete online. The modules address communication skills — particularly the often difficult goals of care or end-of-life conversations — as well as pain and symptom management, care in the final days of life, clinician self-care, and other topics essential to understanding palliative care. The program’s content recently underwent an update. Since 2017, nearly 500 learning institutions have used this curriculum. A graduate-level program focused on primary palliative care for advanced practice nurses is currently in development.

“We’re hoping to encourage schools of nursing to use the curriculum — and certainly to recognize the importance of the competencies so that they teach palliative care — and then trying to reach new graduates whose schools may not have offered it, so that they have this training before they enter clinical practice on their own,” Mazanec told Hospice News. “Many have become very interested in hospice and palliative care as their career choice as a result of being exposed to this knowledge and having. Some schools even have sought out hospice programs that would allow [students or graduates] to have at least a clinical day or two, to be exposed to hospice care and get them excited about considering that wonderful profession.”

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