Palliative care providers face a host of unique recruitment and retention challenges compared to others, with organizations employing diverse strategies to rise above the competition.
Misunderstandings about palliative care can serve as a large barrier to retention, said Wendy Winokur, vice president of Traditions Health Palliative Care, part of Traditions Health LLC.
The nuances of interdisciplinary palliative care delivery must be clearly communicated throughout the hiring and onboarding processes to ensure that staff are fully prepared to navigate the challenges of supporting seriously ill patient populations, Winokur said during the Hospice News ELEVATE conference in Florida. Having staff with a deep knowledge about the emotional, spiritual, psychosocial and physical patient needs addressed in palliative care is crucial, she stated.
“What I found with my own workforce is the importance in that recruitment process of really sitting down and explaining exactly what that nurse practitioner is going to be signing up for,” Winokur told Palliative Care News during the conference. “What are the unique situations that you are in? If you come upon a patient in different settings, you would have all kinds of resources to treat that patient. We have to be a little more creative with our coordination of care. The hardest thing to articulate is the amount of coordination that goes into the care that we provide.”
Hospice News photo by TBAR Productions Hospice News photo by TBAR ProductionsThe interdisciplinary nature of palliative care delivery requires clinicians in this field to have a more diverse skillset compared to others, according to Winokur. Palliative care clinicians need strong capabilities in care coordination and advance care planning, she added.
Primary care providers have historically served as the “gatekeepers” of transitioning a patient’s care, Winokur stated. But palliative care providers have increasingly stepped into the folds of care transitions as a key part of supporting patients’ serious illness trajectories, she added.
Today’s palliative care clinicians need to develop strong communication skills to thrive in the field, according to Winokur. Collaborative care training is an essential part of building a sustainable palliative care workforce and avoiding communication burnout among clinicians, she added.
Micro, macro workforce issues
Insufficient palliative care reimbursement is a common issue curbing stronger recruitment and retention in the field, according to Jennifer O’Neill, national director of palliative care at VITAS Healthcare, a Chemed Corp (NYSE: CHE) subsidiary.
Organizations have long felt the financial strains of launching and sustaining a palliative care program, often turning to a patchwork of payment pathways and philanthropic support. Financial headwinds can at times “dictate what clinical disciplines” a palliative care provider is able to deploy, O’Neill said.
Hospice News photo by TBAR Productions Hospice News photo by TBAR Productions“Significant burnout” is also a challenge among palliative clinicians, O’Neill said during the ELEVATE conference. Palliative care demand soared during the pandemic and left lasting impacts on the ability to retain current and recruit a future clinical workforce, particularly as providers face fierce competition with other health care sectors for increasingly sparse resources, she stated.
The macro-level staffing and funding issues have palliative care providers seeking creative avenues to sustain their services, according to O’Neill. On a larger scale, limitations in palliative clinicians’ career trajectories pose a significant hurdle to improved retention and longevity in the field, she added. Students lack exposure to community-based palliative care during the course of their medical training, which stymies growth of experienced professionals in a field facing rising demand, O’Neill indicated.
“[It’s about] career path and professional development, especially if you’re speaking about nurse practitioners,” O’Neill told Palliative Care News at the conference. “They don’t see a full line of sight into what community-based palliative care looks like to them in terms of a career path, in terms of development or even in a patient setting. Palliative care is largely shifting to the community. I would challenge you to find one community-based palliative care fellowship for a nurse practitioner — it doesn’t exist. These are the kinds of things that are really having a profound impact on the pool that we’re able to hire from.”
The needle is slowly moving toward improved palliative care education among future clinical workforce generations, according to Winokur.
Palliative care programs have increasingly ramped up partnerships with community organizations to increase exposure and boost recruitment during the last decade, Winokur stated. Though demand far outweighs current supply of resources, more educational institutions and local community programs are including palliative care in their curriculum in recent years, she stated.
“All of those points of coordination are completely on the [nurse practitioner (NP)],” Winokur said. “When it comes to interdisciplinary support, I think it’s education, education, education. What we’ve seen in the last 10 years [is] that health care systems, universities and medical schools are becoming more savvy to palliative care and providing some curriculum related to that so that there’s more understanding and people are more apt to come into the profession.”
