Hospices need a greater understanding of clinicians’ most complex and challenging issues in order to sustain and grow their workforce.

The nation is facing a growing deficit of board-certified hospice and palliative care physicians and nurse practitioners, according to Holly Davis, clinical operations manager of community-based palliative care at Atrium Health Hospice & Palliative Care. More hospices have collaborated with educational institutions to shore up this workforce, but the efforts have fallen far short amid rising demand, she indicated.

The educational issues are having a hidden impact on retention, according to Davis.New clinicians often lack the key skills needed to provide quality end-of-life experiences, resulting in greater distress and potentially higher burnout and turnover, she said during a recent Hospice News ELEVATE podcast.

“We know that there’s not enough of those [clinicians] out there,” Davis told Hospice News during the podcast. “How do we provide training and education to all health care professionals so that they know how to start those difficult conversations about, what are those [patient] goals, what really are the options and what do they want to have happen with disease progression? Those quality-of-life conversations are really important. These are just a few of the things that I feel go under the radar that we may not see on a day-to-day basis.”

North Carolina-based Atrium Health provides hospice, home health and pediatric, palliative and primary care. Part of Advocate Health, the organization also offers behavioral health, rehabilitation services and cancer care services, among other programs.

Atrium Health’s community-based palliative care program serves seven counties in North Carolina.

The program serves patients in the home and in skilled nursing facilities. Among the services provided are pain and symptom management, advanced care planning and goals-of-care discussions.

In addition to her role at Atrium Health Hospice & Palliative Care, Davis serves as chair of the National Alliance for Care at Home’s pediatric workgroup and is a member of its hospice and palliative care councils. She is also the pediatric division chair for the National Coalition for Hospice and Palliative Care.

Hospices are entering a different era of recruitment and retention issues, particularly following medical educational trends that heightened during the COVID-19 pandemic, Davis indicated. The evolving scope of experience and training that new clinicians possess vastly differs compared to previous generations, she said.

“Not only are we looking at vacancies or open positions, but [also] the pool in which you have an appropriate or well-trained candidate can be very narrow or slim,” Davis said. “Now it can take much longer to get an applicant in the candidate pool. It looks very different, and the experience that they’re coming with looks very different.”

Technology-based teaching innovations have increased in the medical space, bringing greater opportunities for remote learning. While online education programs can simulate bedside care delivery, medical students often lack the communication skills and hands-on experience as they enter the workforce, Davis stated. 

Online learning trends increased during the pandemic, resulting in a wave of new clinicians who may need additional mentorship and peer-to-peer training to acclimate to their roles, according to Davis. The trend can mean that open roles are taking longer to fill as patient demand swells.

Retaining the next generation of hospice clinicians will involve more peer-based training, supportive organizational cultures and ongoing opportunities for staff engagement and feedback, she indicated. Hospices will need a deeper bench of strategic educational initiatives to reach medical students further upstream in their learning trajectories, as well as greater oversight to support clinicians within the first few years of entering the workforce, Davis said.

“[It’s] how we prepare for those entering the workforce and looking to make that transition into hospice and palliative care,” she told Hospice News during the podcast. “That first year is really going to be the telltale sign that either they’re going to love it or they’re not. Exposure is important. Greater exposure and understanding really helps engage the next generation.”