Day in the Life of a Hospice & Palliative Care NP: Two Experts Share Their Perspectives

The Role of Hospice & Palliative Care NPs

Palliative care can take place in both inpatient and outpatient settings. In inpatient settings, palliative care NPs generally work as part of a collaborative team that can include physicians, nurses, social workers, and spiritual care advisors. This team assists patients who are often at a crossroads in their illness journey, and helps them set goals and secure treatments that meet those goals.

“When a patient is diagnosed with cancer, they might be given radiation and chemotherapy, which can have serious side effects like fatigue, nausea, pain, and decreased appetite,” Dr. Rausch says. “While an oncologist is adept at treating the cancer, they’re not always as focused on treating the symptoms. In a perfect world, that patient should also get a referral to a palliative care specialist to help manage those symptoms, so they could have a better quality of life. If your symptoms are managed better, you’re able to heal better. That’s palliative care.”

While patient encounters in inpatient palliative care may be episodic and brief, outpatient palliative care (which can include hospice care) is very hands-on, and often occurs over a longer period of time. Especially in community-based settings, palliative care teams can be led by hospice and palliative care NPs who work with social workers and other clinicians as needed.

“Particularly when you get into the communities and rural areas where there aren’t a lot of physicians, that’s where NPs can really shine,” Dahlin says.

“Just by our training as NPs, I feel that we are very well-suited for this specialty,” Dr. Rausch says. “Palliative care and hospice care are still not widely available or widely known about, but NPs can really help broaden the field and be good patient advocates for greater accessibility.”

Life as a Hospice & Palliative Care NP

Palliative care, and especially hospice care, can involve some difficult decisions and challenging conversations. Hospice and palliative care NPs are well-suited for this: nursing has been ranked as the most trusted profession in America for 19 years in a row, and NPs who specialize in this field are experts in guiding patients to the goals and decisions that are best for them.

“In the United States there’s still this vision that death is optional,” Dahlin says. “But no matter what our politics are, we are born into this world and we will leave it. The question then is what does that path look like?”

“One of the biggest jobs as a palliative care NP is to talk about goals of care, and to really listen to what the patients want,” Dr. Rausch says. “When I first meet a patient, I tell them that this is their journey, and they’re driving, and I’m just along for the ride. I’m with them to the end, and they can dictate how we go, and how we get there.”

Hospice and palliative care NPs need to have sharp clinical skills, but they also need to be adept at managing personal relationships: they’ll interact not only with patients but with their family members, too.

“It really can be a lot of fun, stepping into a relationship with a patient and family that you don’t know,” Dahlin says. “You’re stepping into the middle of a play, and all this stuff is happening. You have to figure out the cast of characters, their roles, and frameworks. You start to color stuff in and determine how the pieces come together according to what they want, and not what we as NPs may want for them.”

The Future for Hospice & Palliative Care NPs

As the Baby Boomer generation ages, there will be an even greater need for hospice and palliative care NPs. While Baby Boomers have a longer life expectancy than previous generations, they also have higher rates of chronic disease and lower self-rated health than past generations.

“There’s definitely a shortage of palliative care and hospice providers,” Dr. Rausch says. “But Baby Boomers are more educated in terms of what’s available to them for healthcare. They’re savvier and they know that there are different options. They ask tough questions and push the envelope. I think that’s good for hospice and palliative care.”

In 2021, the American Association of Colleges of Nursing (AACN) released the latest version of its core competencies for professional nursing education. The new core competencies are split into four spheres of care, and one of those spheres is hospice and palliative care. While it will take some time to go into full effect, it means that graduate-level NP preparation programs are now mandated to include content on hospice and palliative care.

“There is truly a fine art to end-of-life care and palliative care,” Dr. Rausch says. “I think that people are starting to see that those who are dying deserve more than just hand-holding and that there is a real science to it. There’s a lot more research that’s shining a light on our field, and that’s exciting to me.”

Hospice and palliative care are challenging in uniquely human ways. NPs who work in this area have to be comfortable having conversations that others find frightening; they have to be both hopeful and rational when others feel dejected and emotional; and they have to make personal connections while also maintaining professional boundaries. But for Dahlin and Dr. Rausch, those challenges are part of what makes the job so rewarding.

“It’s just fascinating,” Dahlin says. “It’s never boring. It’s going deep pretty quickly and having conversations with patients that you may never even have with close friends. At the end of the day, I’m tired because I’ve been deeply emotionally engaged with people. I’m not just doing blood pressure checks or diabetes checks, but it’s incredibly rewarding.”

“I know what my job is and I know that my patients are not going to live forever,” Dr. Rausch says. “But I go in knowing that I have a very special place in their life and I feel blessed to be able to go into people’s homes and to share their life and their stories. It’s very personal. It’s an amazing thing to be involved in.”