The Palliative Care Resource Nurses Pilot Survey: A Descriptive Report of Their Primary Palliative Care Role and Educational Needs

Dear Editor:

Despite the stated preference to die at home, 27% of adults 65 years and older still die in the hospital, ¹ often while undergoing treatment for advanced chronic diseases. Palliative care programs, which aim to provide high-quality, well-coordinated care for patients with serious illness, have been implemented in most large hospitals in the United States, ² but, to date, there is a shortage of palliative care specialists to care for eligible patients. ³ Thus, to extend palliative care resources, all clinicians should receive training in primary palliative care, ⁴ which helps patients manage common symptoms, establish value-based treatment decisions, and complete advance care planning during a time of serious illness. In response to this rapidly growing need for palliative care specialists, our hospital has given select nurses advanced training and a new title—the Palliative Care Resource Nurse (PCRN)—who functions as a unit-based advocate for patients with serious illness and their families. To find out how PCRNs view their nursing role, the specific skills they use to advance palliative care in the hospital setting, and their needs for continuing education/training in palliative care, we sent an anonymous online survey with choice-based quantifiable questions and free-response open-ended questions to 45 PCRNs in a large academic medical center. Eleven PCRNs completed the survey (24%); respondents were mostly women (81.8%), who were white (81.8%), 35.5 years of age (SD 9.4), and who had received some palliative care education (50%), such as an End of Life Nursing Education Consortium course. Most respondents had been a PCRN for two years and worked on a medical-surgical floor or in the intensive care unit. Overall, we found that PCRNs viewed their role as a way to advocate for patients and families by discussing goals of care, initiating comfort care, and helping patients complete advance directives and do not resuscitate orders. In addition, respondents stated that their biggest obstacle was a lack of time to perform their palliative care duties because of workload and carrying standard patient assignments. Respondents also revealed that the major barriers to palliative care consults were a lack of understanding of palliative care by both patients and providers, and a treatment-focused plan of care until death was imminent. Finally, they stated their most important educational needs were communication training and specialty certification for palliative care. Several PCRNs expressed the desire to become a certified hospice and palliative nurse, but were concerned about the time required to prepare for the certification examination and the prohibitive costs of certification. Limitations of this survey include the low response rate and, because the PCRN role is unique to our academic medical center, a lack of generalizability of the findings. Despite these limitations, we believe that the results provide direction on how primary palliative care nursing can be extended using PCRNs and highlight the need to provide financial incentives for nurses so that they can pursue specialty certification and communication training in palliative care.