Exploring and clarifying the role of the nurse on the specialty palliative care team

Abstract

Palliative care interdisciplinary teams seek to relieve the pain, stress, and suffering associated with terminal illness. The medical specialty is relatively new, and rapidly developing to attempt to meet the needs of an estimated 6 million Americans coping with a serious illness. Problem: Unfortunately, there is a severe shortage of palliative care professionals, and burnout and dissatisfaction with organizational practices threatens to exacerbate this shortage. Thoughtful use of each interdisciplinary team member's skills is necessary to meet the needs of patients while preserving team satisfaction. Nursing is considered a core role on palliative care interdisciplinary teams, and available evidence suggests nurses positively impact care team satisfaction and the quality of care. However, the palliative care nurse role is under-researched and often misunderstood. The variability of the role across the continuum of care contributes to role misunderstanding. Depending on the setting palliative care nurses may serve as symptom managers, care coordinators, providers of emotional care, team leaders, and/or contributors to quality improvement. This variation requires teams to clarify the role expectations of their palliative care nurses at the microsystem level. Purpose: This quality improvement project aims to create microsystem-specific, evidence-based guidelines for the practice of palliative care nurses on a palliative care interdisciplinary team in western Montana with the goal of increasing care team satisfaction and retention. Methods: A Plan-Do-Study-Act method will be used to guide the project. A committee lead by a clinical nurse leader will facilitate active, interdisciplinary participation in the improvement process. Prior to intervention the interdisciplinary team will complete a Strengths-Weaknesses-Opportunities and-Threats analysis. The nurses will also record their daily activities for one week and complete a role clarity survey. The outcomes of staff satisfaction and improved retention will be assessed with a yearly survey, self-reports at monthly meetings, and repeated role clarity surveys. Recommendations: Since the healthcare environment is ever-changing the quality improvement process should be continuous, and the microsystem specific palliative care nurse guidelines that are created should be considered living documents.