It's not easy to find nurses with hospice care skills. So one hospice provider took charge and developed a hospice nurse residency program to ensure it had a ready pipeline of nurses.
Now, the nurse who developed the hospice nurse residency program is creating a template for a toolkit that any hospice program could use to train new and experienced nurses who want to become hospice case managers. Susan Lysaght Hurley, PhD, RN, director of research at Massachusetts-based Care Dimensions, said the journey to develop a hospice nurse residency program began in 2014, when the Massachusetts Healthcare Workforce Transformation Fund awarded Care Dimensions $249,000 to develop and launch training initiatives, including a residency program and preceptor training. [caption id="attachment_76144" align="alignleft" width="300"]
Susan Lysaght Hurley, PhD, RN[/caption] The grant was in response to a recognized need for more trained staff to care for the growing hospice and palliative care populations.
"In nursing schools, there are some critical efforts underway to increase exposure to palliative care content in the nursing curriculum," she said. "But there still are gaps. We wanted to offer this as a transition to practice model."
The resulting hospice nurse residency program, which is three months long for experienced nurses and six months for new graduate nurses, introduces mentors and transitions nurses into hospice care careers. Launched in 2015, Care Dimensions' hospice nurse residency trains between four and six nurses a year and has trained more than 20 nurses to date. The program includes classroom lectures and a significant amount of field placement training, according to Hurley. "From the second week on, they're in the field doing shadowing," she said. The residency also can include simulation and pediatric hospice care training. It also features a dedicated preceptorship, so nurses have a one-to-one preceptor to help introduce them to the nurse case manager role. The residency is both a recruiting and a retention tool that encourages educational achievement. Nurses who complete the Care Dimensions hospice nurse residency commit to working as full-time case managers there for two years.
The residency also makes graduates eligible to sit for the national exam to become a Certified Hospice and Palliative Nurse (CHPN) before the end of the two-year commitment.
Transition to a national model
In January, Hurley was one of 10 palliative care leaders in the country accepted into the Cambia Health Foundation's Sojourns Scholar Leadership Program. The program's identifies, empowers and advances palliative care leaders to make a difference in the specialty. Hurley, like other Sojourns Scholars, will receive $180,000 over two years. In her case, the funding is to build a national model toolkit for a hospice nurse residency that prepares nurses to become hospice case managers. The model will be tested in three other hospices across the country. Hurley's goal is to create a national model for improving the quality and sustainability of the hospice and palliative care nursing workforce. "This project addresses the gap between nursing education and practice for new graduate and experienced registered nurses wanting to begin a career in this specialty field," Hurley said in a Care Dimensions press release. "As the population with serious illness grows, expertise and leadership in these two areas will be critical for ensuring the provision of high-quality care for persons with serious illness."
The need, and efforts underway
The number of hospice patients and facilities are on the rise. In the U.S., 1.49 million Medicare beneficiaries were enrolled in hospice care for one day or more in 2017. That was a 4.5% increase from the prior year. And during 2017, there were 4,515 Medicare certified hospices, based on claims data, representing an increase of 9.6% since 2014, according to the National Hospice and Palliative Care Organization. Work is underway to better prepare nurses for their roles in hospice and palliative care. The American Association of Colleges of Nursing End-of-Life Nursing Education Consortium is spearheading efforts to integrate palliative care competencies into undergraduate and graduate nursing programs. More than 9,000 students at 200-plus U.S. nursing schools have completed or are completing ELNEC's undergraduate curriculum since its launch in January 2017. And more than 350 U.S. nursing schools are using the ELNEC undergraduate online curriculum, according to AACN. ELNEC's Graduate Online Curriculum launched in 2019 for master's degree and doctor of nursing practice students. Still, Hurley said, hospice is a specific area of palliative care and requires training. Just like there are residencies in acute care for specialty training in the ICU, emergency department, med-surg, labor and delivery and other areas, Hurley is taking the acute care model and using it in a specialty area in the community setting. Nurse residency programs have proven their value in the profession. "Establishing a nurse residency program bridges the gap between education and practice and provides support to graduate nurses entering the workforce," authors wrote in an article published in the Journal for Nurses in Professional Development.
Next steps
Hurley is currently working on the toolkit. After that, there will be a request for proposal for hospices interested in participating. If successful, the hospice programs and maybe even palliative care settings could incorporate the hospice nurse residency program to train future nurse case managers, she said. In the meantime, all nurses have access to ELNEC training to become better hospice and palliative care providers, she said. Hurley, who has been a hospice nurse for 16 years and practices as a nurse practitioner in hospice and palliative care, said there is so much she loves about the career.
"I've always loved the community-based nature of it," she said. "I think this is an area where we really do listen to patients and families. The other thing that I really love about hospice and palliative care is that we are interdisciplinary by our very nature. We value everyone's opinions and contributions to the team."
It's also a challenging nursing focus, in which self-care is a necessary skill. "One of the things that we emphasize in the nurse residency is helping nurses who are new to this work -- and particularly if this is their first job in nursing -- really understand how important it is to take care of yourself in order to take care of patients," Hurley said. "That is a skill that we develop and train over time, and we pay particular attention to it because we are caring for people for whom this is a very poignant time but also can be very sad. I think self-care is something that needs to be enforced and reinforced over time."
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