Promoting Excellence : Advanced Practice Nursing: Pioneering Practices in Palliative Care

APN Report Cover

In July 2001, Promoting Excellence in End-of-Life Care, a national program office of The Robert Wood Johnson Foundation, convened a group of advanced practice nurses (APNs) to discuss the state of palliative care advanced practice nursing in the United States, to identify gaps in and barriers to that practice, and to develop strategies for the future. The report from this day-and-a-half- long meeting, Pioneering Practices in Palliative Care, has three objectives: to facilitate conversation among nursing leaders about how to improve the state of palliative care advanced practice nursing, to illustrate successful models of pioneers in advanced practice nursing and to promote the advanced practice nurse’s role in providing palliative care.

Principles of Palliative Care
A primary tenet of palliative care is that clinical professionals be aware of and respect patients’ treatment wishes. Although preferences vary according to race, ethnicity and religion, most Americans—more than 90 percent in a recent Gallup poll—wish to be in their own homes or in a homelike setting when they die. Unfortunately, barely 20 percent of Americans die at home.

Other principles of palliative care, such as attention to physical comfort and personal dignity, pertain regardless of where a dying person resides. Certainly, the 80 percent of Americans who die in institutions need—and deserve— expert symptom management and attention to personal and interpersonal aspects of life closure. (See sidebar "What is Palliative Care?")

The Impact of an Aging Society
At the start of the 21st century, the oldest of America’s 76 million baby boomers are in their mid 50s and the youngest are approaching age 40. As advances in medical technology continue to extend life, these aging Americans will have to contend with the aches, pains and progressive disabilities of chronic illness. The need for specialized palliative care to improve comfort and quality of life for this population is great— and it is growing. Policymakers, payers and consumer groups must encourage the development and application of better tools and strategies for bringing palliative care to more Americans.

Nursing Leadership
By articulating and asserting their values and vision, nurses can positively influence public discourse and social policy on caring for the most ill, infirm and aged Americans. Nurses are present in every setting where Americans receive care. In many health care facilities, it is a nurse who sees and evaluates patients first. Even when a patient dies at home, a home health or hospice nurse has been overseeing the person’s care.

Advanced practice nurses play a critical role in expanding access to services and improving quality of care for patients with advanced chronic illness. By facilitating coordination and maximizing continuity of care, APNs are not only particularly helpful to patients and families, but also highly valued by their clinical colleagues and administrators.

APNs: Improving Quality and Access to Palliative Care
In communities and health systems nationwide, APNs with specialized training and experience in palliative care are leading the effort to improve access, promote clinical excellence and improve cost effectiveness. In addition, advanced practice nurses are contributing to health services research in palliative care, oncology, neurology, critical care, surgery and pediatrics.

APNs: Valuable Members of Interdisciplinary Teams
Palliative care advanced practice nurses often can provide patient care and family support throughout the continuum of care and disease trajectory. Practicing as members of interdisciplinary teams, APNs work with:

  • Patients and families: APNs use listening skills to learn the full spectrum of patient and family concerns and to serve as patient/family advocates.
  • Physicians and the palliative care team: APNs contribute to diagnostic evaluations and treatment. They also model and mentor effective modes of caring.
  • Facility administrators: APNs manage the delivery of valuable health care services at the point of patient contact. Working within institutions and communities, APNs reach those in need while managing resources in an efficient, cost-effective fashion.

What’s Inside
This report provides a window into the practices of APNs who specialize in palliative care. The practice settings described span the spectrum from hospital-based to independent practice to academia. Most of the featured pioneering APNs work as part of an interdisciplinary clinical team; others work in private practice or as consultants to teams or physicians.

As this monograph illustrates, APNs specializing in palliative care effectively and compassionately address the needs of patients and families who are experiencing life-threatening illness. They exemplify both the science and art of nursing by coupling expert knowledge and clinical judgment with respect, dignity and care. By melding basic human values with the pragmatism needed to be effective in today’s environment, APNs are an invaluable resource as we strive to care for our nation’s ill, infirm and elderly.

This report is available in the following formats:
  1. PDF versions of the Advanced Practice Nursing: Pioneering Practices in Palliative Care report and A Position Statement from American Nursing Leaders, which provide a convenient downloadable format. Viewing the PDF files requires downloading and installation of Adobe Acrobat Reader.
  2. HTML version, for those wishing to view the content online (see Table of Contents links at top-left of this page).

Advanced Practice Nursing: Pioneering Practices in Palliative Care
pdf PDF 2,043 KB

A Position Statement from American Nursing Leaders
pdf PDF 70 KB


Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.

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