Promoting Excellence : Introduction

What is Palliative Care?
Palliative care is an approach to care that addresses the patientís physical, emotional, social and spiritual needs and seeks to improve quality of life not only for the ill person, but also for his or her family. Palliative care is provided by interdisciplinary teams of professionals, often including physicians, nurses, social workers, chaplains or spiritual counselors, and other health care disciplines.

What is an Advanced Practice Nurse?
The advanced practice registered nurse has a master's or doctoral degree and has concentrated in a specific area of advanced practice nursing. She or he has had supervised clinical training in a specific area of practice at the graduate level as well as ongoing clinical experience. An advanced practice registered nurse may be a clinical nurse specialist (CNS), nurse practitioner (NP), nurse anesthetist (CRNA) or nurse midwife (CNM).

Roles of the Palliative Care Advanced Practice Nurse
In addition to direct involvement with dying patients, APNs in palliative care act in a variety of other roles. They can be:

  • Designers of innovative practices for end-of-life care in a variety of settings.
  • Educators of and consultants to other clinicians, medical residents, nursing students and other providers.
  • Researchers who make important contributions to the professional literature and body of knowledge.
  • Administrators within health care systems, institutions and clinical education programs.

Palliative Care Certification
Certification in hospice and palliative nursing is offered at the generalist level through The National Board for Certification of Hospice and Palliative Nurses Association. An advanced practice palliative care certification examination is being developed through a partnership of the American Nurses Credentialing Center and the National Board of Hospice and Palliative Nurses Association. The examination will be available for nurse practitioners and clinical nurse specialists in spring 2003.

Paying for APN Services
As this monograph illustrates, APNs can receive several forms of reimbursement for their services.

Direct reimbursement for APN services can come from several sources. APNs can bill Medicare at 85 percent of the rate physicianís receive. To be reimbursed, an advanced practice nurse must collaborate with a physician and be certified as an advanced practice nurse by a national organization. A masterís degree will be required by 2003 to receive reimbursement from Medicare. APNs can bill Medicaid for reimbursement, but the rules and rates vary from state to state. Other third party payers, such as insurance companies, usually reimburse APNs for clinical care.

APNs are also often on salary in medical institutions that bill for APN-provided services. Furthermore, in a number of institutional and practice settings, particularly capitated or federally financed safety net health systems, APNís salaries can be financed through cost avoidance of unnecessary hospitalizations or ICU days or through improved system efficiency resulting from their involvement in palliative care.


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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