Like other organizations, a hospice is made up of individual parts that come together to make an efficient, comprehensive team. Some of those pieces have roles that are clearly defined. The doctors treat illness, the chaplains offer patients and their families spiritual support and guidance, and the medical records clerks keep all the files in order. Some positions and responsibilities are a little less clear.
What is a Nurse Practitioner?
Nurse practitioners play an integral part in the healthcare industry, one that is not always easy for other healthcare professionals to fully comprehend. In addition to becoming registered nurses, practitioners have gone on to obtain a master’s degree and additional certification. This gives them the authority to diagnose, prescribe, and treat illnesses for their patients in close conjunction with primary physicians. The duties of the nurse practitioner in the hospice setting, however, are even more specialized.
“Being a nurse practitioner in hospice is not like any other nursing job,” says Vicki Reece, a nurse practitioner at the Crossroads Hospice Atlanta location. “It’s pretty common for people not to understand how we operate within the team.”
The Physician’s Right Hand
At Crossroads and in other hospice settings, nurse practitioners are vital in determining a patient’s ongoing need for hospice services. Medicare requires that once a hospice patient has been on care for six months, their needs have to be reassessed and they must be recertified to continue receiving services.
“As hospice nurse practitioners, we go out and do face-to-face assessments that provide physicians with the information they need to evaluate patient recertifications,” explains Reece. “That entails reviewing the patient’s chart, talking to their case manager, consulting with the facility staff, and of course, seeing the patient. We’re looking for specific things that are markers for decline.”
To conduct her assessments, Reece travels throughout the community, meeting with patients in their homes or care facilities, often surrounded by their family caregivers. On a first visit, she collects their medical history and reviews their care chart. She also reviews the primary nurse’s assessment notes and consults with social workers. As the patient progresses, she compares their health to her initial assessment, noting any increases in pain, weight loss, or other declines.
Because of their heavy workloads, physicians depend on the work nurse practitioners do in distilling this vital information which is needed for making their recertification assessments.
“Physicians rely heavily on our specialized ability to look at the markers that indicate why a patient should or should not continue to receive hospice services,” says Reece. “They don’t want it to be a rambling dissertation, but something they can quickly say ‘yes’ or ‘no’ to.” It’s important then for Vicki and others like her to be accurate and concise in gathering and communicating patient health findings.
Reece notes that patients and families, too, sometimes have misconceptions about nurse practitioners.
“Families are scared because they see me coming in and think they’re going to lose hospice support once I reassess their loved ones,” she says. “I do my best to assure them I’m not there to find a way to take them off of hospice care. I’m there to give an assessment and make sure that what we’re doing is what we need to be doing. The decisions about hospice care are not up to me, it’s a team effort.”
The Difference in Hospice Care
Aside from the day to day practice of patient assessment, a hospice nurse practitioner’s role differs from that of their colleagues working in hospitals on another fundamental level. Hospice nurse practitioners must care for their patients knowing they are approaching the end of life. It is important for the nurse practitioner then to reassure families the hospice team will be there to take the remaining steps with them. “Being there physically and emotionally is what you can provide and that’s what is important,” says Reece.
While their place on the hospice team is a unique one, nurse practitioners are no different in their commitment to patient care and lending a helping hand when called upon.
“If I see the CNA doing something physical with the patient, I don’t sit back — I ask for a pair of gloves and help,” says Reece. “It’s about availability, always. A nurse is a nurse and I am a nurse. I am going to do whatever I need to do to be part of the team and help take care of the patient.”
Nurse practitioners in hospice are a conduit for a patient’s ever-changing medical information, helping ensure each person is able to get the care they need, when they need it. They bring a high level of medical knowledge, communication skills, and compassion to their work. “As with the rest of the hospice team, our focus is on enhancing quality of life,” says Reece. “That’s the job we hospice nurse practitioners are called on to do.”
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