The Next Generation Of Hospice Nurses

Hospice nursing is a delicate balance of specialized clinical care focused on relieving pain, treating symptoms of advanced disease, and providing compassion and communication during one of the most challenging times in a person’s life. It’s not a surprise, then, that finding nurses with experience and top-notch skills in all areas is a challenge.

Care Dimensions, the largest hospice provider in Massachusetts, decided to try a new approach to finding qualified hospice nurse case managers: It would train its own through the creation of a hospice nurse residency program. In 2014, Care Dimensions was awarded a $249,000 grant from the Massachusetts Healthcare Workforce Transformation Fund to develop and implement three training initiatives: a nurse residency program, preceptor training and the creation of online learning videos to strengthen staff engagement and retention and enhance patient care.

 

Specialized Skills
“Hospice care requires specialized skills and experience that many nurses are not exposed to, which makes it challenging to recruit new staff,” said Diane Stringer, RN, president and CEO of Care Dimensions. “In addition, with staff that operates 24/7 in the field, it’s challenging to deliver ongoing clinical training to support their development.

“The residency program is allowing us to introduce and mentor new nurses to hospice care, and the online training tools for clinical staff will allow them to access support wherever and whenever they need it,” she explained.

Developed in partnership with the nursing program at Regis College in Weston, Mass., the Care Dimensions hospice nurse residency program is open to new nursing graduates as well as experienced nurses who are new to the field of hospice and palliative care.

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“This residency program is a dynamic example of transition to practice, and it benefits both institutions by helping them fulfill their purposes,” noted Diane Welsh, DNP, APRN, CNE, associate dean of nursing at Regis College.

“Nurse leaders across the country are looking for programs that can help new graduates move into interprofessional, fast-paced careers,” Welsh said.

 

Developing Expertise
Care Dimensions launched the hands-on training program in August 2015 with five nurses. Two RNs had clinical experience and three were new graduates. New graduates have a 6-month residency, while experienced nurses have a 3-month residency.

“The nurse residents develop their hospice expertise through a combination of classroom lectures, simulated patient care scenarios, field observations, and a controlled caseload of patients guided by a dedicated preceptor,” explained Susan Lysaght Hurley, PhD, GNP-BC, ACHPN, director of the residency program.

“A major focus of the program,” Hurley added, “is teaching how to communicate with patients and families in crisis, managing family dynamics, having difficult conversations, and learning the finer points of case management.”

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Nurse resident Erin Dunphy, RN, assesses patient John Goldsberry. Case manager and residency program
preceptor Tracey Schwartz, RN, CHPN, observes. 
Photo courtesy Care Dimensions

“Hospice nursing is very specialized, and it’s hard to gain that experience coming straight out of school,” explained Erin Dunphy, RN, who is a new graduate participating in the residency program (see photo).

“Going out on visits with other members of the interdisciplinary team (social worker, chaplain, physician, hospice aide) is allowing me to learn all the different aspects of managing the care of a patient,” Dunphy said. “Each one uses different skills to communicate effectively with the patient, family and other members of the patient’s healthcare team.”

 

Emotional Support

Through journaling and group discussions, the residents have been able to work through the emotional aspects of caring for dying patients.

“I’m part of a great peer group,” Dunphy said, “so we learn from each other, ask questions, and get support from our preceptors while working with patients and gradually building up our caseload.

“There is no other program out there like this that would give me the opportunity to develop the case management and communication skills that are needed to succeed,” she added.

Nurse residents are employed at Care Dimensions during the residency, and upon successful completion of the program, they are offered a full-time position as a primary nurse case manager. A commitment to work full-time for 2 years is expected for all nurse residents. In addition, all nurse residents are eligible to sit for national certification in hospice and palliative care (CHPN) prior to the end of their 2-year commitment.

The residency program has also provided an opportunity for the nursing educators at Regis College to learn more about the specialized skills that hospice nurses need and how to best provide that training.

“As the educators of the healthcare workforce of tomorrow, we at Regis find this partnership an exciting opportunity to use today’s interactive teaching tools to reach current healthcare providers, and from the educators’ side, to learn how we can adapt our curriculum for the healthcare industry needs of the future, including sustaining quality care,” said Penelope Glynn, RN, PhD, dean of the School of Nursing, Science and Health Sciences at Regis.

 

Judy Cranney is the vice president and chief operating officer for Care Dimensions in Danvers, Mass.

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