Become a Palliative Care Nurse in 3 Steps

Nurse Types / Palliative Care Nurse

As a registered nurse, you become very invested in everything your patient needs. Often this includes caring for the needs of a seriously ill or terminally ill patient. Many nurses, both those with extensive critical care experience and even some new grads, feel drawn to offer something more to their patients in this situation. 

You may have discovered palliative care as the “something more” in these situations. Palliative care is a specialty area of treatment, where the focus is on the comfort and well-being of a seriously ill patient.

It offers symptom relief and better quality of life for these patients no matter what their prognosis is. It can be started at the time of the patient’s diagnosis with a serious illness, to support them through the course of their disease process. 

Let’s take a look at how to change your specialty to a palliative care nurse. We’ll examine the following:

• What is a palliative care nurse?
• What do palliative care nurses do?
• Where do palliative care nurses work?
• What are specific types of palliative care nurses?
• How do you become a palliative care nurse in 3 steps?
• What are additional requirements of palliative care nurses?
• What are the salary and career outlooks for palliative care nurses?

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What is a palliative care nurse?

Palliative care nurses focus on the holistic care needs of their patients- the physical, psychosocial, emotional, and spiritual needs of those who are suffering from a serious illness. 

Unlike nurses whose focus is on curing or managing a chronic illness, palliative care nurses concentrate on the patient’s needs that will support quality of life, provide comfort, and alleviate pain. This care covers the span of treatment for their condition from diagnosis onward and can include curative goals.

Qualities of a successful palliative care nurse

To be a successful palliative care nurse, it’s important to have excellent communication skills. This includes above-average listening skills, and the ability to empathize with both patients and families. 

A palliative care nurse must also feel comfortable discussing difficult topics such as end-of-life goals, terminal illness, and family dynamics. 

This is a very personalized type of care that reflects the needs of the patient and family based on their diagnosis, culture, background, and other influences. Emotions can run high, and the palliative care nurse must maintain professionalism and stay calm. 

What do palliative care nurses do?

Much of what a palliative care nurse does is centered around collaborating with patients and families. The nurse’s role is to make sure the patient’s medical care aligns with their goals for comfort and quality of life. To do this, a palliative care nurse will:

• Collect and review a detailed medical history
• Evaluate patient and family goals of care
• Review current medications
• Assess the patient’s level of pain control
• Administer medications 
• Conduct physical assessments to evaluate current needs 
• Assess psychosocial and spiritual needs
• Collaborate with the palliative care team 
• Conduct follow-up visits to re-evaluate goals of care
• Educate patients and families about their treatment options

A day in the life of a palliative care nurse

On a typical palliative care nursing shift, the nurse may be responsible for performing any of the above tasks with each of their patients. They will have an assignment of patients to visit, usually as scheduled consults. Often, the palliative care nurse is responsible for organizing their patient visits, including scheduling times with patients and their families. 

If they work for an agency and perform home visits, they will also travel to where patients live. 

After a visit is completed, the palliative care nurse must document all the care provided and ensure any other care needs are coordinated with the rest of the palliative care team.

Common conditions treated by palliative care nurses

Any serious illness, including those with a terminal diagnosis, can be treated by a palliative care nurse. Some include:

• Cancer
• Congestive heart failure
• Kidney disease
• Respiratory disease
• HIV/AIDS
• Alzheimer’s
• Parkinson’s
• Amyotrophic lateral sclerosis (ALS)

Where do palliative care nurses work?

Palliative care nurses work in a broad spectrum of settings, and sometimes their role may require extensive local travel. Palliative care nurses may visit patients in the following settings:

• Hospitals (as part of hospital palliative care team)
• Patient’s home
• Outpatient palliative care clinic
• Assisted living or skilled nursing facilities

What are specific types of palliative care nurses?

Palliative care nurses can be found across all nursing degree levels, from associate degree nursing to BSN to Advanced Practice Registered Nurse (APRN). Depending on their specific degree and job responsibilities, a palliative care nurse may have the following roles:

• General care- assessment and management of all types of patients with multiple conditions.
• Specialty care- focus on a specific area or condition like pediatrics, oncology, or geriatrics.
• Home care- working through a palliative home care service to provide home visits.
• Advanced practice care- advanced practice nurses such as nurse practitioners see patients as the primary specialty palliative care provider under the supervision of a physician.

Closely related fields

Some other nursing specialties have especially close ties to palliative care nursing. These include:

• Hospice care– focused on end-of-life care for patients who have a prognosis of 6 months or less to live; does not involve curative treatments (palliative care may).

• Oncology- this patient population’s complex physical, psychosocial, and emotional needs often require interventions similar to palliative care.

• Pain management- specialty providers in pain management focus on managing this specific symptom.

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How do you become a palliative care nurse in 3 steps?

If you have decided palliative care nursing is a good fit for you, there are 3 steps you can take to make this goal a reality. For nurses with some experience, you may have already completed some of these steps and are well on your way to making palliative care your specialty nursing area.

Step 1:  Become a registered nurse

This step is your initial investment in any nursing career. The great news is that the overall job outlook for nurses continues to be robust. Once you have taken the steps necessary to become a registered nurse, you have many directions you can take with your new career, including becoming a palliative care nurse. 

To become a registered nurse, these are the main requirements: 

Earn a BSN degree  

Today’s nursing employers increasingly look for Bachelor of Science in Nursing (BSN) trained nurses to fill positions. With this degree, a nurse has more job opportunities available to them, which might include a palliative care role. 

You can earn a BSN a few different ways. If you don’t have a college degree, a BSN can be your major right off the bat. For Associate Degree in Nursing (ADN) level nurses who want to advance to a BSN, an RN to BSN degree is a shorter program that counts credits already earned. 

The same is true for an Accelerated Bachelor of Science in Nursing (ABSN), which allows you to change careers from a degree earned in different field than nursing. This can be completed in less than 2 years.

Pass the NCLEX-RN exam

A nursing degree is only the first step to getting your nursing license. You’ll need to take the NCLEX-RN exam after you graduate. A passing score shows that you have the knowledge it takes to successfully and safely practice registered nursing. 

To earn state licensure, either the NCLEX-RN is required for registered nurses, or the NCLEX-PN for practical nurses.

Step 2: Accumulate experience

Getting some general nursing skills and experience under your belt is helpful in choosing a nursing specialty and advancing your nursing career. If you’re a seasoned nurse, you may already have plenty of skills and experience that would be valuable as a palliative care nurse. If you’re a new grad, you may need a little time to practice new skills.

Helpful skills and experience

Any acute care or critical care experience will help prepare you for a palliative care nursing role. This helps you have a better understanding of serious illnesses, their outcomes, and the challenges patients and families face with these diagnoses. 

If you are well versed in assessment skills, nursing care planning, and collaborating with other healthcare team members, these skills will translate into a well-rounded palliative care nurse. 

Most importantly, palliative care nurses must have good communication skills. They must not only be able to explain detailed information to patients and families, but also to mediate difficult family conversations, and to communicate patients’ needs to the palliative care team.

Changing specialty to a palliative care nurse 

If you are already an experienced nurse and working in another specialty but would like to change to palliative care nursing, you may want to first consider if there is a specific focus in palliative care nursing that appeals to you. For example, are you more interested in pediatric palliative nursing? Sometimes it can be easier to transition from a similar role, such as pediatric critical care.

You can also consider taking a more specialized role in something like oncology nursing, to help you get more experience with working closely with terminally ill patients and their families. This may help you decide if this important aspect of palliative care nursing is the right fit for you.

Step 3: Obtain certifications

A great asset to a potential palliative care nurse’s resume is additional specialized certifications. For palliative care nurses, the Hospice and Palliative Nurses Association (HPNA) offers three different certifications for hospice and palliative care registered nursing professionals through their Hospice and Palliative Credentialing Center. 

With one of these certifications, your dedication to palliative care nursing will stand out:

• Certified Hospice and Palliative Nurse (CHPN)
• Certified Hospice and Palliative Pediatric Nurse (CHPPN)
• Advanced Certified Hospice and Palliative Nurse (ACHPN)

What are additional requirements of palliative care nurses?

As a palliative care nurse, you’ll be required to complete continuing education each year to retain your nursing licensure and enhance your training as a palliative care nurse. The number of hours required will depend on both your employer and your state board of nursing. 

What are the salary and career outlooks for palliative care nurses?

According to the Bureau of Labor Statistics, a registered nurse can expect to earn an average salary of $82,750 per year. Job growth is expected to be 6% between 2021 and 2031. It’s also important to consider the highest paying states and cities for nurses when looking for a palliative care nursing job.

In the field of palliative care, there is rapid growth, and you can expect the demand will reflect that. In a recent report, the overall number of hospital palliative care teams in facilities with 50 or more beds has increased from 7% in 2001 to 72% in 2019.

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Job satisfaction

If you’re curious what the overall job satisfaction is for palliative care nurses, it’s a great idea to have a few conversations with other nurses who are already working in this specialty to hear about their experiences. 

Palliative care nurses handle sensitive and emotional subject matter every day and can develop long-term relationships with the patients they serve. For many, this is the most rewarding part of the job, and they describe feeling like they get to make a meaningful difference in their patients’ quality of life.

Next steps

Once you’ve become a palliative care nurse, you may find you enjoy this specialized role so much that you want to advance your degree to an advanced practice nurse, so that you can work as a palliative care nurse practitioner. No matter what course you choose, palliative care nursing is a specialty area that requires special nurses- just like you!