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J Hosp Palliat Nurs. 2020 Feb 1. doi: 10.1097/NJH.0000000000000634. [Epub ahead of print]

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting.

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Susan E. Hickman, PhD, is the director for the Indiana University (IU) Center for Aging Research, Regenstrief Institute, and a professor in the IU Schools of Nursing and Medicine, Indianapolis, Indiana. Melanie Parks, MS, BSN, RN, CHPN, is a certified hospice and palliative care nurse with IU Health Physicians, Indianapolis, Indiana. Kathleen T. Unroe, MD, MHA, is an investigator in the IU Center for Aging Research, Regenstrief Institute, and an associate professor of medicine at the IU School of Medicine, Indianapolis, Indiana. Monica Ott, MD, is the former medical director for the OPTIMISTIC Project, Indiana University, Indianapolis, Indiana. Mary Ersek, PhD, RN, FPCN, is a senior scientist at the Corporal Michael J. Crescenz Veterans Affairs Medical Center-Philadelphia and professor of palliative care in the University of Pennsylvania School of Nursing.


There is a growing recognition of significant, unmet palliative care needs in nursing facilities, yet limitations in the workforce limit access to palliative care services. Attention to palliation is particularly important when there are efforts to reduce hospitalizations to help ensure there are no unintended harms associated with treating residents in place. A specialized palliative care registered nurse (PCRN) role was developed as part of the OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, and Improving Symptoms: Transforming Institutional Care) program, a federally funded project to reduce potentially avoidable hospitalizations. Working in collaboration with existing clinical staff and medical providers, the PCRN focuses on managing symptoms, advance care planning, achieving goal concordant care, and promoting quality of life. The PCRN serves as a resource for families through education and support. The PCRN also provides education and mentorship to staff to increase their comfort, knowledge, and skills with end-of-life care. The goals of this article are to provide an overview of the PCRN role and its implementation in nursing facilities and describe core functions that are transferrable to other contexts.

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