Nursing practice is conducted in the context of multiple legislative, environmental and social issues at all times. For this reason, it is imperative that practicing nurses understand the changes in legislation, and the introduction of new legislations that affect practice in one way or the other. One of such legislations is the Palliative Care and Hospice Education and Training Act introduced as an amendment to part D of title VII in the Public Health Service Act. The bill was proposed with the objective of enhancing the quality of palliative care by increasing the number and quality of faculty in such care environments. In particular, the act outlines specific features that palliative care facilities should meet to be considered effective for their roles in terms of faculty training and dealing with students. With the hypothesis that the act will promote the performance of faculty members in palliative care and hospices, this paper attempts to explore specific elements of the act. The paper is developed with the question: Would increasing the number and capacity of faculty in a palliative care environment result in better care outcomes for the patients relative to the conventional staffing practices?
About the Act
H.R. 647 was introduced into the House of Representatives on 19th January 2019. The bill, named the “Palliative Care and Hospice Education and Training Act”, was aimed at improving the number of palliative care faculty and also to support their development in order to enhance performance in different areas. To accomplish this goal, the act proposes the addition of a paragraph to the Public Health Service Act. The additional paragraph would provide stipulations for palliative care systems to be considered approved. Some of the recommendations for palliative care and hospice education centers include: to improve inter-team collaboration during training and practice; to develop an inter-professional team curriculum which is to be used during the treatment of patients with complex conditions in palliative care; to support faculty training and re-training for the improved capacity of the inter-professional palliative care team; and to support continuous improvement in the performance of the inter-professional team among others (116th Congress First Session, 2019). For the already existing systems, the paragraph points out the need to provide various training options and evaluation processes for the inter-professional teams in palliative and hospice care.
In the content of this act, various conditions are also mentioned. For instance, the act describes the functions of graduate medical education, the role of different professionals in palliative care and the eligibility of individuals in performing these roles. Furthermore, the act describes a program referred to as the Palliative Medicine and Hospice Academic Career Award, which will be issued to eligible individuals in order to promote their academic and professional growth. One of the conditions required for individuals to be considered eligible for this award is that they must be certified by a licensing board. The act also provides for other awards for individuals in palliative care based on different performance evaluation categories including career incentive awards, fellowship programs and grants for the pursuit of further education among the inter-professional teams (116th Congress First Session, 2019). The implications of these awards on the practice of nursing and other healthcare professions are extensive.
Roles of Registered Nurses in Palliative Care
Registered nurses are commonly associated with nursing leadership roles in any healthcare environment. In particular, leadership skills for palliative nurses should exist across the entire range of nursing roles including nurse assistant, bedside nurse through to the nurse in a designated leadership position. According to a study by Dahlin (2018), the leadership skills developed by palliative care nurses enable them to act proactively to change rather than responding reactively. Leadership in such an environment is characterized by the ability to guide others through clear initiatives, motivating them and inspiring them to work collaboratively in delivery of healthcare while at the same time creating healthy work environments and changing professional behaviors. For this reason, many organizations focus on developing the nurse leadership skills of their faculty members, engaging particularly those in designated leadership positions in initiatives that implement leadership skills beyond those required in their specific roles (Cox, 2018). Most times, such skills are not taught in the nursing education contexts, and have to be developed outside the classroom setting.
Nurses are considered the leaders in the development of inter-professional team collaboration efforts within the palliative care environment. They can develop, promote, implement and sustain programs that foster inter-professional team collaboration through leadership in distinctive aspects of palliative care practice (Najum & Centeno, 2014). While doing this, extensive care has to be focused on administration, practice, education, research and policy, an extensive part of which is under the leadership of nurses. Furthermore, the requirement of person-centered care practice models in palliative care imply that nurses spend an extensive amount of time in such care environments relative to other healthcare professionals. They are often the first to identify patient needs in palliative care, the issues facing patient care and even patient distress under certain conditions. They therefore play an essential role in palliative care advocacy among patient families as well as within inter-professional teams (Cox, 2018). This means that while the focus is on the development of an inter-professional team collaboration system, any changes made in palliative care education administration requirements directly impact on nursing practice.
Impacts of the Legislation on Nursing Practice
The role of nurses in palliative and hospice care and education systems means that nurses have to be agile in recognizing and understanding any legislation that would affect such environments. Nurses, more than other healthcare professionals, are engaged in palliative and hospice care. As such, most of the leadership roles fall on them across the entire range of roles that they play in such care environments. This means that as much as the legislation provides conditions for improved education of palliative care faculty, the nurses will be at the center of the targeted population. Nurses comprise of the largest percentage of palliative care faculty, and calling for the increased number of faculty members indirectly calls for the increase in the number of nurses in the palliative care environment. This comes with various implications for nursing practice such as increased efficiency and improved personalized care management. One of the reasons commonly mentioned for nursing practice inefficiency is fatigue as a result of low staff numbers, and increasing faculty members can address this perfectly.
Additionally, since most of the leadership roles in palliative care are assigned to nurses, calling for improved inter-professional team collaboration is like emphasizing the need for improved capacity of nurses to foster inter-team collaboration. The American Nurses Association Professional issues Panel (2017) explains the role of nurses in enhancing inter-professional collaboration in palliative care. From his argument, nurses are the best placed and the most suited for promoting inter-professional collaboration in any healthcare setting as they are in all positions and work with all patients within a particular healthcare setting. They also offer more personalized care to the patients they attend to hence the need for capacity building. With a focus on this legislation therefore, nurses are bound to benefit significantly both in terms of the awards and in their competency levels both in leadership and in inter-professional collaboration.
116th Congress First Session (2019). H.R. 647. Retrieved from www.govinfo.gov/content/pkg/BILLS-116hr647ih/pdf/BILLS-116hr647ih.pdf
American Nurses Association Professional Issues Panel (2017). Call for action: Nurses lead and transform palliative care. American Nurses Association. Retrieved from www.nursingworld.org/~497158/globalassets/practiceandpolicy/health-policy/palliativecareprofessionalissuespanelcallforaction.pdf
Cox, S. (2018). Pausing for better leadership. Nursing Management, 49(10), 56. Retrieved from journals.lww.com/nursingmanagement/Fulltext/2018/10000/Pausing_for_better_leadership.11.aspx
Dahlin, C. (2018). Palliative nursing leadership intensive (PO3). Journal of Pain and Symptom Management, 55(2), 548-549. Retrieved from www.jpsmjournal.com/article/S0885-3924(17)30728-5/fulltext
Najum, M. & Centeno, C. (2014). Leadership of a palliative care team: A personal view. European Journal of Palliative Care, 21(4), 166-169. Retrieved from www.researchgate.net/publication/263965044_Leadership_of_a_Palliative_Care_Team_a_personal_view