Staffing a Palliative Care Program
Estimating Staffing and Projecting Growth
Staffing an Interdisciplinary Team
Sample Job Descriptions
Estimating Staffing and Projecting Growth
A first step in estimating program needs is to make assumptions about staffing ratios. The table below presents an example of staffing ratios required for a 12-bed acute palliative care unit. The numbers are for illustration only and should not be assumed to be a model for staffing.
Staffing levels generally correlate directly to service volume. However, the team may find that certain minimum staff requirements are needed for an effective program, even when early patient volumes may not appear to warrant it.
Example: Staffing Requirements for 12-bed Acute Palliative Care Unit
| Discipline | Ratio of Staff to Patients | Full Time Equivalent FTE Based on 12-patient census staffed 24/7. |
| Physician | 1:12 |
1 |
| Registered Nurse | 1:4 |
9 |
| Social Worker | 1:12 |
1 |
| Nurse’s Aide | 1:4 |
9 |
| Chaplain | 1:12 |
1 |
| Program Director | 1:12 |
1 |
| Ward Clerk | 1:12 |
1 |
Estimates of service volume can also assist the team in determining staffing needs. The table below illustrates this process.
Example: Estimating Service Volume to Determine Staffing Requirements
| Resulting Estimated Service Volume |
YEAR 1 |
YEAR 2 |
YEAR 4 |
| Assumed annual growth estimate |
20% |
30% |
|
| Number of cases [Annual growth = Prior year's Number of Cases x (1 + % growth)] |
220 |
264 |
317 |
| Avg Hospital LOS for Palliative Care Patient |
8.0 |
8.0 |
8.0 |
| Avg
post-referral LOS in PC Program |
5.0 |
5.0 |
5.0 |
| Total palliative care inpatient days [Avg post-referral LOS x Number of cases] |
1,100 |
1,320 |
1,584 |
| Average palliative care inpatient
days/week |
21.2 |
25.4 |
30.5 |
|
Average palliative care inpatient
census/day |
3.0 |
3.6 |
4.3 |
[For illustration only, not based upon actual data]
Take the assumed 1 MD FTE and multiply it by the average inpatient census per day (3.0). Then dividing by 12 (number of patients for 1 MD FTE), the team can determine what level of staff coverage will be required based on the organization's assumptions (.25 MD FTEs).
This calculation does not include MD time for administration, teaching or marketing a palliative care program. Forecasting Future Patient Volume is a tool that can assist in developing these estimates.
More on this topic can be found in Financing the Palliative Care Program.
A Guide to Building a Hospital-Based Palliative Care
Program provides more details that will assist you in generating these estimates.
Staffing an Interdisciplinary Team
Because the needs of seriously ill patients and their families are typically complex and multidimensional, a palliative care program requires an interdisciplinary team of professionals. In addition to the suggested staffing requirements outlined on the program models chart, consider the following in identifying the clinical expertise needed to support the program:
The core interdisciplinary team should consist of:
- Physician
- Nurse and
- Social worker.
In addition, the ideal interdisciplinary team includes dedicated staff time from a bereavement or pastoral care counselor. Effective bereavement support has been shown to improve family and caregiver outcomes and satisfaction. Because of fiscal constraints, many programs pursue a shared arrangement with the hospital’s social work and pastoral care departments.
Other interdisciplinary palliative care staff who provide important clinical and support services to the core staff, patients and families include:
- Patient advocates
- Pharmacists
- Anesthesia pain experts
- Rehabilitation (physical and occupational) therapists and
- Psychiatry consultants.
The skills required include:
- Complex medical evaluation
- Expert pain and symptom management
- Professional-to-patient and family communications
- An ability to address difficult decisions about the goals of care
- Sophisticated discharge planning and
- An ability to deliver continuity of care and reliable access to services.
The interdisciplinary team should have special training and/or work experience in:
- Palliative medicine
- Hospice, or nursing home settings and
- Familiarity with the demands and standards of the acute hospital culture.
Palliative care programs can serve patients from several major clinical programs, including oncology, cardiology, pulmonary medicine, neurology, and nephrology. Team members who are recognized in their specialty and respected within their institution are key to generating confidence in and support for a program.
Consider the institution’s culture as well. A physician-led team may work more effectively in a private-practice, or academic culture, while a nurse-led team may be ideal in a more institutional, collaborative culture.
The ideal palliative care team will integrate into the hospital culture by taking into consideration the characteristics listed above. In addition, team members often participate in hospital ethics committees and other groups within the institution to help build recognition for the vital role of palliative care.
Sample Staffing Requirement Worksheet