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Feature Article: Interview with a PCLC Leader
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Elise McKenna, RN, MPH, MSEd, recently
interviewed Lyn Ceronsky, MS, APRN, BC, System Director of Palliative
Care, Fairview Health Services, and Principle Investigator, Palliative
Care Leadership CentersSM (PCLC) of Fairview. Lyn shares how
she has integrated the nursing role into a system-wide palliative care
program. She also discusses her views on the innovative and diverse
opportunities for nurses in palliative care and how she thinks palliative
care nurses are raising the bar of care at the bedside.
Tell us about your program:
The palliative care program at Fairview Health Services, Minneapolis, MN,
includes site-specific clinical programs as well as system-wide
initiatives. Our palliative care consultative services are available at
five hospitals; two are academic university hospitals-one of these is a
pediatric hospital, and three are community hospitals of varying sizes.
System-sponsored programs in professional education, bereavement and
quality improvement support the consultative services.
What is your role at Fairview?
Actually, I wear two hats in my current role; one is the system
administrator of the palliative care program at Fairview Health Services
and the other is the Principle Investigator (PI) of the Palliative Care
Leadership CentersSM (PCLC) at Fairview. As a nurse and administrator,
I initially played a key role in the operations and development of
clinical consultative palliative care services across our health system.
Now my focus is on strategic planning and new initiatives.
In 2003, we were named one of six exemplary Palliative Care Leadership
CentersSM (PCLC) by the Center to Advance Palliative Care
(CAPC). As the PI of the PCLC at Fairview,
I administer the program to train teams from visiting hospitals in the
development of palliative care programs. Our medical director and I lead
our PCLC. So far, we have trained over 80 hospitals.
From your perspective, how do nurses
impact the development of palliative care programs?
I believe that nurses bring a wealth of skills to program development
that is especially relevant to palliative care. These include an in-depth
knowledge of clinical processes on the patient care unit; the ability to
facilitate effective communication among members of the interdisciplinary
team; quality improvement methodology expertise; knowledge of the
practical aspects of ensuring continuity of care across settings, and
proficiency in meeting
patient-and-family-centered standards of care delivery. Additionally,
nurses have always focused on symptom assessment and patient education.
What other diverse roles for
palliative care nurses are integrated throughout your system?
I think it is important to note that our guiding principle, as we have
developed our programs across Fairview,
is to design a clinical model according to the unique needs of each
hospital and community, and support it with quality improvement processes
and professional education. To this end, in our system, advanced practice
nurses (APNs) work in a variety of settings and roles. For example, at
the University
Hospital, they work
as members of the consult team, which includes physicians, a social
worker and a chaplain. At our 150-bed community hospital, an APN-led team
model is utilized, which incorporates the patient's physician, unit
social worker and chaplain, and offers consultations in both pain and
palliative care. In our two 50-bed community hospitals, APNs are
predominantly located in ambulatory settings because these are the best
environments for them to effectively meet patient and family palliative
care needs, within these smaller facilities.
Describe the clinical roles of
advanced practice nurses in your program:
Advanced practice nurses, both Nurse Practitioners (NPs) and Clinical
Nurse Specialists (CNSs), anchor the clinical consult services at all Fairview sites. In
addition to providing direct consultation, these nurses coordinate policy
development, offer professional education and represent palliative care
on nursing department and hospital-wide committees, such as pain
management and ethics. Working closely with nursing colleagues in home
care, long term care and hospice, our palliative care APNs also support
the transition of plans of care across settings. Additionally, APNs
participate in research and clinical projects that inform the content for
nursing orientation and continuing education programs, practice
guidelines in our Electronic Medical Records system and competencies to
enhance the role of the bedside nurse in family conferences.
How do you think APNs impact the
success of your program?
The biggest impact APNs have on the success of our program is that they
promote a greater understanding of the scope of palliative care among
patients, families and clinical staff. I also find that nurses play a
major role in identifying solutions to challenges faced by the
institution, which also helps to build ongoing support for our palliative
care program. For example, two questions we are currently investigating
are: How can the palliative care program help nursing departments achieve
or maintain magnet status? And how can palliative care nurses work with
unit staff on evidenced-based practice?
Palliative care is a relatively new
field for advanced practice nurses. How do they prepare for their roles
in this practice area?
Some APNs have had clinical palliative care experience in their graduate
programs. Others transition to palliative care from specialties such as
oncology, pain management or geriatrics, all of which provide an
excellent base for a palliative care specialty focus. At Fairview, we use Hospice and Palliative
Nursing Association (HPNA) resources* as a guide for preparing APNs for
palliative care roles. HPNA has developed standards for a clinical
practicum in palliative care for practicing nurses. We strongly encourage
our staff to obtain certification in palliative care nursing through
HPNA.
As a leader in the field, how do you
think palliative care nurses strengthen hospital-based nursing practice?
One of the most important ways palliative care nurses strengthen the
overall nursing practice is through their role as consultants/mentors to
nurses at the bedside. RNs work in close collaboration with palliative
care APNs, and I believe that this raises the bar of quality patient care
by improving the assessment and identification of appropriate referrals
to palliative care, as well as the implementation of interventions
recommended by the palliative care team.
What future opportunities do you see
for palliative care nurses?
One frontier for nurses in palliative care is senior programs, such as
assisted living facilities. I also see an expanding need for palliative
care presence in primary care and specialty clinics; oncology
survivorship programs and telemedicine. I believe that nurses will
continue to make a significant impact through education, research and
clinical care, as we more forward in the field of palliative care.
*Competencies
for Advanced Practice Hospice and Palliative Care Nurses, Core Curriculum
for the Advanced Practice Hospices and Palliative Nurse
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APN Coding and Billing Breakout Session Added to CAPC Seminar
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A new breakout session, Coding and Billing for APNs, has been added to
the CAPC Fall Seminar.
Building
Palliative Care Programs in Hospitals: Tools and Strategies for Success
Date: November 1-3, 2007
Location: San Francisco, California
Coding and
Billing for APNs
Faculty: Constance Dahlin, APRN,
BC, PCM
Navigating the complexities of coding for palliative care services
delivered by APNs and billing appropriately under Medicare Parts A and B
are critical to your program's bottom line.
- Learn billing and documentation requirements
for inpatient, outpatient and home palliative care services
- Review differences between Medicare and
commercial insurance billing with regard to advanced-practice nurse
providers
- Develop an action plan to maximize your
collections and manage billing denials
To learn more
and register, visit www.capc.org/sanfrancisco.
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National Hospice and Palliative Care Organization (NHPCO) Publishes
New Guide
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The National
Hospice and Palliative Care Organization (NHPCO) has just published "Navigating Palliative Care: Positioning
Hospice for the 21st Century," a guide that documents the
status of current hospice-based palliative care initiatives and
identifies opportunities and barriers faced by hospices. A primary goal
of this project was to gain a greater understanding of the challenges
encountered when offering palliative care services in collaboration with
other providers. The NHPCO consulted with the Center to Advance
Palliative Care (CAPC) on this initiative. To learn more, visit www.nhpco.org.
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Palliative Care Research Grants from the National Palliative
Care Research
Center (NPCRC)
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The National
Palliative Care Research Center (NPCRC) is accepting Letters of Intent online for
its pilot/exploratory project support grants and junior faculty career
development awards in palliative care. This call for applications is a
groundbreaking effort by the NPCRC to build strong evidenced-based
palliative care research. The RFA is limited to applications that focus
on palliative care research in one or more of three specific areas:
- Pain and symptom management
- Improving communication among health care
providers, patients and their families
- Evaluating delivery models and systems of care
for patients living with advanced illness and their families
Deadline for Letter of Intent
submission is
November 1, 2007. To learn more and apply, visit www.npcrc.org.
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American Academy of Hospice and
Palliative Medicine (AAHPM) Names New CEO
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The American
Academy of Hospice and Palliative Medicine (AAHPM) has recently
announced the appointment of Steve R. Smith, MS, CAE, as its newest Chief
Executive Officer. Smith brings to his new position an extensive amount
of experience in the management of heath care associations, most recently
at the American
Academy of Physical
Medicine and Rehabilitation, as Senior Director, Business Development,
Marketing and Membership Services. To learn more, visit www.aahpm.org.
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Articles and News of Interest
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San Antonio Express-News,
August 13, 2007: Palliative-care
Doctor Teaches Other Physicians to Provide Comfort as Well as Treatment,
by Melissa Fletcher Stoeltje.
The Washington Post, July 3,
2007: A
New Focus on Easing the Pain, by Joanne Kenen.
Science Daily, June 14,
2007: Early
Palliative Care Linked to Shorter Stays in Intensive Care.
Medical Newswire, June 5,
2007: Health
Insurers Maintain A Competitive Edge By Expanding Palliative-Care
Coverage.
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American Academy of Hospice and
Palliative Medicine (AAHPM) Selects Training Sites for Clinical Scholars
Program
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The American
Academy of Hospice and Palliative Medicine (AAHPM) has announced the
selection of eight training sites that will host its Clinical
Scholars Program, beginning in 2008. This program is designed to
provide physicians with an intensive clinical experience in hospice and
palliative medicine. The eight sites selected are Capital Hospice in
Falls Church, Virginia; Hospice of the Bluegrass in Lexington, Kentucky;
Medical College of Wisconsin in Milwaukee, Wisconsin; Midwest Palliative
& Hospice CareCenter in Glenview, Illinois; San Diego Hospice &
Palliative Care in San Diego, California; Stanford University/VA Palo
Alto Hospice and HPC Program in Palo Alto, California; University of
Alabama at Birmingham/VA Medical Center Palliative Care Program in
Birmingham, Alabama; and University of Pittsburgh Institute to Enhance
Palliative Care in Pittsburgh, Pennsylvania. To learn more, visit www.aahpm.org.
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Intensive Update with Board Review in Geriatric & Palliative
Medicine
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Mount
Sinai School of Medicine is presenting the Intensive Update with
Board Review in Geriatric and Palliative Medicine CME course from
September 30, 2007 - October 3, 2007. A practical, comprehensive review
of all aspects of geriatric and palliative medicine, this four-day course
offers participants intimate workshop sessions designed to foster
one-on-one mentoring and networking opportunities with nationally
recognized experts in both fields. Case-based workshops will include
specialized content, ranging from geriatric assessment and pain
management to hip fracture and urinary incontinence. For more
information, click
here or contact geried.programs@mssm.edu.
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Next CAPC Audio Conferences
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A
National Framework and Preferred Practices for Quality Palliative Care:
Raising the Bar
Tuesday, October 16, 2007
1:30-2:30 PM Eastern
Featured Speaker:
Betty Ferrell, RN, PhD, FAAN
Research Scientist
Nursing Research and Education
City of Hope
Medical Center
Duarte, California
To learn more and register, click
here.
Pediatric Palliative Care:
The State of Art
and Science
Tuesday, November 13, 2007
1:30-2:30 PM Eastern
Featured Speaker:
Sarah E. Friebert, MD, FAAP
Director, A Palette of Care Program
Haslinger Division of Pediatric Palliative Care
Associate Professor of Pediatrics
Pediatric Hematology/Oncology
Akron
Children's Hospital
Akron, Ohio
More information coming soon!
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New Palliative Care Leadership CentersSM Training Dates
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It's not too late to jump-start or grow your palliative care program by
training at one of six Palliative
Care Leadership CentersSM (PCLC).
Find new 2007-2008 PCLC training dates below. To learn more about PCLC
and which program is right for you, click
here.
We encourage you to register soon,
while sessions are still available. CME credits are available
for physicians.
Fairview
Health Services - Minneapolis,
MN
2007
October 17-19
2008
January 16-18
April 23-25
Medical
College of Wisconsin - Milwaukee, WI
2007
October 24-26
December 19-21
2008
February 27-29
April 23-25
June 25-27
Mount
Carmel Health System - Columbus, OH
2007
October 4-5
2008
January 29-30
April 17-18
September 18-19
November 12-13
Palliative
Care Center of the Bluegrass - Lexington, KY
2007
October 10-12
November 7-9
2008
January 16-18
February 13-15
March 26-28
April 16-18
May 7-9
June 11-13
August 13-15
September 24-26
October 1-3
November 5-7
University
of California, San Francisco -
San Francisco, CA
2007
October 25-26
2008
June TBD
VCU
Massey Cancer Center - Richmond, VA
2007
November 12-13
2008
March 17-18
May 19-20
September 15-16
November 10-11
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National Board for Certification of Hospice and Palliative Nurses
(NBCHPN®) Receives CMS Recognition
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The National Board for Certification of Hospice and Palliative Nurses
(NBCHPN®) has been recognized by the Centers for Medicare and
Medicaid Services (CMS) as a national certifying body for advanced
practice nurses (nurse practitioners and clinical nurse specialists),
effective November 19, 2007.
NBCHPN's® recognition by CMS paves the way for advanced
practice nurses to obtain Medicare and Medicaid billing numbers in the
future. The recognition of NBCHPN® by CMS follows an extensive
review process. To learn more, visit www.nbchpn.org.
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CAPC
Fall Seminar
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Early
Bird Deadline is October 8!
Building
Palliative Care Programs in Hospitals: Tools and Strategies for Success
November 1-3, 2007
San Francisco, CA
Seminar includes the new breakout
session:
Coding and Billing for APNs
Faculty: Constance Dahlin, APRN,
BC, PCM
Learn from the
nation's
No. 1 resource for palliative care program development and growth . . .
This highly practical CAPC Seminar offers a unique, comprehensive
overview of all the financial and operational essentials of building a
successful palliative care program. It's the field's basic primer for
planning, exploring and starting a palliative care program.
You'll learn
how to:
- Develop and implement a strategic plan for
establishing a program
- Create compelling business and financial plans
- Collect, interpret and present data needed to
justify a program and to evaluate outcomes
- Select among various organizational and delivery
models
- Identify target audiences and implement
marketing strategies
- Outline strategies for funding programs
- Develop successful hospital-hospice partnerships
- And more!
Who should attend:
Hospital and hospice physicians, nurses, social workers, finance
managers, administrators and others responsible for planning, exploring
or starting a palliative care program.
Questions? Email capcevents@mssm.edu or call (212)
201-2680.
To learn more and
register, click
here
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