Clinical Training Recommendations for Registered Nurses Caring for Patients with Serious Illness

These training recommendations will help registered nurses (RNs) address the unique needs of patients living with serious illness.

Examples include nurses working in oncology, cardiology, or primary care.

Assess the Needs and Concerns of Patients

• Assess patient’s physical, mental, social, and spiritual well-being at all stages of disease
• Know what palliative care is, and when to request a consult

Strengthen the Clinician-Patient Relationship and Understand Goals of Care

• Identify the patient’s surrogate decision-maker
• Elicit information from patients about what matters most to them now that they have a diagnosis of a serious illness, and advocate for care that is aligned with patients’ values and preferences
• Conduct advance care planning conversations and complete advance directives
• Identify how culture, race, gender, sexual orientation, and context (e.g., social determinants of health) influence patient and family decision-making in the context of a serious illness, and deliver responsive, unbiased care matched to needs and priorities
• Identify patients who are eligible for hospice and discuss with the care team

Manage Pain and Symptoms

• Manage the implementation of treatments for common symptoms associated with serious illness, including pain; nausea and vomiting; constipation; dyspnea; fatigue; depression; anxiety; delirium and agitation
• Assess the feasibility and safety of the care plan with the patient (e.g., whether prescribed medications are accessible and affordable)
• Identify cognitive impairment
• Identify patients that would benefit from a specialty palliative care consult for complex or intractable symptoms, and discuss with the care team

Prevent Crises and Plan Ahead

• Recognize non-physical sources of suffering, and refer patients for social work, behavioral health, and/or spiritual support when needed
  • Investigate access to virtual behavioral health support based on patient insurance
• Assess function and refer patients for a home safety and/or fall risk evaluation when appropriate
• Screen for polypharmacy, and work with team to consider de-prescribing

Complete the Learning Pathway, Registered Nursing Serious Illness Designation: Foundational Skills, to acquire these skills and earn CAPC Designation.

Examples include nurses working in geriatrics, home-based care, or nursing home settings.

Assess the Needs and Concerns of Patients

• Recognize common sources of suffering for patients with serious illness
• Collect data on social risk factors, including presence of caregiver; caregiver burden; access to housing, food, and transportation; racism; financial strain
• Perform a medication review for polypharmacy
• Screen for emotional and spiritual distress, and advocate with team for effective management
• Screen for common symptoms, and advocate with team for effective management, including pain; nausea and vomiting; constipation; dyspnea; fatigue; depression; anxiety; delirium and agitation
• Screen for communication barriers (e.g., vision, hearing, language, and health literacy)
• Screen for need for adaptive equipment

Strengthen the Clinician-Patient Relationship and Understand Goals of Care

• Facilitate and participate in conversations with patients and families about what to expect, and advocate on behalf of patients’ values and preferences

Manage Pain and Symptoms

• Anticipate symptoms related to specific serious illnesses
• Consult with, or refer patients to, palliative care specialists when implementation of first-line treatments according to the palliative care plan have not been effective at managing symptoms

Prevent Crises and Plan Ahead

• Identify community resources that can support patients living with serious illness, and their caregivers (either directly or by connecting your patients to a social worker)
• Identify barriers to meeting patient and family needs and honoring their priorities, and discuss the least restrictive alternatives (e.g., home redesign or board and care home versus nursing home placement) either directly, or through referral to the appropriate health professional

Complete the Learning Pathway, Additional Skills for Registered Nurses who Focus Primarily on Supporting People with Serious Illness, to acquire these skills.