A Day in the Life of a Palliative Care Nurse Practitioner
The growth of palliative care services in the United States equals increased demand for palliative care nurse practitioners, who play a vital role in delivering this essential healthcare offering. Contessa, together with parent company Amedisys, is proud to provide innovative palliative care in the home with both a value-based palliative care approach and a fee-for-service structure, depending on the program.
While some palliative care programs are delivered in a hospital or outpatient clinic setting, potentially with high patient volumes and little autonomy on the part of its nurse practitioners (NPs) in scheduling and organizing the practice, Contessa and Amedisys are different.
Our nurse practitioners enjoy autonomy (within their state’s licensure guidelines) and an opportunity to collaborate with community providers to offer individualized care in the home to patients with chronic, complex or life-limiting illness.
“We really focus on patient-centered care. Which means we’re their team, and we talk to the cardiologist, the oncologist, the PCP, and we make sure they’re all looped in on how the patient is doing. We aim to be that voice for the patient and give them all of their options.”Lindsay Craycroft, DNP, AGPCNP, BSN, Senior Director of Clinical Operations for Palliative Care
Let’s look at a day in the life of our Palliative Care NPs, and why a role within our palliative care programs is an exciting career move.
Why our Palliative Care Nurse Practitioner role is unique
Our Palliative Care Nurse Practitioners assess patients wherever they call home. They help manage symptoms, provide education, coordinate transitions of care with primary care providers, and establish individualized goals of care.
These visits are often virtual, assisted by a registered nurse (RN) or Community Health Worker (CHW) in the field, or they may take place in-person at a patient’s home, depending on the patient’s need.
For many patients, bringing palliative care home makes improved quality of life more accessible. Nurse practitioners help patients and their families understand their diagnosis by providing advanced care planning and extensive care coordination.
Because this is provided at home, they can establish and maintain a relationship with these patients over the course of their illness, and patients are able to receive care without traveling to a clinic or struggling to piece together care on their own.
Lindsay Craycroft, DNP, AGPCNP, BSN, Senior Director of Clinical Operations for Palliative Care at Contessa, explains, “We really focus on patient-centered care. Which means we’re their team, and we talk to the cardiologist, the oncologist, the PCP, and we make sure they’re all looped in on how the patient is doing. We aim to be that voice for the patient and give them all of their options.”
At Contessa, Palliative Care at Home is offered through a value-based reimbursement structure, working together with payers to bring the service to those whose diagnoses would benefit from palliative care support. Similarly, our parent company Amedisys provides palliative care in the home through Medicare Part B.
Regardless of the approach, these Palliative Care Nurse Practitioners enjoy:
- Autonomy (within their state’s licensure guidelines)
- The opportunity to profoundly impact improved quality of life for patients
- In some cases, the opportunity to deliver care remotely
- A rewarding involvement in community-based medicine
Value-Based Palliative Care at Home and the NP role
In our Palliative Care at Home program, nurse practitioners have a focus on advanced care planning, working with an interdisciplinary team to deliver the right care at the time right time to meet patient needs. By working collaboratively as needed with physicians, they develop care plans and help providers and patients communicate and coordinate care goals.
Educating patients is an integral part of this care. “My job is to see where patients are with their understanding of their disease, and to make sure that as a team we are preparing them for the next steps. Oftentimes these patients and their families have not yet sat down and had these conversations,” Craycroft shares.
The regular schedule follows a Monday-Friday format, 8:00 a.m. to 5:00 p.m., generally with no weekends, nights or holidays required. On-call is minimal, and on-call care is delivered virtually. NPs can expect to supervise a caseload of between 150-200 patients. There is also support from a 24/7 Virtual Care Unit, with nurses and care partners who manage in-bound patient calls during the workday, and are available to patients and caregivers after hours, as well as on weekends and holidays.
Palliative Care with Medicare and the NP role
For NPs who provide care under Medicare Part B, there is also flexibility in the role and an opportunity to support patients with education and case management. Sandra Perrotta, DNP, APRN, FNP-C, ACHPN, Director of Clinical Operations for the Palliative Care Part B Program, notes that these Palliative Care NPs are in a specialist role, seeing patients who are referred externally to their practice. “Most specialists don’t coordinate and collaborate as much as we do,” she says. Palliative Care NPs “make themselves very much present and part of a patient’s care.”
Perrotta notes that nurse practitioners who enjoy being deeply involved with the local community find this role rewarding, as it requires developing a strategy to build your own practice and engage in community outreach, presenting regularly to potential referral sources and the community.
Unlike a typical specialist who may see as many as 25-30 patients in a day, the Palliative Care NP role involves much more intensive consultation and individualized specialty care, allowing for quality direct patient care for around five patients in a day. And, that quality care drives more referrals to the program.
A typical workday as a Palliative Care Nurse Practitioner
A typical day in the life of a Palliative Care NP will span not only visits with patients (either virtually or in-person), but also time spent reviewing charts and any patient calls over the past 24-48 hours. There are also regular phone calls to primary care physicians and other resources to assist with ongoing care coordination.
“We’re building the best palliative care there is, and doing a really great job of it. Our culture is amazing— we have an open-door policy, and that’s how we end up with solutions and everyone is heard. You’re able to be the provider you want to be.”Sandra Perrotta, DNP, APRN, FNP-C, ACHPN, Director of Clinical Operations for the Palliative Care Part B Program
“The visits are based on the patient’s needs,” Craycroft explains. “If we have them on a regular routine, month to month, and they end up at the hospital with a COPD exacerbation, we might start having a nurse see them every two weeks, with a phone check in by the NP in between those visits.”
Ideally, “We are making sure that we are providing really good care that keeps patients out of the hospital,” she adds. “And unlike working in a hospital clinic, where you send the patient home and that’s the end of your journey with them, you follow these patients, you really get to know them, and they become yours.”
What are some challenges of the Palliative Care Nurse Practitioner role?
The nature of the care provided and the chronic and complex illnesses that patients enrolled in palliative care face gives Palliative Care NPs the unique opportunity to have the more in-depth, difficult conversations that might not happen in other settings. “These are tough conversations, and a big portion of what we do,” Craycroft points out. “If you don’t like having conversations around end-of-life care and planning, this role might not be the best fit for you. But we also have a lot more options here to do what we need to do to make sure the patient is getting what they need.”
Aside from that, it’s also worth noting that for NPs who work remotely, there isn’t an-person work social scene, even though the team is close-knit and always collaborating. And in the Part B program, networking, relationship-building and giving presentations are must-have skills.
The Palliative Care Nurse Practitioner role and its benefits for providers and patients
While Palliative Care NPs also collaborate with physicians as needed, as a Palliative Care NP, “This is [like] your own private practice,” notes Craycroft. “You have the flexibility and control to organize how you manage patient care each day. It’s a very autonomous role where you help navigate the ship.”
Perrotta says, “We’re building the best palliative care there is, and doing a really great job of it. Our culture is amazing— we have an open-door policy, and that’s how we end up with solutions and everyone is heard. You’re able to be the provider you want to be.”
These positives equal empowered providers and patients with better outcomes, less hospitalizations and improved quality of life. Palliative Care NPs also help to guide patients through transitions to hospice, if necessary— helping them to access this valuable support at the right time.
Wrapping up the shift
At the end of the day, Palliative Care NPs enjoy great work-life balance and the satisfaction of delivering care in the home that improves the lives of patients living with complex and chronic illness. As Craycroft explains, “We hold each other accountable to make sure the patient is well taken care of. There’s just something about home based palliative care that stands out from really any other approach.”
To see available Palliative Care Nurse Practitioner roles, check out our job postings here.