NUR 301 Module 3 Project One Preparation example

Project One Preparation: A Career Goal in Hospice and Palliative Nursing

[Student Name]

Southern New Hampshire University

NUR 301: Concepts of Professional Nursing Practice

Module Three Project One Preparation

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project One Preparation: A Career Goal in Hospice and Palliative Nursing

Current Role and Strengths

I am a registered nurse with six years of experience on a 32-bed medical-surgical unit that admits many older adults with advanced heart failure, chronic obstructive pulmonary disease and cancer. I am often the nurse assigned to patients whose goals of care are changing, because I am comfortable sitting with families during difficult conversations and I know how to manage symptoms such as breathlessness and pain. I completed my associate degree in nursing and am now enrolled in the RN to BSN program.

Three strengths support my goal. First, I have practical experience with symptom management at the end of life, even though I have never worked in a formal palliative setting. Second, I have repeatedly been asked to participate in family meetings and have learned to listen before explaining. Third, I have served on our unit's comfort care committee for two years, which has introduced me to the hospital's palliative care team and to the gaps in how our unit supports dying patients.

Career Goal

Within three years of completing my BSN, I will work as a hospice registered nurse case manager for a community hospice agency and will hold the Certified Hospice and Palliative Nurse credential. The goal is specific because it names the role and the credential. It is measurable because both the position and the certification can be verified. It is achievable because I already care for patients near the end of life and can build the required hospice experience while employed. It is relevant because it matches both my strengths and the growing need for palliative expertise as the population ages. It is time-bound because it sets a three-year limit.

I chose case management within hospice, rather than inpatient palliative care, because hospice case managers coordinate care across the home, the family and the interdisciplinary team, which is the part of end-of-life care I find most meaningful and where I see my unit's patients lose continuity after discharge.

Professional Attributes the Role Requires

Three professional attributes will be central to success in hospice nursing, and each will be developed in Project One. The first is advanced communication. National competencies for undergraduate palliative care education emphasize communication with patients and families about prognosis, goals and values as a core nursing skill, not a specialist add-on (Ferrell et al., 2016). My experience in family meetings is a starting point, but I will need formal training in goals-of-care conversations.

The second attribute is clinical judgment in the home. A hospice case manager assesses symptoms and makes decisions without a physician down the hall, so the expert intuition that Benner (1984) describes as developing through experience in a specific domain will need to be rebuilt in a new setting. I expect to move back toward the competent or proficient stage for a time, and I plan for that rather than assuming my hospital experience transfers completely.

The third attribute is self-care and resilience. Hospice work involves repeated loss. A survey of the hospice palliative care workforce found that many workers reported high compassion satisfaction alongside risks of burnout and compassion fatigue, and that workplace supports affected which of those outcomes predominated (Slocum-Gori et al., 2013). I will therefore look for an employer with regular team debriefing and bereavement support for staff.

How the Goal Serves Patients and the Profession

A career goal in a professional nursing course should say what the nurse will contribute, not only what she will gain. On my unit, patients who choose comfort-focused care are often discharged home with a hospice referral and very little preparation for what the first night will bring. Families call the unit afterward asking how to give liquid morphine or what the change in breathing means. As a hospice case manager, I would be the nurse on the other end of that transition, and my hospital experience would help me anticipate the questions families carry home.

The goal also serves the profession. Nurses who move into specialty roles with certification contribute to a workforce that can meet the needs of an aging population with more serious illness. Bringing a medical-surgical perspective into hospice may help me build better handoffs between the hospital and the agency, which is a gap I have already seen from the hospital side and would now see from the other.

Timeline and Steps

The table below outlines the steps toward the goal. Dates assume BSN completion in the spring of next year.

Table 1

Steps Toward a Hospice Case Manager Role With Certification

Note. Certification eligibility requirements, including recent hospice and palliative practice hours, are set by the credentialing center and should be confirmed before scheduling the examination.

Anticipated Barriers

Two barriers are most likely. The first is financial: many hospice positions pay less than hospital staff roles with shift differentials, so I plan to keep a per diem hospital position during the transition. The second is the experience requirement for certification, which means I cannot sit the examination until I have practiced in hospice for a period of time. Starting per diem hospice work before leaving my current role should shorten that delay. A third, less obvious barrier is emotional readiness. I will talk with hospice nurses during shadowing about how they manage repeated loss before I commit to a full-time move.

Sources for Project One

Project One will draw on the national palliative care competencies for nursing education to define the communication skills the role requires (Ferrell et al., 2016), on Benner's model of skill acquisition to explain how expertise develops in a new specialty (Benner, 1984), and on workforce research on compassion satisfaction and burnout in hospice to support the self-care section (Slocum-Gori et al., 2013). I will add the credentialing center's current eligibility requirements and at least one recent study of the hospice case manager role before writing the final project.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Ferrell, B., Malloy, P., Mazanec, P., & Virani, R. (2016). CARES: AACN's new competencies and recommendations for educating undergraduate nursing students to improve palliative care. Journal of Professional Nursing, 32(5), 327-333. https://doi.org/10.1016/j.profnurs.2016.07.002

Slocum-Gori, S., Hemsworth, D., Chan, W. W. Y., Carson, A., & Kazanjian, A. (2013). Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative Medicine, 27(2), 172-178. https://doi.org/10.1177/0269216311431311