Palliative NP Job

[castan]

Hello, everyone! I'm a new NP applying for jobs. I have an interview for an inpatient palliative care position and was hoping to get a little more perspective of the job/role. I understand that a major part of the job is meeting with the patient to discuss goals, providing education, helping to manage illnesses, and acting as an additional advocate. My questions is, in addition to these responsibilities, how much prescribing of medications, ordering labs/imaging, and diagnosing is typically involved (if any) on the inpatient side? Are there any inpatient palliative NP's that could share what a usual day is like? I would love to hear your experiences. Thanks in advance!

[barcode120x, RN, NP]

I know this post was in January, but would love to see your input if you did end up taking this position. I'm a former telemetry nurse that just accepted an outpatient palliative care NP position, but I didn't even know there were palliative care NP positions inpatient. I would love to do that!

[NRSKarenRN, BSN, RN]

OP hasn't posted in several months.   In my area, Palliative care NP's often consulted on end of life issues, provide pain management consults, along with following palliative care program patients and emotional support/hospice referrals. 

I was grateful to inpatient Palliative care NP adjusting DH antidepressant and getting him to realize 3 Percocet not controlling his pain , explained tolerance + there were plenty pain meds available if needed in future.

[QEOLAdvocate]

Hi, 

I'm a palliative NP at a cancer hospital, we do one week inpatient and one week outpatient, and are acting as consultants as patient's are receiving their cancer treatments. 

Since I am new to this hospital, I don't get the very complicated cases, those are handled by the physician, but this past week when I was inpatient, some of the things I was responsible for included:

• Reviewing patient's chart to see what the last provider did/didn't do (to get an understanding of what is going on with the patien
•  Ree what meds have or have not worked in the past/currently
•  Review MAR to see how much of PRN meds are being used and looked the pain score documentation to get an objective sense of if PRN meds are working, which allows me to assess effectiveness of current regimen
• Monday-Friday 0900, sit in on the IDT meeting with the physician, social worker, chaplain, RN liaison (she helps us coordinate hospice transfers) and hear from the physician what the patients were like over the weekend (the physician rounds on our patients and is on call for that weekend and the following week, so on Monday they present all the patients, and then assign which pts will be seen by the NP and which the physician will see)
  • During IDT physician and I decide which pts we need SW/CH support with and decide on our tentative times we will see each patient and then we go off and see patients .. 
• During pt visits
  • Assess pt's comfort, assess pain, nausea/vomiting, SOB, constipation, PO intake, mental status, plan for the day from the primary team (hematology/oncology), any questions, and if current regimen isn't managing symptoms, than discuss that with patient for potential changes or if not changing, why you aren't changing the meds (is patient too sedated? recently made changes and enough time hasn't passed to assess effectiveness? did pt refuse doses/were doses held? etc..) 
    • For routine meds (TID around the clock), you still should assess if it is actually helping the patient.. just cause it is being given, doesn't mean the patient is actually getting relief of symptom from that medicine.. 
• After visits, 
  • Send messages to primary team to get clarity on their plan and to inform them of my/our recommendations... 
  • Write notes 
  • Discuss plans with physician (since I'm new) 
  • Put in orders after discussing with physician
  • Make phone calls to pt family/decision makers.. 
• Reassess some patients who need to be reassessed 
• Wrap up the day (put in addendums to original notes if anything changed.. ) 

Tues-Fri it's the same essential structure, and you rinse and repeat.. 

There is soooo much information to know and it is overwhelming right now. It is completely different than outpatient palliative/hospice care which I did for 11 years. I know part of me feeling overwhelmed is because each physician's expectations are different, as is their workflow, and physicians have years of being able to read and understand information, and I haven't had that same luxury, so I do need to find a way to have some information readily available and some frameworks that I can refer to quickly. 

I'm outpatient this week and have a couple of days of WFH where I'll respond to refill requests, patient phone calls for things that come up in between their visits with our team, and I plan to use this time to organize information, so I'm not so lost.

Hope that helps! 

[barcode120x, RN, NP]

I appreciate the detailed response! In-patient palliative sounds very daunting. I have my final interview for an outpatient palliative NP position on Wednesday. They told me I already have the job, I just need to do a final in-person interview as more of a meet and greet since the previous meetings were all over the phone.