1. Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN, Editor-in-Chief

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In May 2011, I had the privilege of visiting with nurses in California's safety net hospitals-those who serve the poorest of society and whose patient populations are the most vulnerable of all those served by palliative care. These public hospitals provide care to patients who are seriously ill and dying while facing such overwhelming issues of homelessness, substance abuse, high rates of psychiatric illness, poverty, and few resources for care at home. These hospitals are participants in a major effort by the California HealthCare Foundation to integrate palliative care in public hospitals.1


During one of my visits, I had an opportunity to see palliative nursing at its finest. At Los Angeles County-University of Southern California (LAC-USC) hospital, I met with Eve Cruz, MSN, RN, CNS, who is a member of the palliative care service of one of the busiest and most burdened hospitals in America. As we discussed the critical role of nursing in public hospitals, Eve recalled a special day that I think captured the essence of palliative nursing, not only for this hospital, but also for our profession.


Eve recalled the day in 2008 when patients in the massive old hospital structure were to move to a new building. One can only imagine the months of planning for this monumental day. Teams of administrators, managers, physicians, construction crews, and others had orchestrated a detailed plan of moving hundreds of seriously ill patients with the support of hundreds of staff across disciplines.


Amidst the organized chaos, the nurses realized that there were three ICU patients, across two units, who were critically ill and were imminently dying. The nurses recognized how very traumatic and unfortunate it would be if these three patients died amidst a transfer, perhaps spending their final hours or moments in a hallway or elevator or while transferred to a completely unfamiliar unit and likely amidst noise and chaos. These nurses recognized that, for these three patients, today could be their final day and that the final hours of life are a sacred time. Today was not just "LAC-USC moving day"; today could well be the final day of life for three humans, three people whose lives matter and who deserve comfort, dignity, and peace.


The nurses brought the three patients together into one unit and surrounded them with expert nursing care that ensured that a hectic, overwhelmed system did not ignore their needs. These nurses stopped the proverbial fast-moving train, laying their professional values and commitment on the railroad tracks to stop what could have been a worst-case scenario for end-of-life care.


Palliative care nurses join their professional organization-HPNA. They attend meetings, read textbooks and journals, master clinical skills, and seek certification in our specialty. And they do this not just to be smarter or more proficient. Nurses seek professional growth so that patients and families can receive the kind of care that those three patients received on a day in November 2008.


The commitment of palliative nurses changes things. We are the voice amidst the noise that says how we die matters. Nurses change cultures of care and transform acute health care settings into sacred spaces. Nurses remind everyone that things that may not seem to matter really matter.


Thank you, Eve, and thank you to all nurses in public hospitals who are demonstrating for all of us that the best care is possible for those most in need.


Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN




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1. California HealthCare Foundation. Spreading palliative care in public hospitals. Accessed June 6, 2011. [Context Link]