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

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Thinking Big

"Barn's burnt down[horizontal ellipsis] now I can see the moon."


-Mizuta Masahide, 17th-century Japanese poet


This haiku has always been one of my favorite thoughts, reminding us that in the most challenging times there are often new opportunities. There are times when simply holding on seems like success. Or when faced with overwhelming odds, inching forward in small steps may seem like the most reasonable and safest course. But at other times, thinking big-leaping into the unknown or the seemingly impossible-may be the best approach.


In October 2014, the Hospice and Palliative Nurses Association (HPNA) took a giant leap forward. The HPNA, the Hospice and Palliative Nurses Foundation, and the Hospice and Palliative Credentialing Center joined forces to transform the care and culture of serious illness. Together, they launched a $5 million, 5-year campaign aimed at increasing the number of certified hospice and palliative nurses, advancing research into best practices of hospice and palliative care, elevating palliative nursing leadership at the local and national levels, and enhancing nursing competence through certification. The Advancing Expert Care Campaign has already raised more than $1 million in gifts and pledges. That is thinking big!


The shared mission statement of the three organizations is "advancing expert care in serious illness," whereas the shared vision is "to transform the care and culture of serious illness." These singular mission and vision statements formed the foundation for the strategic planning of the Advancing Expert Care Campaign. The goal of the Advancing Expert Care Campaign is to transform the care and culture of serious illness through six core strategies: (1) performing ongoing evaluation and research into the educational needs of hospice and palliative professionals; (2) designing programs, courses, and curriculum to advance expert care in serious illness; (3) advancing research into best practices of hospice and palliative care, while supporting and developing palliative nursing researchers; (4) developing nursing leadership programs at the local and national levels; (5) enhancing nursing competence through certification; and (6) providing scholarships to offset certification and course fees for hospice and palliative nurses.


With the announcement of the Advancing Expert Care Campaign and shared mission and vision statements, the HPNA, the Hospice and Palliative Nurses Foundation, and the Hospice and Palliative Credentialing Center also launched a joint Web site, Contributions to the Campaign can be made directly on the Web site. Contributing to the efforts of this campaign is an important opportunity for each of us to "think big" about the future of our profession.


Another recent big step forward is the Sojourns Scholar Leadership Program launched by Cambia Health Foundation. This program was developed to cultivate emerging palliative care leaders in nursing and medicine. The first cohort of Sojourns Leadership Scholars began their terms as Scholars in October 2014 and two of these emerging leaders are nurses, Abraham Brody, PhD, RN, and Lynn Reinke, PhD, RN. Dr Brody's work centers on dementia symptom management at home, and he is also "thinking big" as he hopes to develop nurse-led, interprofessional models of care. He is also taking a big leap ahead in testing his previous work in a population of special concern, Spanish-speaking patients in New York City. He hopes to eventually see this model of care spread nationally to relieve the many symptoms in dementia such as behavioral and psychological symptoms and the burden, depression and care for family caregivers.


Dr Reinke's project also addresses a very vulnerable population of Veterans. She hopes to test methods of assessing high-risk patients to facilitate getting them to palliative care early. She also has a vision for how her work could become a model for other Veteran's Administration hospitals across the country. Both Drs Brody and Reinke are role models for the nursing profession.


What are your opportunities for big steps? Sometimes just thinking big is enough. Seeing the world from the 10 000-foot perspective is often enough to reframe our thinking and to see the big picture.


Dr Atul Gawande, renowned surgeon and creator of the checklist manifesto leading to major reform in surgical errors, has just released a new book, Being Mortal. It is an excellent book, and I would recommend it for any palliative care nurse. It offers a big-picture view of the needed changes in our culture and health care system in ensuring compassionate care. The book acknowledges the critical role of nursing in that care.


Now is the time for big steps, big solutions. What is the big step you might take to leap into the future of all that palliative nursing can be?


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




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