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advance care planning, conversation nurse, hospital-based palliative care, innovative care models, palliative care nursing



  1. Lally, Kate MD
  2. Rochon, Therese MS, MA, APRN, ACHPN
  3. Roberts, Nancy RN, MSN
  4. McCutcheon Adams, Kelly LICSW


This article reports on a quality improvement project designed to answer the following question: Given the shortage of providers trained in hospice and palliative medicine, could a registered nurse assume the role of a "Conversation Nurse" to expand the capacity of the palliative care team by undergoing training focusing on communication about end-of-life care wishes? In collaboration with the Institute for Healthcare Improvement, Care New England's (Rhode Island) palliative care team developed the model of the Conversation Nurse-a nurse trained in conversations with patients and families about end-of-life care. We used a series of "plan, do, study, act" cycles to test the model. Over a 3-year period, the program developed an interdisciplinary team that allowed for a 15-fold increase in hospice and palliative care consults. In this same time period, the hospice program grew as well, with a 41% increase in average daily census and an 18% increase in length of stay on hospice. Eighty-five percent of referring providers agreed that these palliative care consults improved care. The reach of a small palliative care team has been expanded by using Conversation Nurses, allowing increased capacity to provide palliative care.