Abstract
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.