1. Approved by the HPNA Board of Directors January 2005
  2. Sidwell, Jane C. MSW, RN, CHPN(R)
  3. Ersek, Mary PhD, RN
  4. Kestner, Marlene CHPNA
  5. Kraybill, Beth Miller BSN, CHPN(R)

Article Content


Nursing assistants play a central role in providing care to patients with progressive, life-limiting illnesses and their families. Many nursing assistants are deeply committed to their work in hospice and palliative care, and strive to maintain a very high level of care. However, nursing assistants frequently receive low wages, burdensome workloads, and lack of recognition and respect.1,2 These factors contribute to job dissatisfaction and turnover, factors that negatively influence the quality of end-of-life care as well as patient and family satisfaction.3


The cornerstone of practice for the nursing assistant is providing personal care and assisting with activities of daily living. Nursing assistants practice within a variety of hospice and palliative care settings including long-term care and acute care and within patient's homes. In some of these settings, nursing assistants provide up to 90% of hands-on patient care.3


Because of their intense, consistent interactions with patients and families, nursing assistants may be the first providers to observe the physical, psychosocial, and spiritual symptoms that are common as patients experience the progression of their disease. Nursing assistants also witness and experience the profound, multiple losses and grief that accompany the dying process and the loss of loved ones.


Although nursing assistants do not make decisions about medical therapies or administer therapies such as medications, they are responsible for observing, screening and reporting symptoms for which these therapies are given and the outcomes occurring as a result of the therapies. Because the attitudes of nursing assistants towards certain therapies, such as opioids and artificial nutrition, are communicated either directly or indirectly to patients and families, nursing assistants must be educated about reasons for implementing or withdrawing these therapies. In addition, they must be encouraged to reflect on and understand the impact that their beliefs and values may have to influence patients and families. Nursing assistants also must be kept informed about the medical decision-making processes for patients in their care so they can provide support and reinforcement of the care plan.


Nursing assistants are integral members of the hospice and palliative care team and as such can contribute substantially to treatment planning. Yet their expertise in observing and reporting relevant patient and family information is not consistently recognized across settings. To be actively involved in planning and providing quality end-of-life care, nursing assistants need to possess a thorough knowledge of hospice and palliative care concepts and practices. In addition, their experience and insights must be recognized and validated by the interdisciplinary team.4 (Nursing assistants who are educated and involved in the team care planning process experience greater job satisfaction, which may in turn decrease job turnover that threatens the quality and consistency of end-of-life care.)5



The Hospice and Palliative Nurses Association (HPNA) is committed to compassionate care of persons at the end of life. It is the position of the HPNA Board of Directors that:


* Nurses and healthcare organizations recognize that care provided by nursing assistants is critical to achieving established goals of care for patients with progressive, life-limiting illness and their families.


* Healthcare institutions and organizations ensure that nursing assistants in all settings receive adequate educational preparation to care for patients with progressive, life-limiting illnesses and their families.


* Nurses and administrators in all clinical settings advocate for and respect the contribution of nursing assistants within the interdisciplinary team. Approved by the HPNA Board of Directors January 2005



Approved by the HPNA Board of Directors January 2005


Developed by:


Jane C. Sidwell, MSW, RN, CHPN(R)


Mary Ersek, PhD, RN


Marlene Kestner, CHPNA


Beth Miller Kraybill, BSN, CHPN(R)


To obtain copies of HPNA Position Statements, contact the National Office at One Penn Center West, Suite 229, Pittsburgh, PA 15276-0100


Phone (412) 787-9301, Fax (412) 787-9305, Web site:




1. Fitzpatrick PG. Turnover of certified nursing assistants: a major problem for long-term care facilities. Hosp Top. 2002;80(2):21-25. [Context Link]


2. Pennington K, Scott J, Magilvy K. The role of certified nursing assistants in nursing homes. J Nurs Adm. 2003;33(11):578-584. [Context Link]


3. Mesirow KM, Klopp A, Olson LL. Improving certified nurse aide retention. A long-term care management challenge. J Nurs Adm. 1998;28(3):56-61. [Context Link]


4. Burack OR, Chichin ER. A support group for nursing assistants: caring for nursing home residents at end of life. Geriatr Nurs. 2001;22(6):299-307. [Context Link]


5. Ersek M, ed. Core Curriculum for the Hospice and Palliative Nursing Assistant. Dubuque, IA: Kendall-Hunt; 2003. [Context Link]