Ryan Van Wert headshot
Ryan Van Wert, M.D.

With more than 3.8 million registered nurses nationwide, nursing is the nation’s largest healthcare profession. Nurses are truly the backbone of healthcare and home care — performing a wide variety of functions in diverse care settings and serving as critical patient advocates. COVID-19 has further highlighted the integral role nurses have always played in our healthcare system.

The pandemic has also revealed the critical need for advance care planning conversations facilitated by skilled clinicians. Nurses are some of the key players at the frontline of patient care, so it is only natural that they are increasingly being recognized for their ability to conduct these sensitive conversations with patients and their families.

The role of nurses in ACP

The American Nursing Association states that it is a nurse’s obligation to provide comprehensive and compassionate care at the end-of-life, and the Hospice and Palliative Nurses Association notes that nurses need to take a leading role by implementing the education of patients, their families and other healthcare clinicians into their everyday practice. 

When nurses empower patients to discuss and establish their care goals through ACP conversations, they open the pathways to palliative care, which focus on delivering relief from the symptoms and stress of serious illnesses, improving quality of life and hospice care, which provides compassionate support for people with incurable diseases. 

In 2017, ANA and HPNA put together “Call for Action: Nurses Lead and Transform Palliative Care,” urging nurses across roles and care settings to have the knowledge, skills and abilities to guide and promote palliative care services. To make palliative care a reality across the care continuum, every nurse must deliver primary palliative nursing. 

The  benefits of nurse-facilitated discussions

The benefits of nurses engaging and guiding patients through the ACP process include:

Relationships: Nurses are often delivering patient care on the front lines. They are at the bedside and attending to individuals and their families, which fosters trust and creates close connections between nurses and their patients. According to Gallup, nursing is the most trusted profession, with 89% of Americans rating nurses’ honesty and ethical standards as “high” or “very high.” This bond enables patients to feel more comfortable engaging in delicate ACP conversations to express their end-of-life care wishes. 

Time: Physicians are increasingly overbooked and only able to spend a limited amount of time with each patient. While nurses also work busy schedules, they can often take the necessary time to participate in shared decision making. Having nurses facilitate  these conversations is beneficial since their roles as essential caregivers provide them with the ideal opportunity to start them and conduct any follow-up correspondence. 

Training: Nurses receive core empathy training and incorporate empathy into their daily practice, which better positions them to have these nuanced discussions around an individual’s preferences, values and goals. Since very few American medical schools incorporate ACP training in their curriculum, it is logical to focus on educating other healthcare providers on the importance of leading these critical discussions with patients and their families. 

The impact of nurse engagement

recent study of a population of adults 65+ with multi-morbidities published in JAMA supports the idea that people are more likely to have ACP conversations and complete documents when the process is facilitated by a trained clinician. Individuals in the nurse navigator-led ACP group had a higher rate of ACP documentation (42.2%) versus those who did not (3.7%). Patients in the nurse navigator group were also more likely to designate a surrogate decision-maker (64% versus 35%) and ultimately had a higher rate of form completion (24.3% versus 10%). 

Due to their crucial and trusted role in healthcare delivery, nurses are well-positioned to engage in sensitive, personal conversations with patients and their families. It is through these discussions that patients can ask questions, make their care preferences heard and ultimately drive a better end-of-life care experience for all involved.

Ryan Van Wert, M.D., is an intensive care physician, and CEO and co-founder of Vynca.