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The “Conversation Nurse” Model: An Innovation to Increase Palliative Care Capacity

Lally, Kate MD; Rochon, Therese MS, MA, APRN, ACHPN; Roberts, Nancy RN, MSN; McCutcheon Adams, Kelly LICSW

Journal of Hospice & Palliative Nursing: December 2016 - Volume 18 - Issue 6 - p 556–563
doi: 10.1097/NJH.0000000000000294
Feature Articles

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.

Kate Lally, MD, is chief of palliative care, Care New England; hospice medical director, VNA of Care New England; and assistant professor of medicine (clinical), Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Therese Rochon, MS, MA, APRN, ACHPN, is director, Advanced Illness Management, VNA Care New England, Warwick, Rhode Island.

Nancy Roberts, RN, MSN, is senior leader and practice change leader, John A. Hartford Foundation, New York, New York.

Kelly McCutcheon Adams, LICSW, is director, Institute for Healthcare Improvement, Cambridge, Massachusetts.

Address correspondence to Kate Lally, MD, Care New England Health system, 455 Tollgate Rd, Warwick, RI 02886 (

The authors have no conflicts of interest to disclose.

© 2016 by The Hospice and Palliative Nurses Association.