Professional Practice and Quality
Professional Practice and Quality
Hospice and palliative nurses practice within state nurse practice acts, organizational policy, and professional standards. Know the Medicare hospice benefit: eligibility (prognosis of six months or less if the disease runs its expected course), election, the interdisciplinary group, plan of care, levels of care, and recertification. Documentation must support eligibility, skilled need, symptoms, interventions, and responses. Quality improvement uses measurement, root-cause analysis, and QAPI; safety includes medication reconciliation, high-alert medication safeguards, infection control, and fall prevention. Recognize burnout, moral distress, and compassion fatigue; use self-care, debriefing, and boundaries. Advocacy includes pain relief access, culturally congruent care, and addressing disparities.
Traps: practicing outside scope; delegating assessment to unlicensed staff; charting opinions without observations; assuming the hospice benefit pays for all treatments; and treating quality as only chart audits. Do not confuse certification with licensure, or use a coworker's credentials for your documentation.
Worked example/rule of thumb: an unlicensed aide reports a new pressure injury. The nurse assesses, documents, notifies the IDG and provider, and initiates a plan; the aide cannot perform the initial assessment. Rule: if it is assessment, judgment, or teaching, it stays with the licensed nurse; document the who, what, when, and response.