Friday, August 20, 2004

Support Hospice Nursing Now


"The Board of Nurse Examiners for the State of Texas recently voted to change the rules and regulations relating to Nurse Education, Licensure and Practice preventing hospice and palliative care advanced practice nurses from obtaining recognition as a specialty in the State of Texas.

The change that has been proposed is currently posted on the Texas Register for your comment.

An invitation for comments has been made available to comment on-line or send a letter to Katherine Thomas, MN, RN, Executive Director, Board of Nurse Examiners, 333 Guadalupe, Suite 3-460, Austin TX 78701 before September 12, 2004

The proposed rule change requires that nurse practitioners may practice and hold a title only in the specialties of acute care adult, acute care pediatric, adult, family, gerontological, neonatal, pediatric, psychiatric/mental health and women's health. Furthermore, the rule change limits the clinical nurse specialist to adult health/medical-surgical, community health critical care, gerontological, pediatric and psychiatric/mental health. Education and certification in these specialties do not address the education needed for hospice and palliative care certification. End of life care, although the newest specialty, is very specialized and the population we serve deserve the highest quality care meeting the standards of the recently released Clinical Practice Guidelines for Quality Palliative Care as well as the long recognized Standards of Practice for Hospice Programs. If this proposed rule change becomes a reality, the Board of Nurse Examiners will continue to deny the need for this knowledge and skill thereby denying recognition to those who have achieved this knowledge through education, practice and experience. Others who achieve advanced practice education in adult, med-surg, family, psychiatric, etc would be deemed competent by the Texas Board of Nurse Examiners to provide hospice and palliative care on an advanced practice level. Please be aware that only 7 of the 13 board members attending the meeting voted in favor of this proposed rule change, one abstained and five voted in favor.


It is our belief that these proposed changes are in response to the National Council of State Board of Nursing's (NCSBN) APRN Advisory Panel's recommendation that advanced practice nurses must have a broad preparation. NCSBN considers hospice and palliative care to be a subspecialty. Since the breadth of death is 100%, it is hard for us to understand NCSBN's narrow interpretation of hospice and palliative care!! Providing hospice and palliative care demands an extensive knowledge of virtually all systems of the human body, all acute, chronic, and traumatic end stage disease processes, extensive pharmacology, and a complete understanding of the assessment and treatment of psychological and spiritual distress. Unlike former decades where hospice nurses cared for only cancer patients, hospice and palliative nurses now see nearly all medical conditions that lead to death, supporting the position that hospice and palliative nursing practice is not a small specialty, but rather a broad and expansive specialty that requires knowledge and skills to understand and assist dying people, regardless of their disease, location or level of acuity. Is it not broader than women's health or psychiatric/mental health?


1) GO TO as soon as possible to review the proposed change and offer your comments

2) A SECOND ALTERNATIVE IS TO OFFER YOUR COMMENTS BY LETTER AND SEND TO KATHERINE THOMAS by SEPTEMBER 12, 2004 (see address in the text above) Be sure to emphasize the impact this rule change will have on providing quality end of life care for the citizens of Texas.


4) Make your voice be heard - support your colleagues in Texas while also helping yourself since other states are beginning to consider this same NCSBN recommendation. YOU can make the difference!!


-Hospice & Palliative Nurses Association

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