As a nurse practitioner on the palliative care consult service, I assess, evaluate, and manage adult patients with various life limiting conditions including cancer, dementia, heart failure, kidney disease, COPD, and polytrauma. Important aspects of my role include aggressive symptom management to promote comfort/quality of life in addition to having goals of care discussions with patients and families to ensure their treatment choices reflect their wishes. The role of the palliative care NP definitely requires advanced communication skills!
About Janice Noort, RN, FNP-BC, NP-C, MS, ACHPN: Janice Noort is a nurse practitioner at the University of California Davis Medical Center (UCDMC) in the palliative care consult service where she provides clinical expertise to adult in-patient palliative care patients and their families on an on-going basis. She works in collaboration with a multidisciplinary team to provide advanced palliative care and education to patients and families experiencing life-limiting conditions. In her current role, she also acts as a resource person by providing education to interns, residents, fellows, health care providers, and nursing staff. Prior to her current role on the palliative care team, she was a nurse practitioner and faculty member at UCDMC Pain Management Clinic, where she managed the complex chronic nonmalignant and malignant pain conditions of inpatients and outpatients. She previously worked at Midwest Pain Management Center in Indiana where she also managed patients experiencing chronic pain conditions in an outpatient clinic setting.
Ms. Noort earned her Master of Science from Purdue University School of Nursing’s Family Nurse Practitioner program in 2003, and her Bachelor of Science in Nursing from Purdue University in 1995. She has been in the nursing field for 30 years having earned an Associate Degree in Nursing in 1986 from Thornton Community College in Illinois. She is certified as a Family Nurse Practitioner through the American Academy of Nurse Practitioners Certification Program, and is also an Advanced Certified Hospice and Palliative Nurse (ACHPN) through the Hospice and Palliative Credentialing Center. Additionally, Ms. Noort is a certified pain management nurse through the American Nurses Credentialing Center.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Nurse Practitioner for the Palliative Care Consult Service at UC Davis Medical Center? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Janice Noort, FNP-BC, ACHPN] As a nurse practitioner on the palliative care consult service, I assess, evaluate, and manage adult patients with various life limiting conditions including cancer, dementia, heart failure, kidney disease, COPD, and polytrauma. Important aspects of my role include aggressive symptom management to promote comfort/quality of life in addition to having goals of care discussions with patients and families to ensure their treatment choices reflect their wishes. The role of the palliative care NP definitely requires advanced communication skills!
Palliative care is a unique discipline that is provided in an interdisciplinary manner utilizing a team approach; thusly, I work in collaboration with other palliative team members including physicians, social workers, chaplains, and pharmacists. I also collaborate closely with various other health care team members including physical/occupational therapists, dieticians, speech therapists, and case managers to deliver optimal palliative care addressing patients’ and families’ physical, social, spiritual, and emotional needs.
Our palliative care consult service meets as a team twice weekly to review patient’s care needs and management plans. We provide consultative services to medical and surgical primary teams in our 600+ bed Level 1 trauma center, assisting in the management of patients requiring complex decision-making and management of refractory symptoms interfering with patients’ quality of life. Our team is also involved in goals of care discussions and advanced care planning with patients and families. As medical care has become more advanced and patients/family’s needs more complex, the role of palliative care has grown significantly. This growth has occurred because palliative care focuses on providing quality compassionate care for people facing life-limiting illnesses through expert medical care, pain management, and emotional/spiritual support expressly tailored to the patient’s unique needs and wishes.
Prior to my transition into the field of palliative care, I held several positions in the pain management field; both in the academic and private practice settings. Most recently, I worked as an NP at UCDMC seeing complex chronic pain patients in the clinic setting for multi-modal pain management and in follow-up to interventional procedures. The physicians I worked with at UCDMC pain clinic included neurologists, psychiatrists, psychologists, anesthesiologists, and physical medicine & rehab specialists. I independently performed PENS (percutaneous electrical nerve stimulation) for patients with myofascial pain syndromes (similar to acupuncture), evaluated patients’ outcomes to interventional procedures (including epidural steroid injections, facet joint injections, trigger point injections) and saw patients for multimodal medication management including rationale opioid therapy involving opioid agreements and urine drug screen monitoring. I saw spinal cord stimulator candidates for pre-op/ post-op visits and also refilled intrathecal pumps. I followed my own patients, collaborating with physicians on an as needed basis.
[OnlineFNPPrograms.com] You also worked as a Nurse Practitioner at the Midwest Pain Management Center. Could you please explain what your daily and long-term responsibilities were in this role, as well as the team on which you worked and the patients you assisted?
[Janice Noort, FNP-BC, ACHPN] My prior role was very similar at Midwest Pain Management Center; however, it was a private clinic as opposed to an academic setting. The major difference between the settings was volume of patients seen and lack of learners (fellows and residents) in private practice. At Midwest Pain Management, I worked with six different anesthesiologists in addition to several nurses and another nurse practitioner. It was an extremely busy practice with a very dedicated, hard-working support staff which prepared me very well for my transition to the academic setting!
[OnlineFNPPrograms.com] You completed your MSN with a concentration in Family Nursing, but for the majority of your career you have worked in palliative care settings. How do you feel your graduate training in primary care and family nursing prepared you to work in palliative care and pain management environment?
[Janice Noort, FNP-BC, ACHPN] I was very much drawn to pursue Family Nurse Practitioner training as providing nursing care across the entire life span greatly appealed to me. I also felt I would have more employment options upon graduate study completion as an FNP. I was residing in Illinois and there were limited employment opportunities as a nurse practitioner in the Midwest region at that time, especially in the hospital setting. One of my goals was to maximize my marketability and give myself more career options. It’s wonderful to see how the nurse practitioner role has expanded and changed over the years!
[OnlineFNPPrograms.com] Why did you decide to work in palliative care and pain management, and what academic and professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Janice Noort, FNP-BC, ACHPN] When I retrospectively look back upon my career pathway, it appears that my journey into palliative care was almost predestined! I was working in a hospital PACU as an RN, which led me to consider the pain management field. The anesthesiologists I worked with in PACU were doing nerve blocks for pain control and the pain management field was really growing at this time. I ended up working in pain management for 10+ years and was encouraged to continue my studies to become an NP by co-workers. My experiences working in pain management provided a smooth transition into palliative care. I found working with the cancer patient population especially rewarding and I also happened to have a close family member enter hospice at this time. I was greatly impressed with the overall philosophy of hospice care and its patient/family-centered focus. I felt drawn to palliative care and made the conscious decision to spend the rest of my career as a palliative care advanced practice nurse. I was very fortunate to be offered a NP position assisting with development of the palliative care consult service at UCDMC approximately 7 years ago and have had the pleasure of seeing the service grow exponentially! I pursued certification as an Advanced Practice hospice and palliative nurse after I had accumulated the required clinical hours as I wanted to maximize my knowledge base and practice scope.
I truly believe that palliative care is an area where advanced practice nurses can thrive based upon their acquired skill set and training to provide total patient care focusing on mind, body and soul. I believe the terms nursing and palliative care are virtually synonymous! It is possible to find Acute Care NPs, FNPs, Pediatric NPs, and Geriatric NPs in the palliative care field depending upon the population served.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in palliative care nursing and pain management? On the other hand, what specific challenges have you encountered in your field of work, and how have you managed these challenges?
[Janice Noort, FNP-BC, ACHPN] There are many rewarding aspects to working as a palliative care nurse practitioner. It sounds cliche, but it is true that I receive much more back from my patients than I actually give! Assisting patients and their families in meeting their goals and focusing on quality of life gives me a significant sense of accomplishment with immediate positive feedback. I typically leave work daily with a sense of having performed “a job well done.” It is also very rewarding to work with a strong, cohesive team with a shared mission. I certainly could not perform my role as a palliative NP without my palliative team which is like my family!
Although the rewards can be great, the role can be very challenging at times as I am involved with end of life care and dying patients on a frequent basis. Palliative care is essential throughout the entire trajectory of serious illnesses; however, in a hospital-based setting the palliative care service provides a lot of care for dying patients definitely putting one at risk for compassion-fatigue and burn-out. It is essential to have a healthy work-life balance and utilize activities such as self-reflection, exercise, peer-support, journaling, etc. to cope with associated stressors.
I would encourage students interested in entering palliative care or pain management fields to seek out mentors and pursue educational offerings focused in their area of interest. It is very helpful to join organizations specific to discipline of interest on local and national levels. There are even international organizations with palliative care and/or pain focus available to join! Attending conferences are also beneficial for peer-support, networking and education offerings. I firmly believe that peer-networking and on-going continuing education to stay current is essential in whatever career pathway is selected.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in working in family nursing and/or palliative care nursing, what advice can you give them about optimally preparing for these fields while pursuing their degree?
[Janice Noort, FNP-BC, ACHPN] For current MSN students in a FNP program, my advice would be to absorb as much information as possible, including exposure to as many varied clinical experiences as possible. There is a significant amount of clinical content in graduate school which will help provide a strong solid foundation and refine critical thinking skills. Specific skills will be acquired and further developed in your clinical role in your chosen field.
For the MSN student considering either the FNP or palliative care specialty, I whole-heartedly recommend seeking out potential mentors and experts in your desired field. Speak to these mentors and experts in depth about their roles and responsibilities to see if it aligns with your professional vision. Seek out as many educational opportunities as possible in your areas of interest. If hospice and palliative care is your desired area, I would also recommend volunteering for a hospice agency for further exposure and insight into this specialized field. Most importantly, follow your area of passion!
Thank you Ms. Noort for participating in our APRN career guide interview series!