Collective Leadership in Home-Based Palliative Care: Advancing APRN Roles to Enhance Success

Abstract

Developing and practicing in home-based palliative care programs presents a distinct set of challenges and opportunities. These stem from the unique differences in reimbursement, resources, patient care environments, and the variability in program structures and sustainability. Unlike hospice programs, which are mandated and funded by legislation to provide interprofessional team-based end-of-life care, home-based palliative care programs operate in a less regulated environment, serving patients throughout the serious illness trajectory. As a result, home-based palliative care programs do not necessarily operate with an interprofessional team, and the administering organizations determine their structure and objectives. The dynamics of the home-based environment create tension and opportunities for flexibility in program design. Therefore, the success and sustainability of these programs are largely driven by organizational leaders. Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. However, their leadership is not always recognized. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.