The principles of hospice care embrace holistic patient- and family-centered care, offered by an interprofessional team of practitioners. Built on the foundation of hospice care, palliative care (PC) addresses care of the mind, body, and spirit as health practitioners develop the most effective and appropriate plan of care for and with patients and families experiencing serious, life-threatening, progressive, or chronic illnesses. As a new paradigm of healthcare, PC is responsive to the need for healthcare reform in America and globally. This chapter presents an exemplary palliative care action plan developed in the state of Maryland. In both generalist and specialist roles in palliative and hospice care, nurses are leaders of healthcare reform in the United States as they combine knowledge, experience, and commitment to advancing the specialty and promoting quality palliative and end-of-life care. The chapter discusses the roles of advanced practice palliative care nurses.

Palliative care (PC) and hospice nursing reflects a holistic philosophy of care implemented across the life span and diverse health settings. PC and hospice nurses relieve suffering along the course of illness, through the death of the patient, and into the bereavement period of the family. This chapter presents an evolutionary perspective of hospice and palliative care nursing. The standards of practice in PC and hospice nursing describe a competent level of generalist and advanced practice registered nursing care as demonstrated by the nursing process. The standards of professional performance require the integration of specific core competencies aimed at ensuring the delivery of safe, quality patient-centered care, including the demonstration of competent professional role behaviors in practice, education, research, and leadership. PC nurses collaborate with all members of the interprofessional team, to insure quality and continuity of care in meeting the needs of patients and their families.

The DNP is acknowledged as a nursing practice doctorate and has been developed to create expert nurse clinicians regardless of nursing role. The DNP degree is a huge accomplishment for the nursing profession. Doctoral degrees included in the literature encompass DNPs, PhDs, and EdDs as well. The DNP project is the pinnacle for completion of the degree. Much like the nursing profession, there is not a standardized terminology for the project. The DNP opportunities are boundless and will build upon the fundamentals of nursing practice. This chapter provides an overview of the evolution of the DNP degree, different programs, and learning environments available. In addition, it is hoped that this chapter will create a vision for potential personal and professional options offered with pursuing the degree. Choosing the DNP degree will enhance multiple opportunities to open pathways in nursing that are not always available without a terminal degree.

Core competencies are important to the nursing profession as they play a role in advancing mastery of nursing behaviors and skills essential to practice. Genetic/genomic-based health care is one essential core competency for today’s nursing practice; it also is vital for the future of nursing. The advances in genetics/genomics are important to practice as health care moves toward significant developments in risk assessment, diagnostics, treatments, pharmacogenomics, and personalized and precision medicine that impact individuals across the life span and throughout the health and illness spectrum. This chapter describes essential genetic and genomic competencies for nurses with graduate degrees and states specific skills required for advanced practice registered nurses (APRNs) regarding the risk assessment process. The Essential Genetic and Genomic Competencies for APRNs were introduced, as they are considered core competencies and skills that all APRNs should acquire.

Education loans for advanced nursing degrees come in the following categories: Federal Direct Unsubsidized Student Loan; Federal Direct Grad PLUS Loan; Nursing Student Loan; and Private Education Loan. Federal Direct Student Loans are a form of financial aid that must be repaid with interest. Grad PLUS is a federal loan also funded by the Department of Education; its benefits are similar to those of Federal Direct Loans. Students should check with the financial aid office of their institution to determine whether the institution offers its own nursing student loan program. Private education loans are nonfederal loans made by a private lender such as a bank, credit union, or state agency, and there are no federal forms to complete. Graduate students who consider using private education loans often also consider using a personal residence or home equity loan to finance their education. Borrowing from retirement accounts also may be considered as a source for college funding.

A pivotal strategy to improve the quality of health care while lowering costs in the United States is value-based purchasing (VBP). Advanced Practice Registered Nurses (APRNs) can lead this transformation through collaboration, coaching/mentoring, direct patient care, research, ethics, and leadership. To achieve success in improving patient safety and outcomes, leaders must focus on interprofessional, team-based collaboration to effectively lead all involved to system and process improvements in the delivery of care. APRNs should also take professional accountability to become knowledgeable about the Affordable Care Act and VBP, not just the program that applies to the APRN’s practice but about all programs, and discuss these with other providers, colleagues, and patients. Finally, APRNs must also become involved in policy making to remove barriers for all nurses and to allow APRNs to practice at their highest level of education, skill, and competency.

Older adults represent a segment of the population that has the greatest dependence on government policies, whether they are national, state, or local. Advanced Practice Registered Nurses (APRNs) who care for this population need to understand the impact policy has on the health care and daily lives of their older patients. These policies also impact the practice of APRNs and may erect barriers that prevent the provision of the quality of care that they have the skills and training to provide. This chapter presents a demographics of adults over the age of 65, a review of key legislation, and discussion of strategies to take advantage of opportunities to participate in the policy process. Having health care covered by Medicare and Medicaid is a key to the health of older adults, but there are other social determinants of health that require adequate resources.

Genetics is the primary cause or plays an important role in many medical conditions and birth defects. Given that approximately 3" of newborns have a birth defect or genetic condition, many more develop significant conditions after birth, and more and more women with genetic conditions are having children, medical genetics is of prime importance in obstetric care. This chapter describes how RISK elements can be used when providing a genetic/genomic risk assessment for preconception care (PCC). It discusses ancillary and laboratory measures in obstetrics that are used as part of the genetic risk assessment for screening and diagnosis of the fetus. The risk-assessment process is important in preconception counseling and prenatal care. An important part of the process is a thorough personal and family history. Advanced practice registered nurses (APRNs) should be knowledgeable as to how the risk-assessment process impacts maternal and fetal well-being and the potential for genetic conditions.

This chapter outlines the historical perspective on the advancement of the compact licenses, how this could benefit the profession and what next steps should be taken. The Advanced Practice Registered Nurse (APRN) compact is newer on the scene in terms of full enactment, but it has also been a part of the discussions about APRN practice since the initial discussions of registered nurse practice and the interstate compact in 2015. Conceptually, the APRN compact makes sense and takes the APRN Consensus Model document and moves it to a new level in that the proposed regulatory language includes a nod to the Consensus Model language. The actions and activities of the APRNs, the patients, and the employers have a role to play in the full implementation of the compact. Each APRN has to weigh and measure the need for the compact in their personal practice.