The Hospice and Palliative Care Advanced Practice Registered Nurse Workforce

Results of a National Survey

Patricia Pawlow, MSN, ACNP- BC; Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; Caroline L. Doherty, MSN, AGACNP-BC, AACC; Mary Ersek, PhD, RN, FPCN


Journal of Hospice and Palliative Nursing. 2018;20(4):349-357. 

In This Article



We developed a 31-item online survey in consultation with experts in palliative care and APRN education. It covered the following domains: (1) work experience, (2) educational preparation, (3) licensure and certification, (4) practice population, and (5) barriers to practice. The authors piloted the survey among 5 APRNs to evaluate the clarity of the questions, determine the length of time for completion, and address logistical issues with the online format.


Because of the difficulty in identifying and contacting HPC APRNs, we used several methods for recruiting respondents. First, we sent an email invitation to members of the HPNA Advanced Practice Nurse Special Interest Group (SIG) listserv (≈1700 members) and the Pediatric SIG listserv (≈500 members). We also sent a link to the Hospice and Palliative Credentialing Center's Certificant SIG listserv (≈1600 members). Recipients of the email link were encouraged to forward it to colleagues who were eligible to participate. Last, the survey email link was also distributed through the HPNA Graduate Nursing Faculty Council to alumni of graduate level palliative care programs (usually specialty tracks within a master's or Doctor of Nursing Practice program). Reminders were sent up to 3 times via the listserv and twice in the HPNA newsletter, which is sent to all Association members.

The survey was anonymous; however, to encourage participation, we offered respondents the opportunity to participate in a random drawing for a paid 2-year HPNA membership. Respondents who wanted to be entered into the drawing provided an email address, which was not linked to their responses on the survey. Data were collected from October 2016 to January 2017. All procedures and measures were approved by the University of Pennsylvania Institutional Review Board to ensure ethical conduct of research.


Eligible participants included any master's- or Doctor of Nursing Practice–prepared APRNs currently practicing either full or part time in an advanced practice nursing role in HPC. Participants did not need to be certified as an Advanced Certified Hospice and Palliative Nurse (ACHPN) by the Hospice and Palliative Credentialing Center or members of HPNA to participate.


Data were automatically entered and stored securely in an online Qualtrics (Qualtrics LLC, 2017) survey and database. Data were analyzed using the statistical package SPSS Statistics 24. Descriptive statistics were used to summarize multiple-choice responses. Content analysis was used to examine free-text responses. Two members of the research team first coded all narrative data independently, and then both reviewers looked at data together to identify common patterns and key themes.