Jessie Brain, Callie Siegert and Kate Sciacca are palliative care nurse practitioners at the Brigham and Dana-Farber Cancer Institute.

Kate Sciacca, MSN, AGACNP-BC, felt her calling to end-of-life care as a patient care assistant in Labor and Delivery before she had ever heard the term “palliative care.”

“I was the person who took photographs of deceased or stillborn babies for the families to have,” she said. “I cherished that part of my role and felt that it was so important. I took great care to do it well.”

That experience set her on a path to palliative care. After earning her nursing degree and working in general medicine, she was selected for a nurse practitioner fellowship in Palliative Care at Dana-Farber Cancer Institute and Brigham and Women’s Hospital — one of only seven programs of its kind in the country.

“The fellowship training really accelerates careers as clinicians, educators and leaders,” said Barbara Reville, DNP, ANP, nursing director of Adult Palliative Care at the Brigham and Dana-Farber and director of the fellowship. “Kate is only three years out of graduate school, and she is already a leader of the Kidney Palliative Care program.”

Offered through the Harvard Medical School Center for Palliative Care, the fellowship trains an interprofessional cohort of physicians, nurses and pharmacists with supervised practice and mentorship.

The program combines on-site clinical practice at Brigham and Women’s Hospital and Dana-Farber with classroom learning focused on pain and symptom management, advanced communication skills, interdisciplinary collaboration, quality improvement and different palliative care and hospice delivery models.

About 40 nurses nationwide apply each year, with one fellow selected for training at the Brigham and Dana-Farber. The nurse fellowship is supported by a grant from the Ho Chiang Foundation.

A Unique Learning Opportunity
As a clinical nurse in the Medical ICU, Jessie Brain, MSN, FNP-C, CCRN, and her colleagues often provide end-of-life care to many patients and families each year due to the complex needs and critical nature of patients admitted to the unit.

“I had a sense that some families were blindsided by how sick their loved ones were, and that we were having conversations about values and goals too late in the patient’s illness,” she said. “I wanted to gain more skills to better care for these patients and support their families during traumatic times.”

She reached out to Sciacca to ask about her experience as a palliative care fellow. “I’ll never forget that call,” Brain said. “Kate told me she learned more in one year of the fellowship than in undergrad and grad school combined. She said it was the best decision she ever made.”

Callie Siegert, MSN, AGNP-C, sought the kind of structure and support that the fellowship provides as she transitioned from the bedside in the Cardiac Surgery Intermediate Care Unit to a nurse practitioner role.

“Through the program, I found that palliative care was fully aligned with a lot of the philosophies that nursing is based on and who I wanted to be as a provider,” said Siegert, who completed the fellowship in 2020 and is a team leader on the Brigham’s Palliative Care Service. “The ability to learn alongside and collaborate with physicians, pharmacists and social workers also makes this fellowship special.”

Mentors and preceptors play a crucial role in enriching the learning experience for fellows.

“You have access to incredible teachers throughout the fellowship, and you experience real, in-the-moment learning every day,” Sciacca said. “Every day that you see patients, you also talk to others about what you’re doing and think critically about the care you’re providing.”

Siegert agreed, noting that the hands-on experiences Sciacca describes were complemented by didactic learning. “I would see my preceptor having a conversation with a patient and family that went beautifully, and then I would learn later in the classroom that this is a skill we can develop over time.”

Preventing Burnout
By nature, serious illness and end-of-life care is challenging. Patients and families are facing difficult circumstances and emotional decisions, and the stress, emotion and moral distress that accompanies palliative care can lead to burnout for care providers.

“The struggle of palliative care is being able to do this every day,” Sciacca said. “It’s a very weighty job.”

To prepare nurse practitioners and other fellows for these challenges, the fellowship focuses on resiliency and well-being.

“We were taught how to recognize warning signs of burnout before it becomes burnout,” Sciacca said. “You have to be able to recognize when you’re a little distressed and develop coping skills.”

The Division of Palliative Care also places a strong emphasis on resiliency. “As a team, we build in time to talk to each other about our experiences with difficult cases and how we’re doing,” Siegert said. “It’s part of our regular practice and dialogue.”

The department also holds a weekly remembrance service so that team members can talk about the patients who have died during the week, honor them, and support each other.  “We can read a poem, share some reflections and talk about how the patient affected us as providers,” Siegert said.

Trusting Relationships
Despite the challenges, Siegert, Brain and Sciacca say that palliative care is very rewarding.

“I think that being part of a death is just as meaningful as being part of a birth,” said Brain, who works on the Palliative Care Service and part-time as a clinical nurse in the MICU. “Being able to support a patient in dying with dignity and respecting their wishes is so important to me. I also feel that I can provide more comprehensive palliative care to patients with serious illnesses in the MICU because the fellowship has enriched my practice.”

Sciacca says that the most fulfilling aspect of her role is the relief she can provide to patients. “They’re grateful to have someone to talk to, especially for things they’ve never talked about before,” she said. “You can see the relief on their face when they know they can ask you their questions and talk openly with you. There is so much trust and gratitude in these conversations.”

Siegert noted that the interprofessional collaboration is also a fulfilling aspect of palliative care.

“There is something special about the people in our department and having a safe space to talk and to collaborate with other providers. It’s a privilege for us to work together and support people during some of the most difficult times of their lives.” – Callie Siegert

Learn more about the fellowship here.