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May/June 2025 Issue: Linked Articles Only
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The Vital Role of the Nurse Practitioner in Hospice
What is a Nurse Practitioner and What is Their Role in Hospice?
Teamwork and collaboration are hallmarks of hospice care, with the goal of providing care, comfort, and quality of life for each patient every day they are on hospice. The hospice team includes a medical director, doctor or provider, nurse, social worker, spiritual caregiver, home health aide, grief counselor, and a variety of therapists, as well as volunteers, each inhabiting a clearly defined role. One additional vital member of the hospice team—whose role is not always understood—is the Nurse Practitioner (NP).
NPs are advanced practice registered nurses (RNs) with additional education and clinical training beyond their initial RN preparation. In addition to working in close collaboration with the medical director, developing care plans, prescribing and reviewing a patient’s medication, a hospice NP will regularly assess and certify a patient’s eligibility for hospice after their initial 6-month term on hospice. They will also provide updates and answer questions from family members while continuing to provide comfort and support to their patients. In April 2020, Seasons Hospice welcomed its first NP, who has since become a valuable member of the clinical team.
The NP profession—with more than 385,000 currently licensed—has a long history in the United States. The NP role was created because of a shortage of physicians. In 1965, the first NP training program was launched at the University of Colorado with the goal of bridging the primary care provider gap in underserved urban and rural areas. In 1989, limited reimbursement for NPs began and in 1997, the Balanced Budget Act granted NPs direct reimbursement. By 2000, NPs were legally able to practice in all 50 states. Medicare granted NPs the ability to function as a hospice attending physician in 2003; in 2011, NPs were allowed to complete the required face-to-face visit to validate hospice eligibility for patients in their third or subsequent hospice benefit period.
The education and training to become an NP is extensive. All NPs complete a master’s or doctoral degree, and they practice under the rules and regulations of the state in which they are licensed. In Minnesota, NPs perform a history and exam, diagnose conditions, order and interpret diagnostic tests, prescribe medications and other treatments, manage patients’ overall care, and provide counseling and education.
The Personal Perspective
by Heidi Seaberg, NP
As a NP at Seasons Hospice, I have the opportunity to collaborate with hospice and facility staff, the patients’ primary care providers, patients, hospice volunteers, and family members and caregivers of our patients. I work most intimately with our talented RN and LPN staff to effectively manage symptoms such as pain, shortness of breath, nausea, anxiety, and restlessness to promote comfort at the end of life. I admire and appreciate the value each person on our team brings to the hospice journey. Whether it be through a massage, a song, a prayer, a meaningful conversation, a dog snuggle, a bed bath, or a dressing change, the hospice team invests themselves wholeheartedly. On a daily basis I see our employees and volunteers extend themselves to nurture all dimensions of the patient and support their goals and wishes.
Meeting with patients and their families and engaging in meaningful conversations is my favorite part of being a NP. Establishing trust, knowing their story, and building an authentic relationship provide personal satisfaction. In my previous role as a NP, I worked as a primary care provider and cared for adult patients in our community for over six years. Around the same time that I transitioned to Seasons Hospice, one of my elderly patients with a terminal diagnosis started care with Seasons Hospice. I had the continued privilege of guiding her care and making a visit to her home to see her and her family members before she died. Her husband proudly showed me her extensive collection of art she had painted over the years; the hobby that was so dear to her. This was such a powerful experience for me and I am so honored to be a NP at Seasons Hospice.
MEET THE STAFF
This year, we’re excited to give you an inside look at the incredible team behind our hospice care. Each issue of Connections will introduce you to different groups within our staff, showcasing the compassionate individuals who make a difference every day. Providing care, comfort, and quality of life to hospice patients comes from a variety of disciplines, including chaplains and therapists. This is the group we want to tell you more about in this issue.
While spiritual support is required by Medicare to be part of the services offered to hospice patients, it is only provided to those patients who want it. Hospice patients and their loved ones are always given a choice of what covered services they want. At Seasons, our chaplains connect with and provide support to both the patients and their loved ones. Although our chaplains are involved with condolence calls, most interaction occurs while the patient is still living, with constant connections throughout the patient’s journey. Within 5 days of enrollment, one of our chaplains will visit with a new patient. They hope to add another layer of support, not to take the place of their patients’ regular clergy.
The work of our chaplains is an ongoing process, not just a quick check-in. They get to know their patients through the stories their families share, which helps them in their ministry to both the patient and the family. Because of the immediacy of end of life, it is not uncommon for our chaplains to make fast connections and get to know patients and their families quite well. Through their multiple interactions, they are privileged to get to witness the incredible closeness of spouses, children, and other loved ones over the time they have with a patient. The chaplains find their hospice work to be greatly fulfilling and altogether beautiful.
As with all professions, hospice chaplains also experience challenges, often in the form of misperceptions of their role. They reassure the family that they are more than just someone walking into a patient’s home with a bible, and that their presence doesn’t automatically mean that death is imminent. They will often call first before visiting to try to lower the family member’s anxiety level. They want to let all concerned know that hospice chaplains are there for the journey, not just the ending.
Above and beyond the Medicare requirements for hospice, Seasons also offers music therapy and massage therapy for our patients, again only to those who want it. In both disciplines, our therapists are trained specifically for hospice care, and the services they provide are unlike the commercial offerings in music and massage. And, as with all hospice services, our staff will come to wherever the patient calls home.
Our board-certified music therapists work alongside other members of the hospice team to support the wants and needs of each patient. An average visit lasts about 45 minutes, depending on the person’s energy level and choices. At the first visit, the music therapist learns what music the patient enjoys and finds out how they are doing—physically, mentally, and emotionally. They consider how music therapy might enhance each patient’s comfort and well-being, whether through symptom distraction, enjoyable social time, or special legacy projects.
For those with dementia, our therapists use the patient’s familiar music to support alertness, decrease agitation, promote mood uplift and speech, as well as encourage movement and music making. The family is invited to join if they wish. It can be fun and meaningful to gather loved ones for music together. When a patient is tired or unresponsive, music therapy supports their relaxation.
Our music therapists find fulfillment through the personal connections that are sparked in each visit. From small moments like an isolated person lifting their head and opening their eyes in response to music, to relief from pain or anxiety, or talking through challenges and joys together—music therapy can be incredibly enriching. This is how music therapy is different from music in general: in the end, the goal is not the music, the ultimate goal is to help the patient.
Our registered massage therapists care for our patients by helping to address their discomfort or pain. Unlike a spa massage, our therapists use a wide range of touch and pressure to meet the individualized needs of patients.
Our therapists work with patients to help relieve muscular tension, increase circulation and refresh large muscular-skeletal groups all while promoting relaxation. Our patients can find massage therapy helpful by being able to ease or reduce the degree of their pain, and for some, increase the ability to breathe through relaxation. Massage therapy can be beneficial during illness as it can compensate for the lack of exercise and lack of muscle contraction, thus creating an increased feeling of well-being.
When our massage therapists do their work, it is in the patient’s personal surroundings. There is no massage table, and no need for removal of clothing. If a patient is bed bound, our therapists will still do all they can for the patient. Using a variety of massage techniques—elements of Swedish massage most often—our therapists focus is on the needs and goals of each patient.
Sometimes, our massage therapists will be called in as a patient reaches the stage of actively dying. Families appreciate how they can ease the patient’s agitation and discomfort through calming massage techniques. Our therapists are grateful to be a source of comfort to each patient all the way through their journey.
DID YOU KNOW?
HOSPICE FACTS & FIGURES
The National Alliance for Care at Home complies a wide range of data regarding the delivery of hospice care. In 2025 they sponsored a Hospice Care Chartbook from the Research Institute for Home Care. The charts below represent just a small portion of the data. We will continue to share more data in future issues of Connections.
Source: Hospice Care Chartbook 2024. Research Insitute for Home Care. Prepared by KNG Health Consulting, LLC. Sponsored by National Alliance for Care at Home.
NOTES FOR THE JOURNEY:
RESOURCES FOR THOSE NAVIGATING HOSPICE
We all need some self-care to see us through the journey of hospice and beyond. Here is a collection of book and podcast recommendations from some of our chaplains and therapists.
BOOKS
Dying Well: Peace and Possibilities at the End of Life by Ira Byock
A short book that offers four things to think about/do when approaching end of life. An all-time favorite books of one of our chaplains.
First Nations Version: An Indigenous Bible Translation of the New Testament by Terry M. Wildman and First Nations Version Translation Council
A dynamic equivalence translation that captures the simplicity, clarity, and beauty of Native storytellers in English, while remaining faithful to the original language of the New Testament.
The Circle of Life: The Heart's Journey Through the Seasons by Joyce Rupp and Macrina Wiederkehr
An easy read that invites us to listen carefully and closely to the wisdom of each season as we search for connections in the midst of disconnected lives.
Musicophilia: Tales of Music and the Brain by Oliver Sacks
Written in an attempt to widen the general populace's understanding of music and its effects on the brain, Sacks asserts that music is omnipresent, influencing human's everyday lives in how we think and act. Among other topics, he examines human’s musical inclination through the lens of musical therapy and treatment, as a fair number of neurological injuries and diseases have been documented to be successfully treated with music.
PODCASTS
On Being with Krista Tippet
Spiritual inquiry, science, social healing, and poetry. Conversations to live by. 20 years of episodes featuring luminaries such as Mary Oliver, Thich Nhat Hanh, and Desmond Tutu. Each episode brings a new discovery about the immensity of our lives.
