One of the few lectures from nursing school that I can recall vividly was from my senior year in the course on leadership. The professor informed our class that as soon-to-be graduates we would be unique at the university ceremony as we would also be assuming the role of professionals. She explained the criteria of a discipline to be considered a professional, which included that the discipline existed to meet society's needs and that it was committed to ongoing quality improvement. That image has remained with me these 35 years since my graduation.

Nursing is a profession, deeply rooted in a commitment to respond to society's needs and to improving the quality of care. Palliative care nurses have responded to the enormous social needs for a new model of care for the seriously ill and dying. In the years ahead, we will respond to emerging needs for outpatient palliative care, extension of care into dementia programs, and much greater integration of palliative care into chronic illness care, pediatrics, intensive care areas, and likely many other settings and populations we have not yet even considered.

This issue of the journal features several articles addressing quality-of-care issues. This includes concerns for quality care for pediatric and adult patients and for the care provided to family members. The authors of these articles have taken the commitment to being professionals seriously by daring to question current care, expose barriers and weaknesses, and to propose change that can improve the quality of palliative care.

I believe that professionals in palliative care have an even greater obligation to society given the population we serve. Our patients and families are often overwhelmed and exhausted, and they enter palliative care at perhaps the most vulnerable time of life with low expectations of what we can provide. The sharp contrast between a cure-focused system of care and the now open arms offering attention to symptoms, fears, spiritual distress, and life completion is often overwhelming in itself. We as the providers of this care must continuously set new standards, ever improving on the foundation that has evolved for our field.

There is a growing voice in palliative care that the quality of our care for patients is directly related to our own self-care. This is a vital quality-of-care concern. How well does your agency care for patients and families? But of equal importance, how well does it care for the nurse providing this care?

In March 2013, another very significant advance in quality for the field of palliative care occurred with the release of the third edition of the "Clinical Practice Guidelines for Quality Care" by the National Consensus Project (http://www.nationalconsensusproject.org). Every nurse involved in palliative care should be familiar with these guidelines and use them as a solid foundation to advocate for quality care for patients and families. This third edition of the guidelines raises the bar even higher for our field. Special thanks for these guidelines goes to Constance Dahlin, ANP-BC, ACHPN, FPCN, FAAN, a palliative nursing leader, who served as editor for this edition, and to the Hospice and Palliative Nursing Association, who continues to serve as the administrative home for the National Consensus Project. Nursing is not only at the table for quality care but once again illustrating the Hospice and Palliative Nursing Association motto of "leading the way."

Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN

Editor-in-Chief

[email protected]