Hospice: A naive, first-year nurse's perspective

In nursing school, the importance of learning countless medications and techniques was always stressed by our teachers; however, the lesson of keeping someone comfortable in the dying process was often overlooked. As a nurse, when we are not seeing improvement in a patient’s diagnosis, it can feel as if we’re going against everything we were trained to do. Nurses Announcements Archive Article

Hospice: A naive, first-year nurse's perspective

During my experience in nursing school, my days consisted of completing stacks of medication cards, answering hundreds of NCLEX questions, spending long days in clinicals, and binge-watching Grey's Anatomy. Thanks to the unrealistic expectations I developed from watching an extremely fake yet enjoyable medical show, I went through nursing school believing that we could save anyone. If someone had cancer, some radiation or chemotherapy treatments could eventually cure it. If someone went into surgery, the surgeon would complete the surgery with no complications and the patient would be good as new.

In my class, we spent a majority of our rotations on the med-surg unit at a small hospital, where most patients would improve and go home, better than they came in. Little did I know, there was a field of nursing that we were never prepped for in my nursing program: the complex world of hospice nursing.

As an LPN, we were always told that we could pick between a nursing home or a doctor's office to work. After talking with a classmate who was affiliated with hospice, I decided to try hospice as a new-grad nurse. My biggest fear was that I would lose some of the skills that I learned in nursing school when coming to hospice.

As a continuous care nurse, I could insert subcutaneous sites, manage PCA pumps, administer medications in many different routes, and many more things that I never thought a hospice nurse could do, especially in the home of a patient.

Working as a night nurse, I had to make decisions for the patient based on my observations of my patient; many nights, I had to get in touch with the on-call doctor to request a different medication or dose based on what I believed the patient needed. Needless to say, I was forced to gain confidence for my trade quickly.

Besides the skills and critical decisions that I was required to make during work, the emotional side of hospice was a whole new ball game. I have learned to appreciate the power of silence and holding a patient's hand when there's no need for words. I have learned to keep my composure when all I want to do is break down with the family who is grieving the end of life stage of their loved one.

One of the hardest things to go through is trying to comfort a patient who is afraid and hasn't accepted their diagnosis. Many times, when sitting with a patient who is in the end of life stages of their life, the patient will reminisce on their life. It breaks my heart when a patient feels as if they still have a lot to accomplish, yet their time has been cut short. I admit that I have left multiple patients' houses in tears, aching for my patients. Each time I go into work, however, I feel myself getting stronger and able to be a better nurse for my patients.

A month ago, my mom was rushed into the hospital; she suffered from respiratory arrest and was on a ventilator when I arrived at the hospital. After losing my mom, I didn't think that I could return to work, caring for dying patients every day. During my first night back, I had to do a time of death report for a family who was have a great difficulty coping. Being able to empathize with my patient's families shed a new light on hospice; I realized just how much the presence of a personal who cares meant to a family suffering from a loss. Before leaving this patient's home, the patient's daughter called me an angel, claiming that God himself sent me to them. After this comment, I knew that even though I couldn't improve my patient's condition, I served a purpose when I came into the home.

At this point in my career, I have been a hospice nurse for almost seven months; in these seven months, I have had my fair share of laughs, tears, and soul-searching. Some nights, after leaving a patient's house, I wonder how I could pull it together for the family. The lessons I've learned in hospice were not taught in nursing school because there's no way to learn it other than experiencing it first-hand. Although I know that I won't be able to save a life when going into work, being able to be someone's "angel" is satisfaction enough to feel great about the work I do. Having the opportunity to make the last stage of a person's life more comfortable and memorable makes hospice the most rewarding job a nurse can have, especially when you may be the last person that patient sees before they are called home.

I'm currently an LPN with Hospice and Palliative Care Center. I worked as an EMT at Med Center High Point, a freestanding Emergency Department, for 2 years. I will begin the bridge program at GTCC in May of 2015; graduation will be May of 2016. My career goal is to become a flight nurse. I currently have my BLS, ACLS, PALS, P-ITLS, NIHSS, and EMT-B.

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Specializes in Med nurse in med-surg., float, HH, and PDN.

I feel honored when I work a PD hospice case. To me it is a privilege to help in whatever way I can; especially helping the family with the 'needs' that they didn't even realize that they had.

Seems like many of them ask in some way, "What can we DO?" They want to find a way to make the patient 'better' so that they can feel better about trying everything possible to forestall the inevitable.

My suggestion is always to go sit with the patient, hold their hand, and talk about what their lives were like together, memories, what that person has meant to them, and also to sit silently and just let the person know you are with them, they are not alone. Even if they think the person can't hear them or respond, even if they feel a little awkward doing it, I advocate for talk because, I think you don't ever want to get to feeling, after the person passes, "I wish I had said this or that".

So many people have thanked me for that suggestion, saying what a difference it made in helping them let go when it finally came to that. It is a sacred time, the end of life, and it helps to fill it with as much love as you can.

Specializes in Ortho, CMSRN.

Beautiful article. I had an aunt who died in her 30s of breast cancer that metastasized to the brain. I was a teenager then. So grateful that her husband moved their family (with several children) close by. I would stop by when I could to "talk", but mainly listen. As a nurse now, and a tech a few years ago, when I get the time I try to just listen. I think that when we get close to death, we need to relive, talk through our life, work out the details. It would be nice to know that someone cares.

Jamiejill7

1 Article; 22 Posts

Specializes in Hospice and Palliative Care.

You are both absolutely right, the best thing for a person in this walk of life a lot of times is to sit and listen or in silence. As a nurse, I find silence especially difficult since we're programmed to ask open-ended questions and expect the patient to want to talk about their disease.

BeachsideRN, ASN

1,722 Posts

Specializes in NICU, Trauma, Oncology.

This is absolutely beautiful. Hospice nursing is one of my (many) interests for post-graduation. When my grandfather was dying of end stage metastatic pancreatic cancer the hospice nurses were a God send to our family. Ever since, I have felt a strong calling to hospice nursing. I truly believe in death with dignity.

TammyG

434 Posts

You are right that end-of-life nursing is not covered at all in most undergraduate curricula. This is really a shame, but nursing school administrators say it is because they feel their primary obligation is to prepare students to pass theNCLEX. There are a few if any questions about end-of-life on the NCLEX test, and therefore they give it short shrift. I think continuous care nurses are extremely important and very underrated in hospice. They tend to get much less support than the RN case managers do, yet they spend much more time with the family and are present for many more deaths.

Specializes in School Nursing.

I was lucky in that I was able to do a hospice rotation for my community health class. It was by far the best clinical experience of my nursing school career, and led me to where I am today (working in hospice). We had several lectures throughout nursing school that included palliative and hospice care. It sounds like my school was ahead of the curve in this area. I remember my NCLEX having several end of life related questions as well. Thank you for your wonder article.

SeattleJess

843 Posts

Specializes in None yet..
You are right that end-of-life nursing is not covered at all in most undergraduate curricula. This is really a shame, but nursing school administrators say it is because they feel their primary obligation is to prepare students to pass theNCLEX. There are a few if any questions about end-of-life on the NCLEX test, and therefore they give it short shrift. I think continuous care nurses are extremely important and very underrated in hospice. They tend to get much less support than the RN case managers do, yet they spend much more time with the family and are present for many more deaths.

More and more I amazed at my program. We receive training in EOL care in our second semester. In addition to bookwork on the subject, we hear a lecture from a hospice nurse, visit a funeral home and write a paper on EOL care for children.

The story is that at least one of our instructors worked at a facility where she witnessed insensitive behavior from nurses toward parents of dying children. She decided that my program was not going to graduate that kind of nurse, advocated to the other faculty members and obtained EOL teaching for the curriculum. I bet this is part of more and more programs as the US catches up to other countries on EOL care.

I love that about nursing. I love that nurses look to find a need and to meet it both for patients and the profession.

Kak1206

4 Posts

Beautiful

Jamiejill7

1 Article; 22 Posts

Specializes in Hospice and Palliative Care.

Thank you so much!

MarquieshaH

53 Posts

I love this. I see you're 23 years old. I know this is off subject but I wanted to know what school did you attend and how hard or easy was it finding your first job? Also, do you have your ASN or BSN?

Jamiejill7

1 Article; 22 Posts

Specializes in Hospice and Palliative Care.

Thank you! I graduated last year from Davidson County Community College's LPN program in NC, which was a hybrid nursing program. Our SIM labs and tests were pretty difficult but I felt prepared when I took the NCLEX and when I started working. Best teachers I could ever ask for, too. I started looking several months before I graduated so I was fortunate to have a job early. The key to finding one is to start early and network. Good luck :)