How do you know that hospice is right for you?
When people think of death, sadness is what is most associated with it. Hospice/Palliative care can help take away some of that sadness. Providing a dignified end-of-life experience can mean so much to the patient, the patient's family, and the healthcare providers involved. Please share your hospice/end-of-life stories, and tell us why you decided that end-of-life care was right for you....
Currently, I am a nursing student. But, between experiences in a clinical setting as well as my own personal life, I feel like I want to be a hospice nurse. Does anybody have any advice for me regarding this? How does one go about becoming a certified Palliative care nurse?
I currently work as a CNA, and I experienced my first death a few days ago. It was really hard for me, as people insisted on drawing blood and other diagnostic tests on a man who was DNR. For the most part, he was incoherent. But, there were a few times when he was clear as day. He didn't want to be poked and prodded anymore. He just wanted to be left alone. He knew he was dying, and he wanted to go on his own terms.
I am not normally a hyper-sensitive person. ( in that way) I don't cry over lost patients. But, this guy...I did cry. Nobody was there for him, other than me. I was there when he took his last breath...and I was the one who saw the lone tear in his eye. I was the person who had to tell his nurse that I thought he was dead.
I took it upon myself to perform his post-mortem care. I felt it was my responsibility to do so. I was the person who he spent the last hours of his life with. I was the last person he laid eyes on, the last person he talked to, the last person to talk to him. I had to be the one to get him cleaned up and ready.
Unfortunately, as the lone CA on shift, that meant neglecting vitals on some other patients. God forbid the nurses take a couple of readings. ......... Not to mention that they told me not to bother. Somebody had to sit with this poor soul. God knows they weren't going to bother.
This guy died in pain. He spent hours bleeding out. He was in so much pain. I was NOT going to leave him alone. I knew he was dying, he knew he was dying. I could not, in good conscience, leave him alone to die by himself. My heart made me sit beside him and hold his hand. My heart made me clean him up to the best of my ability. It wasn't easy.
I work on a psych floor for elderly patients. Deaths are not a normal occurrence on our floor. This experience has been a profound wake up call for me.
He should not have been in so much pain. No one should have been drawing blood. That man should have been allowed to die with dignity, on his own terms.
I wish I could tell his kids that he was not alone when he passed. I was there with him. I was holding his hand. I know I am just a lowly CA, but I think his kids would take comfort knowing that someone was there with him when he took his last breath. That he wasn't alone. That someone who cared about him was there with him to the end.
I know it's not my place to say such things.Last edit by Joe V on Aug 31, '13
About FlufferNutter, ASN, RN
FlufferNutter has '3' year(s) of experience and specializes in 'peds, geriatrics, geri-psych'. Joined Aug '13; Posts: 21; Likes: 31.Aug 27, '13Its sounds like you have the number one quality needed to be in hospice....COMPASSION....Most of the rest of the hospice philosophy of care can be taught.
Unfortunately, being a DNR doesn't mean "no labs" Maybe these were things his family insisted on?
Ive seen my share of brutality at the end of life as well, and it is heartwrenching. There was once a pt who was in pain, receiving pain meds, when dr wrote order to give narcan (dr was a jerk). Shame on the nurse who gave it....If it had been me, I would have refused to administer. You just hope & pray those instances are few, and far between. Luckily I work for an outstanding hospice, with an awesome medical director who doesn't mind giving scripts whenever needed. You need to find the same....great hospices are out there....
Becoming certified is never a bad idea, but certainly not required. If you find a good company, they will teach you everything you need to know. There's a lot of good free reading online.
Good luck to you. Im sure you made a difference in your pts life....even if all you did was provide comfort.Aug 28, '13I am so glad he had you. I would suggest volunteering for a hospice, inpatient if you can because then you can see what the nurses do day in and day out. Hospice is a beautiful thing and it certainly sounds like you have the right mindset. Letting people die on their own terms, allowing them quality of life during their last days and months and dignity at the end is what it's all about.Aug 28, '13First, let me say there is nothing "lowly" about being an aide. It is a very needed position. Next, you already have the "heart" and compassion that hospice takes. They hire aides as well. Do a little research and sign on with a good company now. I don't believe you will ever regret it. I haven't. And please be sure to keep us posted on your hospice journey.Aug 28, '13I am called to be a hospice nurse, as well.
I got the calling after watching my FIL die from a terminal, untreatable disease at only age 57. I was already on track to begin nursing school, but I did not know what field I wanted to enter.
Last semester, I had my first patient die. It was on a med-surg floor. My instructor randomly assigned him to me. I am glad she did, because (unfortunately) his staff nurse was not his advocate, so I stepped in and offered to take over his care (except for med passes, since I am not allowed to do that without my instructor). This man's nurse gladly relinquished him to me, and it was a beautifully moving experience to give this man his last bath, his last oral care, his last hair combing... I was able to talk with and comfort his family. This family was so happy with me that they offered to hire me on the side as a private aide to stay past my clinical time since my instructor told me I had to leave when she did. I stayed as long as I could, comforting the family and talking to my patient, even though he had slipped into unconsciousness already. He died within a few hours after I left.
I feel like this experience reaffirmed my decision to become a hospice/palliative care nurse. I wondered how I would do with a stranger. It was easy with my FIL because I loved him so. It was easy with my patient last semester because I loved to care for him so. I can't wait to get started on my passion!Aug 28, '13Hospice nursing is indeed a wonderful way to make a difference in people's lives. I've been doing it for 10 years. Once you start working as a hospice nurse and get a couple of years of experience, you can sit for the certification exam. I don't know if it makes you a better hospice nurse, probably not, but you do learn a lot just studying for the exam, and it's another way to challenge yourself. My employer reimburses us for the exam fee and gives us an extra fifty cents to a dollar an hour, depending on if you are an LPN or RN. Hospice nursing can be emotionally wearing but it is also extremely rewarding. I say follow your passion. Good luck!Aug 31, '13Quote from FlufferNutterThen, with all due respect FlufferNutter - whose place is it?...I know it's not my place to say such things.
A crucial part of this profession is to advocate for our patients, which can be a tricky task at best. My take is that you were in a perfect position to observe and advocate for yours, and need apologize to no one.
As far as certification - I know there are cert programs for hospice, but don't know if there are any specifically for palliative care. Realistically, given the difficulty that hospice providers have finding healthcare staff to work for them, just getting a year or two of floor experience in LTC or Med/Surg is usually ample. If anything, I'd advise looking into other areas of certification as well (e.g. gerontology) and volunteering is an excellent way to get your foot in the door. If your schedule permits you may want to look into working as a home health aide for an area hospice as well.
As for me - I was my mother's primary caregiver from 2004 - 2008, and a goodly portion of why I'm inclined toward hospice is exactly what you noted - end-of-life patients are far too often marginalized and denied even the simplest of dignities. Certainly I squared off with plenty of healthcare professionals that tried to deny my mother basic rights & necessities during my stint as her advocate. Not always - there were nurses who went the extra mile for us, but far too often I ran into nurses who did the minimal amount of work needed, pointed out the call light & left. Pretty sad, really.
----- DaveSep 1, '13IEDave----
I was working my very first overnight shift, and I was the only aide on shift at the time. I was not made aware that his family was en route to the hospital. If I had known that, I would have made a point to talk to that family member. I know that if I were in their shoes, I would want to hear from the person that my loved one spent their last hours with. I would also have made sure that he was in a presentable condition and that his room was cleaned out.
Unfortunately, I was not told that family was coming within minutes. I feel really bad about that. I wish his family didn't have to see him in that condition. It must have been so traumatizing for them to see the evidence of what he endured in his last hours. Hearing about it is one thing, but seeing it with your own eyes is something else entirely.Sep 1, '13If your heart is in Hospice-do it. There are not many nurses that can take on Hospice nursing. I did Hospice for four years as an LVN, and one year as an RN. I am currently an ER nurse-I see Hospice patients come in every night because the family panics and calls 911 during the transition. You know what happens then... I hate to see the pain and anguish patients go through when death is inevitable. I am glad I have the experience in Hospice to help families understand what is happening. My goal is to return to Hospice once I feel my clinical skills are up to par. One thing about being a Hospice nurse in the field is you are it in a crisis-get your assessment and IV skills down! Then go for it! There is no greater privilege then to make sure your patients don't die alone (unless that is what they want), or in pain. Death is not painless for most, and if you have the composition needed to provide dignity for these patients-then you are a Hospice nurse! Good luck!Sep 2, '13I am an RN who returned to hospice about five months ago after having last worked in that specialty over six years ago. Interestingly, I happen to work with an RN whom I had also worked with all those years ago.
Upon returning to work after my four day weekend, (I work three 12s on, four days off, and so on...), I inquired to my outgoing coworker before report, as we were counting, "So, I see on the board that Mr. "X" is gone...when did he pass?"
My coworker stated, "He died Monday night...his family was able to get here from out of state just prior."
I said, "Oh that's so GREAT! I'd been so worried they wouldn't get here in time (this patient had wanted them here with him more than anything, and we'd spoken about that many times during my three shifts with him).
My coworker looked at me and chuckled very condescendingly, and asked, "Why do YOU CARE?"
My answer to him shut him up and we haven't broached the subject since. I said, "Why the hell DON'T you care?"
It's one thing to harden oneself to what one sees daily in order to be effective and not overly emotional at inappropriate times while working (though at least once a week I'm certain that I sit with a family after their loved one has passed and shed tears with them, hug them, and express prayers for their loved one, as well as for their suffering to be eased). All good hospice nurses do this, in one manner or other, with the families and patients whom they have grown close to. It makes it evident we are still human!
I told myself that the day I stop caring about my patients and their well-being, is the day I find another profession, and it's been 16+ years.
In my opinion, my coworker's mocking attitude makes it VERY CLEAR he has been in nursing far too long, and if he was my palliative care RN, I'd fire him. I will never, if it's within my power to make such a choice, accept care from an RN, a MD, or otherwise, of it's evident that they truly could not care less about their work, even if they don't personally care about ME yet...that's ok...their quality of work must matter to them, or there is no chance that I ever will!Sep 2, '13Equestrian, i am so thankful for you and nurses like you, the ones with a heart! far too often have i encountered nurses who do not want to get their hands dirty, do not want to be bothered, just put their hous in and do as little as possible - they went into nursing for the pay; probably realized at some point it is not at all what they expected and caring has never been their strong suit to begin...
so to all who want to go into the hospice field, if you do not care more about the patients than yourself it is not for you - oh and you must find a balance as well, so you do not drain yourself in a short time!
FlufferNutter, your heart is in the right place, go follow your heartSep 3, '13Because I've never been happier in a job.
Because even though I may dislike some of the things my company does, I still love what I do.
Because I never get mad when I am feeling emotionally drained, physically exhausted, or overwhelmed....because I will feel all those things in a different job/specialty, but will I still love what I do?Sep 5, '13You know when ANY JOB is" right for me"......when you don't have to ask yourself that question. ..
When don't see your" job" as a" job"
And when you look forward to going to work everyday....
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