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.
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.
More and more I amazed at my program. We receive training in EOL care in our second semester. ...I bet this is part of more and more programs as the US catches up to other countries on EOL care.
I wish I could say the same of my program. My instructors say there simply isn't enough time to cover everything. Students who are interested in hospice might get to spend one day with a hospice nurse during our 2nd year. Unless I have a change of heart over the next year, I plan to work in the hospice unit where my mother was a patient a few years ago.
I am amazed at how many physicians have received no End of Life education. Sure, they know how to treat CHF,CA, Cardiomyopathy etc, but have no idea how to manage ALL end of life symptoms when the treatment plan ceases to be cure. Part of my day is educating patient's and their families. It shouldn't have to include the education of physicians. Some of the doctors are eager to learn. Otheres want no part of educating from a mere nurse. I think that Hospice and End of Life care should be a part of every physician's education
I think that making sure you have a positive mindset is the biggest thing in being successful. As a new grad, you're programmed to want to help people, and you are in hospice, but on a much different level than most of us were accustomed to in school. These people are sick and although they may have good days, they are going to get worse and it's the hospice nurse's job to make that transition as comfortable and positive as possible. When you're working with these patients, the family is just as important; they're going through this with the patient, too. Putting yourself in their shoes is important. You will be with the patient during the worst time in their life and you have to expect some backlash and maybe harsh words from the family or patients during this time. Every person copes differently and the hospice nurse can be the person they take their feelings of despair and frustration out on. Just remember that the good days these patients have can be a direct result from a hospice nurse being with them and being an outlet to let their feelings out to and help them grieve.
thank you soo much for the helpful advice. I may be going into hospice & have those exact worries about family backlash and just being a woman going into other people's homes by myself (not to mention being new and having to make clinical decisions on my own) but yes I very much want to just help people the best I can. feel free to email me about your hospice experience. I could use all the encouragement I can get. ([email protected]) thanx
wildflowergirl
8 Posts
I wish I could say the same of my program. My instructors say there simply isn't enough time to cover everything. Students who are interested in hospice might get to spend one day with a hospice nurse during our 2nd year. Unless I have a change of heart over the next year, I plan to work in the hospice unit where my mother was a patient a few years ago.