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How do we do what we do?

Posted

Specializes in critical care, LTC. Has 20+ years experience.

I had a patients family member ask me the other day "how do you do what you do and still just go eat lunch?" I, for once in my life, didn't know what to say. How do we? How do you? I mean, I know we're helping people die with dignity and in peace. I know we support that families and educate them on EOL. That doesn't stop the grieving. That doesn't make it easier on the loved ones. Do we compartmentalize the grieve? Put it in a box on a shelf and move on to the next? Surely we can't take it home with us. We'd go crazy. Does it sound cold to say we love our jobs? How can we. We see death everyday. We hug crying family members. We listen to their memories. How do we do what we do?

BellionRN

Specializes in Critical Care. Has 7 years experience.

We just do. Like any other high stress job. I always think it's weird when people ask that question.

I, for one, am excellent at compartmentalizing. Not such a good thing. Needed to get away from ICU.

workingmama77, BSN

Has 8 years experience.

I used to work in a geriatric Acute Care unit with a large Hospice patient population. I have to admit that I loved taking care of my Hospice patients. I got to know them and their families, loved hearing their stories, and nothing was as rewarding as making sure their passing was comfortable and peaceful. I always tried to give my patients and their families the care and support I would want someone to give to me and my loved ones. My days were not always easy. I had many families that had a tough time letting go, no matter if the patient was in their 20s or their 90s. And there is nothing harder than trying to get someone with terminal agitation calm and relaxed. It's painful for the family to watch and was hard for me as well. I now work at a short term rehab facility but I am itching to return to Hospice. It was definitely the most rewarding part of my nursing career so far.

Personally, I usually say that working in palliative and hospice comes naturally to me.

It does not affect me in any bad way, death and dying in a natural process of living - just on the other spectrum of life as opposed to birth.

I have very good boundaries and do not "take work home" unless there is something very special. I find talking with my coworkers from the hospice team helps to decompress if I have to.

The reality is that each hospice professional must work diligently to develop and maintain good boundaries and self care. When we neglect those things we will suffer consequences and one of those might be cumulative grief.

That phenomenon is nothing to be taken lightly. Good hospice organizations/employers will have internal strategies and opportunites to assist grieving staff.

Jensmom7, BSN, RN

Specializes in Hospice. Has 36 years experience.

The reality is that each hospice professional must work diligently to develop and maintain good boundaries and self care. When we neglect those things we will suffer consequences and one of those might be cumulative grief.

That phenomenon is nothing to be taken lightly. Good hospice organizations/employers will have internal strategies and opportunites to assist grieving staff.

Setting limits and boundaries is indeed of utmost importance. I've made it very clear that unless I'm on call, my phone goes off at 5pm and doesn't get turned on until the next day I work-which means from Friday until Monday at 8am most weeks.

I make this very clear to families-any time they want to talk to me, they need to call the office, who then sends me an email. I would feel terrible if they had an issue or question and they got my voice mail. They understand, and usually say something along the lines of "You need to have time to yourself."

Some of our patients are only with us for a few days (or hours), so there hasn't been a strong emotional connection formed. For our patients who are with us longer, I've found that going to the wake provides closure.

I love what I do, as someone else said, it just comes naturally to me. Hospice isn't all sadness and tears. It can be very rewarding.

lifelearningrn, BSN, RN

Specializes in School Nursing. Has 7 years experience.

This is so hard to articulate. I have found such personal fulfillment with hospice and helping patients and families in this capacity. It's hard, but at the same time, if we didn't guide the families through this, who would??? Death is such a natural part of living, and there ARE WORSE things than death.

Tell them you do it because it's your pleasure to be there for others, no matter what they are going through. It's your pleasure to know people, even if it's at the end of their lives. And you're honored that they've allowed you into their lives when most others shy away.

OR.RN.4, BSN

Specializes in Operating Room. Has 5 years experience.

Hospice isn't all sadness and tears. It can be very rewarding.

This statement really resonates with me. I am a BSN student graduating in December and trying to determine what area of nursing will suite me best and allow me to function optimally and provide excellent care. I am 21 and I've experienced two end of life cases very close to me. My grandfather fought a 3 month battle with lung cancer, and my mother-in-law a 4 month battle with ovarian cancer. Of course these situations were painful, as losing any loved one would be, but I found so much joy/reward in remaining strong in these situations to be a comfort source for these individuals and interact with them in a positive manner regardless of their deteriorating situation. After the initial pain and shock, I didn't focus on the loss; I focused on maintaining happiness and comfort in the last days of my loved ones' lives. And I find that very important. I know that my husband was very hurt and emotional about his mother's situation, as was I, but the situation cannot be changed... with that in mind, I found it easy to make the best of the time we had, and really make this woman as happy and comfortable as possible while she began the journey of the end of her life.

Compartmentalizing was completely necessary. I definitely felt so much heartache in these situations, and I cried many tears out of the sight of my dying loved ones... and even a few with them when they needed someone to cry with. I believe I can be strong in this area of nursing.

If you have any advice/recommendations for me, please comment!

OR.RN.4, BSN

Specializes in Operating Room. Has 5 years experience.

*Bump*

OR.RN.4, BSN

Specializes in Operating Room. Has 5 years experience.

Anyone with experience in hospice nursing have any input to offer? I would really appreciate it!!

margin261

Specializes in Urology, HH, med/Surg. Has 15 years experience.

TROD, I'll offer what help I can, but bear with me- your post has me wanting to tell you a few different, maybe random, things.

First- I've not been doing hospice long as an RN, but it is the reason I decided to get my ASN after being an LPN for 14 yrs. I love it & it's probably one of the most rewarding medical jobs I've had...& I've worked in quite a few areas. You need to check the hospices where you live- most here won't hire new grads, they want 1-2 yrs of med/surg experience. I'd done a couple years HH as an LPN & did over a year in M/S before applying to hospice.

Next, kudos to taking care of family members during their last few months. I know from past & ongoing experience that is extremely taxing on your emotions from so many directions.

Taking care of patients during EOL can be taxing as well, but in a different way. And, yes, I suppose we do compartmentalize to an extent. But when you are able to 'take action' to relieve someone's pain, anxiety, etc, and make a visible difference in their comfort, it helps. You feel as if you've accomplished something worthwhile...well, because you have. You can't always get them as comfortable as you'd like- and those times are rough. I've found that most families are welcoming & grateful & willing to learn what you're there to teach. When they're not- it can be frustrating.

You need some time after graduating to firm up your skills with dealing with families & patients in a hospital setting where you have back-up, before going it alone in people's homes. It doesn't hurt to firm up your skills either- I have hospice pts I draw blood on, change Foleys & drain Pleurex catheters. I never had any ports or IVs, but it's not unheard of. You need to be really comfortable with yourself & your skills as possible. And exposing yourself to the ways a variety of people can & will act when ill & in stressful situations is only to your advantage! But know that people can & will surprise you!!

Hope that helps at least a little. Good luck!

OR.RN.4, BSN

Specializes in Operating Room. Has 5 years experience.

Margin261, thank you so much. This is great information to hear, very helpful. Glad you took the time to share this with me! I understand your perspective and the insight definitely helps me plan for what to do after graduating. Thanks again!

margin261

Specializes in Urology, HH, med/Surg. Has 15 years experience.

You're very welcome- glad to help!

Tex.

Specializes in Critical Care.

I needed to read this thread today. Right now. We w/d life support on a train wreck of a patient we have been keeping alive in my icu for several weeks. It was an emotional day for all involved, but driving home this eve I felt the lightest and happiest I've felt in a long time after work...like I've done something really good...something that really matters.

Anyone with experience in hospice nursing have any input to offer? I would really appreciate it!!

I did respond.

We all die. People think working in hospice is difficult because people die. I think it is difficult work not because people die but because of our societal denial of death and the cruel things we do to people because of the denial and ignorance about death.

It is not sad or terribly upsetting for me when the vast majority of hospice patients transition to their next experience, death and the afterlife that so many of us believe in. I am more upset with the deaths of our pedi patients. Those children who knew mostly sickness and discomfort in their physical lives. Those families who were robbed of decades of relationships, joys, victories, milestones, etc. Honestly, the more they suffered the easier it is to let go and find peace in the death. Otherwise it seems such a loss of so much potential.

I suspect that the fact that my brother's only child died when he was 7 after a cardiac surgical procedure has permanently broken my heart. That experience certainly impacted my decisions to leave the PICU and ultimately join the league of extraordinary nurses who provide palliative and hospice care to our unfortunate brothers and sisters.

Nurse Leigh

Specializes in Telemetry.

My only nursing experience is acute care so understand I do not have hospice experience. I have had a couple family members who used hospice and were able to spend the last months of their lives surrounded by family and friends.

I agree some acute care experience would help you be the best hospice nurse you can be. Understanding the disease processes and learning to navigate dealing with distressed family members will be easier with other staff around. As another poster mentioned, you may find yourself performing interventions designed to increase pt comfort.

Hopefully as an acute care nurse you will be comfortable asking the providers to order appropriate meds gor those pts who are actively dying, and able to explain to families what to expect.

Once you have some experience, I think hospice would be great.

**I think hospice is one of the areas where nurses can really make the most difference and use their training to a larger extent. Hospice is *real*important*honorable* nursing, although you may encounter some people who do not see it that way.

I always hated sending pts to a hospice facility or home with hospice when they are so close to passing because they and their loved ones will not benefit from the many wonderful ways hospice staff (not just nurses) can intervene and improve things.

Sorry for rambling nut wanted to give the perspective of someone who has seen too many deaths that would have benefited from hospice if family/providers/pt had chosen that route.

I think that it helps to have lived a certain number of years and to have a number of experiences in your life in order to be well accepted by the pt and family as well as to give you insights on what's going on with them. I don't have a magic number for the age or number of experiences that are a good starting point, but a fresh out of school 22 year old person would not be ideal. Are their exceptions - perhaps.

Without a doubt there are good young Rns and MSWs (social workers), but the ability and skill involved with the psycho-social-emotional issues of EOL (end of life) hospice issues require wisdom and experiences, and these are acquired over time.

A useful analogy: there are math prodigies, prodigies in music, painting, and dance. But not really in fiction writing, writing requires not just fascility in the ability to write technically well, but a good writer must be able to understand the human experience.

I am not saying that more years always confers more wisdom and experiences. And I am not trying to incite conflict between the generations. I am just giving my opinion.

GreatDaneAPRN

Specializes in Med-Surg, Hospice. Has 5 years experience.

TROD,

I agree with everything Margin261 wrote. I have been a RN for 5 years, the last 3 years being an on-call hospice nurse. I worked 2 years on a Med/Surg floor. That experience was invaluable. Being an on-call nurse, it is not uncommon for me to go to a patient's house at 2am. I am the one that the family is looking at to provide the appropriate interventions to make their loved ones comfortable. If I get "stuck" there are others that I can call. However, some people don't like to be called at 2am. I find that working in hospice is VERY rewarding. Here is one thing that I think is very important. EVERYBODY IS DIFFERENT. This applies to their disease process, thoughts on taking medications, effects of medications, and everything else.