How do we do what we do?

[nursecathi]

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?

[margin261]

You're very welcome- glad to help!

[Tex.]

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.

[toomuchbaloney]

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]

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.

[chopwood carrywater]

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]

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.

[BerryhappyRN, MSN, RN]

Because you have had significant personal death experiences, please work hard to not be a "grief thief". If you feel your own emotions rising while working with a hospice family, excuse yourself and go dry up. Their experience is not your experience, and their grief is not yours to feel.

Not saying you will, it just may be difficult at first.

Good luck!

[Dublin37]

I've been a hospice nurse for five years, and what I often tell them when they ask, is, it is a privilege, to be part of such a sacred time. I cannot imagine anything more meaningful then easing someone's passing. To remove pain and fear. I often offer prayer. I remind the dying and family that death is painful, and it's okay to fall apart, cry, be angry. But know, we all have to die, and at least their loved one was (usually)at home, with those they love. I always speak of a "soft" passing, the hope that they are relaxed and at peace. Death is not ugly, or frightening. It should be peaceful and sometimes joyful.

[SeaH20RN, BSN]

There is a good book out "One Foot in Heaven". Written by a hospice nurse.

I don't do hospice but interested in oncology. Good luck.

[KMRN81]

I usually answer with "it's a calling". (And it is!) They usually respond with "it takes a special person"...and I respond that we are all special people with unique gifts. I could never do some types of nursing (burn unit *shudder*), nor could I imagine working in construction - in the middle of a dangerous highway, with difficult physical demands (way more than it takes to turn & repo a BB patient!)

[judyrn0604]

I was spending time today with the daughter of a patient that passed away on Friday rather unexpectedly. While he did have multiple myeloma with a severe decline last week, we generally don't lose a cancer patient the same day that he becomes imminent. In any event, she was with him when he died and she described that he opened his eyes just before he died. She seemed to be upset by this. I explained to her that in my experience, it has always felt to me like they are looking up to where they are going and it is one of the most special times I have ever been able to spend with someone. It feels like they are looking up to God and then they pass. I think this helped her to process his death in a more positive manner. This was a very sad case all the way around.