2019 Lessons Learned as a Hospice RN - a year of Thanksgiving

[pmabraham, BSN, RN]

Dear friends, please allow me to share with you the various lessons I've learned as a visiting hospice registered nurse.

One of the primary lessons I've learned as a hospice nurse is that being mortal teaches one about the value of human life as well as how to live life. The journey continues to bring me closer to God, and at the same time expose my weaknesses, my sins, my frailty before God. I'm sure I've not seen it all, but what I've seen over the past year...

--- like late afternoon today where I was the one to tell the spouse their loved one has less than one to two weeks to live and to witness the breadth and depth of emotions of the spouse and their adult child; they were told their loved one was terminal, but they didn't recall being told how terminal.
--- having a patient take their last breath before you and witnessing the love of the family who was also present.
--- helping to calm down a family member who was punishing themselves to the point of an anxiety attack from not waking up at 4:00 AM to give their loved one a medication to help them be more relaxed.
--- the joy of getting a patient's pain so well controlled they were able to plan and go on a family vacation before they died a comfortable and natural death.

Each day, each moment God cared for me and directed my paths though I fail Him often. I'm thankful that God has not given up on me.

Speaking of not giving up on people, it was a surprise on having patients ask me if I will be there all the way for them, something to the effect of hearing "my oncologist gave up on me, will you?" I still remember the one patient ask me at least once a week before they passed if I was coming again, did I give up on them. As I write about this patient, it brings tears to my eyes. Their spouse was one of the handfuls who broke down in front of their loved one crying, "I cannot do this anymore, I just cannot do it." People don't understand how hard it is to take care of someone who is terminally ill. This is why I often share with my families that with no disrespect to the angels in heaven, they are angels here on this earth.

Some days are hard, some days I want to cry for no reason other than the sadness about being around those who are dying, and trying to be supportive to the families. Yet, I cannot see myself doing anything different. God called me, I must answer to the best of my ability.

On the psychosocial aspect, Professor F. (one of my RN school professors) has been an inspiration because I find her teaching about mental health to apply to almost all social interactions. Assess and validate feelings. Do your best to make sure the other party knows they are being seen, know they are being heard. Validate their feelings, and then pick the most positive outcomes to encourage them to engage and move forward. Always encourage, always show how much you appreciate them.

For the one daughter who showed so much self-doubt about her ability to care for her dying mother, find and highlight the areas she is awesome, and give regular praise. For the recovering drug addict managing the pain medication of a dying patient, praise them for how well they are doing while letting them know you are keeping counts for all home patients (not just their loved one). Encourage them with positive ways to deal with the stress of caring for someone they love deeply who is dying before their eyes.

For the elderly daughter who has her own health issues caring for her dying mother, give them praise and bring up memories of the journey that are pleasant. Show and remind them you have been watching, have been hearing, and care.

You see, it is not only the terminal who are dying but from a point of view their loved ones dying inside from watching the ones they love to whittle away and die. They need to know they are not alone as they let their loved ones know they are surrounded by love.

Know, we are called by God to make a difference in this world. Doing so will not save us; I'm not talking/writing about doing good works. Good works NEVER save anyone. Yet, God works through His people who are called for His purpose for His Glory and Honor. Will you answer your calling?

When I first started writing this summary, I was thinking of all of the clinical sides I've learned from becoming an expert in pain management including opioid conversions, knowing among the best practices for symptom management (pharmacological and nonpharmacological), I was reminded of the #1 reason why I love hospice, and why while the clinical side is important it can never be number one... and that is people matter the most.

So I encourage each and every one of you, dear friends, to look for every opportunity to be grateful for the life you have, to appreciate others even with their flaws (we all have flaws), to be kind, considerate, gentle, and show compassion towards others. We truly have no clue what others are going through in their lives; you might be the bright light in someone's storm through your acts of gracious kindness without knowing it. Be that lighthouse!

[Norine13]

Thanks for sharing. I am just starting my hospice career, looking forward to it.

[Kitiger, RN]

On ‎1‎/‎1‎/‎2020 at 7:46 AM, pmabraham said:

Assess and validate feelings. Do your best to make sure the other party knows they are being seen, knows they are being heard. Validate their feelings, and then pick the most positive outcomes to encourage them to engage and move forward. Always encourage, always show how much you appreciate them. 

Well said!

I can't even begin to say how important this is.

[Daisy4RN]

Thank you for sharing your experience's. It can be hard to care for dying patients and their families. Sounds like God has placed you in exactly the right position and you are a blessing to your pts.

I am also thankful that God has not given up on me, or anyone else who asks.

On 1/17/2020 at 8:19 PM, Norine13 said:

Thanks for sharing. I am just starting my hospice career, looking forward to it.

Good luck to you, it sounds a little cliche but it really is an honor to care for hospice pts.

[freesia29, ASN, RN]

My father passed in hospice care almost one year ago. Now I am considering hospice nursing as I get closer to finishing the LPN-RN program.

[Christielhhc, BSN]

Thanks. I am starting new to hospice but I am definitely going to say yes once offered. I'm new on here as well. I definitely feel called but scared out of my shorts.

[IMOKAY, BSN]

Brilliant insights. I wish you could mentor me in person.