My first experience with hospice care was way back when I was a CNA working for a home care agency and a co-worker was out sick. I was asked to cover for her, as the wife of a hospice patient was very distressed about her husband being at the end of life and no longer coherent, due to his disease process and heavy doses of IV morphine. I didn’t think I had any hospice experience at the time but agreed to the assignment, figuring that there would be something I could do to make things better somehow. When I arrived at the patient’s home, the distressed wife answered the door, escorted me in and then introduced me to some other family members who were there and had obviously been arguing. They all seemed to be annoyed with me for interrupting. They must have felt they needed to suddenly switch to being pleasant and polite on my behalf. The family soon left and I was alone with the wife and her dying husband.
I was so worried that I would say or do something wrong, but I really wanted to help and just kept remembering, “all I have to do is make things better somehow.” So I tucked my worries into an imaginary shoebox that I would use later to get sick in after I left. I sat with the wife for awhile and listened while she told me about how difficult this situation had been for her. Not only was her husband dying but she had to deal with her family arguing about what arrangements they wanted to be made both before and after her husband’s death. She told me she really didn’t care too much about the arguing; what frustrated her most was that she felt like she couldn’t communicate with her husband anymore. “He has been like this for a week now. The morphine helps a lot with the pain, but I don’t think he knows anything I’m trying to say to him.”
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“Ah,hah,” I thought. I just saw someone recently using sign language on a TV show. Maybe I could show her some way to communicate using her hands. I showed her (a skill I had totally plucked out of the air somehow) how to massage her husband’s hands in a way that expressed all of her feelings: love, anger, fear, disappointment. A few weeks later I saw the wife in the local grocery store. She seemed relaxed and content as she thanked me for showing her how to use her hands to communicate with her husband. (My imaginary shoebox had another use as a place to store a very special memory!)
If you are fortunate enough to join an organization that is focused on the right patient care values, hospice care can be a specialty filled with tremendous job satisfaction for nurses.
Consider all the services that a potential employer provides, and ask detailed questions about the process for documentation and patient case load when interviewing for a position. I once worked at a nursing home and saw the same hospice nurse come in regularly to see her patients. I was actively looking for another job at the time and discretely asked her about how she liked her job and the company she worked for. She told me she was required to work long hours with unending paperwork. She then broke into tears and quickly left with her rolling suitcase filled with a heavy load of documentation papers.
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Organizations that require excessive documentation or after-hours/on-call expectations are often not necessarily patient care centered, and nurses may not be able to enjoy the rewarding experiences that hospice care holds. In your job search for a transition into hospice care, look for an organization that is locally owned and operated, allows a low patient load for nurses with 1:1 patient care, family support and education and ongoing training programs for professional enrichment. Being able to provide good quality patient care is reason why we became nurses. All of your nursing education and professional background deserves a career that is rewarding and something you can look forward to each day.