The Role of the Hospice Nurse

When you’re a nurse you know that every day
you will touch a life, or a life will touch yours.
 – Author Unknown

Samaritan hospice nurseI’ve always loved that quote. As a hospice nurse, every day is different but, the one common denominator that remains consistent is that I care deeply about my patients and their families. I can say with confidence that every day I’m touching lives --  or a life is touching mine.  It’s a privilege to be welcomed into someone’s home and to guide them through this journey at the end of life.

(photo cred: istock.com/Juanmonino)

What is hospice nursing?

My role as a hospice nurse is to focus on end of life and provide hands-on care to manage pain and other symptoms. I order supplies, obtain necessary medical equipment, and ensure medications are available. I also perform patient assessments and create a plan of care for all professional caregivers to follow.

My day starts bright and early as a hospice nurse.


Learn about the other members of
the Samaritan hospice care team >>

The Day Begins

It’s 7:00 AM and the sun is peeking through my kitchen blinds creating an asymmetric pattern across my kitchen table. I enjoy its warmth, let out an exhale, and take the first sip of my coffee.  I reach for my work phone and begin to scroll through the emails I’ve received overnight to be updated on any inquiries or changes affecting my patients.

I refill my medical supply bag, grab two protein bars, fill up a large bottle of water, kiss the kids and the husband goodbye,  and then get on the road.

Samaritan Hospice CareBob & Rosemary 

I’m at Bob’s* house by 8:30 AM.  He’s 77 years old with a diagnosis of heart failure and late onset Alzheimer’s disease with behavioral disturbances.

His wife Rosemary answers the door when I arrive and she immediately begins filling me in on Bob’s health-related issues. I can see Bob sitting comfortably at the kitchen table.  He’s trying to sip OJ from a straw and having a little trouble. Rosemary instinctually comes to the rescue.

I’m concerned about the onset of a new wet cough Bob’s been experiencing. I listen closely to his lung sounds and hear wheezing. We decide he should use one of his nebulizer treatments, and I tell Rosemary I’m going to order Robitussin DM to help with the congestion. Bob has no fever and no change in his sleeping habits so we’ll just keep a close eye on him.

Rosemary tells me Bob has been getting increasingly more agitated when he has a bath from the home health aide. She says the aide is so patient and gentle, but she’s worried she’ll be upset by Bob’s behavior. He was always a kind man, never used foul language, and always respected women. But his dementia has changed things. I reassure her that we know the Bob we’re seeing isn’t the real Bob. Her eyes tear up and we hug. She thanks me and says how hard this journey is.

I make sure Bob’s medication are refilled and say my goodbyes. I remind Rosemary that she can call anytime, day or night, and we’ll be there. Bob smiles and waves.

It’s 9:30 AM

Lila

I receive notice that one of my other patients has just passed away as I’m pulling out of Bob and Rosemary’s driveway. As a hospice nurse, I am the one who pronounces a patient’s death.  I never want a family to wait for me to arrive. From the side of the road I make a phone call to have a colleague visit Lila, my second scheduled appointment of the day.

I’ll look forward to seeing her at our next appointment. Sadly, I think, that I hope she makes it. Her cancer is spreading quickly and it’s getting hard for her to chat without being short of breath.

samaritan hospice careHenry, June, and Family

I always worry about a loved one being alone with a deceased family member. But, when I arrive at Henry’s home at 10:30 AM, his house is full of family and friends. I’m relieved to see all three of his children and their spouses, plus the grown grandchildren there to support Henry’s wife, June. Everyone seems to be grieving appropriately – some with tears and others with mild laughter remembering better times. I offer my condolences. This process must be handled with grace, respect, and concern.

Henry is in a bedroom at the back of the house. I ask the family if I may go see him. I always ask first. Then, I tell them I will answer any questions when I return. 

Alone in the bedroom, I assess Henry for any signs of life.  After concluding Henry is deceased, I return to the family in the kitchen to confirm the news. I make sure to assess how each family member responds and then request if I may provide post mortem care.

I dim the lights in the room to maintain Henry’s dignity. Henry’s son asks if he can help turn his Dad. He says it will help with his grief. I totally understand and ask if any other family members would like to participate too.

The funeral home arrives to take Henry’s body. I ask the family if they have any more questions, offer my condolences one last time, and prepare to leave.

Henry’s family expressed such gratitude for Samaritan’s care. June tells me how she greatly appreciated the help of the home health aide bathing Henry, and how Henry appreciated the spiritual support counselor easing his fears and spiritual concerns. I am thankful Henry’s death was comfortable, at home, with his loved ones – and Samaritan – at his side.

Jane

samaritan hospice careIt’s almost noon now. My next stop is Jane’s house. She is a 49 year old with ovarian cancer that’s spread throughout her body.

She recently ended up in the hospital from side effects of a trial chemotherapy drug that didn’t shrink her tumors.

Her husband, Larry, their two teenage daughters, and Wanda, her 65-year-old mom, help care for her.

This will be my first visit to Jane’s house. I make sure to call ahead. Hospice care is new to them and I want to help prepare them mentally for my arrival at their house. On the phone, Larry is very gracious and thankful I’m coming. He says Jane has had a very rough night.

I’m in their driveway by 12:15 PM. Larry and Wanda look exhausted and scared – and completely relieved I’m there. Within a few moments they say they didn’t want to bother me so they didn’t call the 800 number for Samaritan; Jane has been short of breath for the last few hours and can’t even talk without gasping for air.

I’m pained to hear they didn’t call sooner. Samaritan is here to help at any time of day.

Jane lays in a hospital bed in the living room with an oxygen mask on. She barely opens her eyes when I lean over her and call her name. I tell her who I am and reassure her that I’m there to make her feel better. She nods.

I ask if she’s in pain and she rigorously nods her head yes. She points to her abdomen which is largely distended from the buildup of fluids  Her agony worsens even after a dose of pain medication, and I can’t get a handle on it.

This severe, uncontrollable pain makes Jane an ideal candidate for The Samaritan Center at Voorhees, a freestanding inpatient hospice center.  At the Center, she can receive the intensive symptom management she needs to be comfortable. I take the next few minutes to explain to the family the concept of the inpatient center and they agree it would be the best choice.

I then proceed with all the necessary consents; reconfirm Jane has a do not resuscitate (DNR) order – which is an inpatient hospice requirement -- and funeral arrangements in place. The hospice team social worker arrives and schedules the ambulance transport.

Before I leave, I make two more quick phone calls:  Jane’s physician to give him an update and the on-duty inpatient center nurse to provide a report.

I take a deep breath and roll down the window. The breeze feels lovely hitting my face.  I’ve spent two and a half hours with Larry, Jane, and Wanda. My stomach growls loudly. I reach for my protein bar.

samaritan hospice careMillie

It’s 2:45 and Millie’s house is just around the corner. She’s 104 years old, sweet as candy, and has a smile as bright as the sun. Her entire face lights up when she sees me. She’s living with COPD and can’t get up too quickly. She scoots to the edge of her seat to give me a hug.

I then give her cat, Tucker, a few quick scratches on the head before he runs off towards the kitchen.

Jackie, Millie’s live-in care taker, arrives in the doorway with Millie’s afternoon snack and the list of supplies she needs. I tell her I’ll order them and they’ll arrive tomorrow.

Millie tells me how well she is doing. Although Jackie pulls me aside to say she’s sleeping more than usual, and not eating as much. We decide Jackie’s going to keep an extra-watchful eye on Millie and call Samaritan as soon as she has any questions or needs assistance.

I finish my assessment, check her medications, and place any re-orders. It’s been a short visit and I offer my apologies. Millie holds my hand and whispers that anytime she sees me is a pleasure, and to drive safely.

I am comforted by knowing she is OK for today.

The End of the Day 

I enjoy a late-afternoon cup of coffee at Starbucks as I update my patient records. Once the day’s details are entered, I stand up to stretch, gather my bags, and head home.

It was a long day and I’m exhausted. But, I look back and think of Bob & Rosemary, Lila, Henry’s family, Jane, and Millie and know that I made a difference in their lives today.

Being a hospice nurse and helping these families at such intimate and difficult time in their lives is a privilege.

I’m proud to say I’m a hospice nurse, and I’m ready to do it all over again tomorrow.


 

*Names have been changed | Photo cred: istock.com

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