6 Lessons Hospice Nursing Has Taught Me

This month marks my one-year anniversary of being a hospice nurse! I still cannot believe that I got the job that I had my eye on when I graduated nursing school. And I cannot believe how much I have fallen in love with it!

I want to do a whole hospice nursing series on the blog, and I figured the perfect place to start is by talking about the major lessons that I have learned the past year as a hospice nurse.

If you are interested in one day becoming a hospice nurse or you are just generally interested in the field of hospice nursing, then I invite you to read the following 6 lessons I learned in my first year as a hospice nurse.

Some of these truly surprised me!

Here’s what to expect:

• Death can be peaceful
• The process of death can be unpredictable
• Family dynamics cannot be ignored
• The IDT is the core of hospice services
• Open and direct communication is important
• Sooner or later hospice nurses will need to confront their feelings about death

Death can be peaceful

In all honesty, I have struggled with death anxiety for most of my life. It is almost ironic that I chose to enter the field of hospice nursing, which has death at is center.

For most of my life I viewed death as something to fear and something that was always painful.

I always thought that most people would know when they are about to die. And I figured that feelings of their imminent death would cause panic and hysteria.

However, just a few weeks into working in hospice I realized that is not the case.

I have witnessed so many deaths in the past year and the majority of them were dignified and peaceful.

One of the great things about hospice is our commitment to keeping patients comfortable. We have a large variety of medications to choose from that allow us to manage any uncomfortable symptoms that may arise.

The medications plus the compassionate efforts of family and staff often allow the patient to die a peaceful death.

The first death that I witnessed was sad, but it was also very inspiring to me as someone who has always feared what the final moments of life would be like.

I watched this man lay comfortably in his bed. Without pain. Without anxiety. With his family by his side. He closed his eyes and took his final breath. And then his body was at peace.

The process of death can be unpredictable

Whenever I began my hospice training, I learned all about death and the dying process. I learned about what symptoms to expect as a patient declines and how to manage those symptoms.

I even studied different scripts to utilize when educating family members on what to expect in the final days of life. I figured that the process of dying happened in a predictable way.

While it is true that the decline of the body may follow the stages described in literature, the actual death of the patient is often unpredictable.

Every body will experience death in a different way.

Some patients may not exhibit any of the typical signs and will pass rather quickly or suddenly. I once took care of a patient who I figured had weeks left to live. The day I took care of her she was eating well, up to the bedside commode with assistance, and talkative.

She died the following day.

I was dumbfounded by her passing!

Other patients may exhibit an array of signs of imminent death but may take many days to a couple weeks to pass.

I have taken care of numerous patients who are in an “active” state of dying for many days. Often family and staff are simply waiting for the moment that the patient takes their final breath.

I learned quickly that to be a hospice nurse, you have to accept the often unpredictable nature of death.

Family dynamics cannot be ignored

For better or worse, whenever I worked in the hospital as a med-surg nurse, I rarely paid attention to family dynamics. Unless it was such a dramatic situation that it impeded my nursing care, I often did not give family dynamics much thought.

I figured it was not my place as a nurse to be involved in a patient and their family’s personal affairs.

However, in hospice nursing it is a vastly different story.

If you work as a homecare hospice nurse, then you will undoubtedly be caught in the middle of family dynamics on a regular basis.

You are in the homes of these families every week, so it is natural that you become aware of the ins and outs of these people’s lives.

Since I work in a hospice inpatient center it may be reasonable to think that family dynamics are less apparent, but that is not the case.

We have so much family drama occur! This is an extremely sensitive time for everyone involved and often tension runs high.

There are sometimes deep-rooted issues that span many years that surface during this stressful time.

There also tends to be many disagreements among family about the care that the patient should receive.

You would be surprised how many people come out of the woodworks and want to put in their two cents whenever a family member is put on hospice services.

Thank goodness for our awesome social workers!

The Interdisciplinary Team (IDT) is the core of hospice services

Teamwork is dreamwork!

The teamwork in hospice is truly such a delight to be a part of.

The IDT is made of many individuals:

• Physicians
• Nurses (RNs, LVNs)
• Nurse Aid (CAN)
• Chaplain
• Social Worker

All of these individuals work together to provide the highest quality of care for the patient.

Each member of the team has their strengths and weaknesses. As a team, we help balance each other out so that the patients and their families receive the highest quality of care.

As a nurse, I am not qualified to talk about religious queries with a patient. I can offer compassion and empathy, but it would not be my place to give religious guidance to a patient.

That is where the chaplain steps in! I just give the chaplain a call and he can schedule a visit with the patient at their convenience.

If there are some heavy family dynamics at hand and I feel like the family could benefit from some mediation, then I can give the social worker a call and see if they can help iron out the situation.

Not only can we all rely on each other in sticky situations, but we also meet up monthly to discuss each patient and identify any areas that need improvement.

The teamwork that I have experienced in hospice has been a delightful experience and has taught me to be even more of a team player!

Open and direct communication is important

The imminent death of a loved one is a scary time for all involved.

Many individuals are not familiar with hospice and our practices. This often requires the IDT to educate the family…and reeducate..and reeducate.

Family members can often times be resistant to certain recommendations made by hospice.

For instance, as patients decline it is not advisable to continue to push food and drink if the patient has no appetite.

This is often very disturbing to family members and they will try to continue to force the patient to eat.

It is in situations like this that the nurse needs to be open and direct with communication.

The family needs to be educated in a way that they will understand and can accept.

It may take many attempts to get the family to understand. Or they may never fully accept some things.

However, it is still imperative that the family continue to be educated.

As difficult as it is to accept, hospice is for individuals who have been given a terminal diagnosis.

Family will often need to be gently reminded that certain symptoms or issues will not resolve and may even worsen.

It is our goal in hospice to keep the patient comfortable and promote their feelings of well-being- in whatever way is most meaningful to them.

It can be uncomfortable to talk about the inevitable death of a patient, but I have learned it is always in the best interest of the family to remain honest about what to expect.

Sooner or later hospice nurses will need to confront their feelings about death

As I mentioned at the beginning, I have experienced death anxiety for a large portion of my life.

When I began working in hospice, I was concerned that I would have a difficult time being around so much death.

I would be lying if I said it has been a breeze!

There are times when things have been rough. Certain patients and situations can take a toll on your mental health.

I can remember one patient that deeply affected all the staff that was involved in her care. It was an incredibly sad situation and hit home for a lot of us.

I was derailed for about a month and a half after that patient passed on our services. I felt a resurgence of my death anxiety and would feel increased levels of anxiety during my normal day to day activities.

It was difficult to experience those feelings but I have always been acutely aware of the issues that I personally have with death. Therefore, those feelings did not come as a surprise to me.

If a nurse is working in hospice and he/she has never even explored their ideas about death, then they will likely be in for a rude awakening!

The nurses that I work with have talked openly about their views on death and do not shy away from the conversation.

I have learned that it is best to take the bull by the horns when it comes to all the “death talk” and avoid avoiding the conversation.

I hope that you enjoyed reading about the 6 lessons that I have learned while working as a hospice nurse. Every nurse will have a different experience but I am glad you took the time to read about mine.

Hospice nursing is an amazing field and I am extremely proud to be a part of it.

You can also check out Hospice Nursing FAQ if you want more information about hospice nursing.

I would love for you to take a look around while you are here.

You can view my blog posts here or all the study material I create for nursing students here.

As always, feel free to reach out to me if you want to chat.

I would love to get in contact with other hospice nurses out there!

Happy Nursing!