Celebrating Compassion: Honoring Hospice and Palliative Care Professionals
November is Hospice and Palliative Care Month, and if you're thinking of becoming a Hospice and Palliative care nurse, are already working as one, or want to celebrate the Hospice and Palliative care nurses in your organization, you've come to the right place!
What Does a Hospice and Palliative Care Nurse do?
The exciting thing about working as a Hospice and Palliative care nurse is that you do a bit of everything. Patients come from a wide variety of backgrounds and suffer from a myriad of ailments. Many are cared for at home by their families without medical experience, and you are their lifeline. They look to you to manage their medication, provide symptom control, wound care, nutritional assistance, equipment troubleshooting, behavioral and mental health care, and more. You likely have an entire team behind you that includes a physician, other nurses, CNAs, social workers, spiritual care, massage therapists, and volunteers. Still, you are on the front line, alone in the room with the patient and their family as they look to you for answers. It's a highly empowering role that can also leave you feeling a bit overwhelmed at times.
What Does a Typical Day Look Like for a Hospice and Palliative Care Nurse?
First, there is no "typical" day for a Hospice and Palliative care nurse. While you may have an assigned caseload, your schedule must flex according to their needs. Furthermore, the Hospice organization works as a team, so it's not uncommon to be called to see another nurse's patient who is in distress. You'll have laid-back days and others that feel hectic, but you cannot predict your day ahead of time.
What we can talk about is how your day might go. You'll start by calling for or listening to a report. You'll need to know if any of your patients called in with concerns while you were off and if other nurses saw them. You'll also gather information on possible admissions and patients who have entered the "actively dying" phase. Next, you'll prioritize your patients by need, starting with those in distress or actively dying.
From there, you'll begin visiting with your patients. One thing I always found interesting was the many places this job takes you. You might start in an old 100-acre farmhouse, where the patient's husband hops down from his tractor to meet with you upon arrival. Next, you might see a single man living in a camper next to a creek whose greatest joy is feeding the ducks outside his door. Your day might take you into the heart of the nearest city where, in a lovely brick rowhome, you are greeted by a large gathering of family sitting vigil by their loved matriarch. Between these home visits, you could see patients in hospital or long-term care settings where staff fluctuates between stoic and heartbroken over a patient they've become attached to.
Finally, you might pull up on the street so close to home that you can see your own front door and visit a neighbor who is grief-stricken over the loss of their husband and has no idea that you live just a few doors down. With each stop, you're welcomed into a patient's home, never knowing what you'll find but constantly aware that your presence is needed. While being accepted into each person's comfort space is an honor and privilege, it's only sometimes what you'd expect. Sometimes, the inside of a patient's home isn't what you'd expect. In fact, any nurse who desires to work in hospice care should prepare to see patients in different environments, some of which are extremely unpleasant.
You'll likely have some documentation left to do at the end of your day. In fact, a day without leftover documentation is uncommon. There's much to manage, communicate, and complete, but it can't happen during your visits. Instead, your visits will be filled with questions, answers, assessments, wound care, medication administration, family and patient education, tears, laughter, and sometimes even prayer.
Why Become a Hospice Nurse
If you're feeling the call to Hospice care, there are some things to consider. Despite what some outsiders believe, Hospice is not a depressing and sad job. Yes, there are hard days. There are more challenging days in Hospice than in some other fields. However, as a Hospice nurse, you get the privilege to be directly involved in and witness some beautiful moments. Sitting with a patient while they reminisce about the best days of their lives, watching as they light up when long-separated family and friends arrive for a final visit, and feeling the tension in the air dissipate as they make amends with loved ones over disputes that suddenly feel inconsequential will send you away with a renewed understanding of the most essential things in life.
Moreover, YOU get to be the one who isn't afraid to help. Death is a scary reality for many, and a person's condition in their final days often sends family, friends, and caregivers running. Yet, they can always depend on you to be there, without fear or judgment, to support and care for them during their transition.
So, when considering a career in Hospice, the question to ask yourself isn't "Can I handle it?" but "Can I see myself doing anything else?"
Hospice Nurse Toolkit
If you've decided to become a Hospice nurse and have landed your dream job, it's time to build your Hospice toolkit. Start by evaluating the state of your vehicle. Is your car well-maintained, clean, and in good working condition? If so, it's time to look at it as a traveling office. While most of your documentation will be electronic, you'll still need to stock up on some supplies.
Stock Your Car
When you're out in the field, there isn't always time to return to the office, so you must ensure you have everything you need to get through your shift. Start with extra chargers and cords, a steering wheel lap desk, and electronic-safe sanitary wipes. If you'd like, add a small cooler to keep additional water bottles and snacks.
Next, create a "clean" and "dirty" bin in your trunk space. These should have tight-fitting lids. Your dirty bin will hold scrubs that must be laundered and any other discarded biohazard waste. Always place dirty items in a biohazard bag before placing them in the bin. You'll also need a small sharps container.
In your clean bin, keep a supply of disposable gloves, disposable chucks (pads), basic wound care supplies, incontinence care supplies, and PPE. It's also advisable to travel with at least two extra pairs of scrubs and an extra pair of shoes. The last thing you want is to arrive at an appointment that is still soiled from the last one.
Choose Your Workwear Wisely
Speaking of scrubs, you must be strategic in choosing your workwear when hopping from home to home. Layers are essential for comfort because you never know what will happen at your appointments. Always wear an undershirt and bike shorts, which, when necessary, will allow you to remove your scrubs and place them in your dirty bin before getting in your car. It'll also help you maintain your temperature as you transition from your vehicle to the outdoors, to homes of all temperatures. Next, choose scrubs with antimicrobial properties. Even if your shift goes smoothly, you must maintain infection prevention practices continuously.
Antimicrobial scrubs provide protection to you, your vehicle, and your patients. Choose jogger pants or pants with a tapered leg to avoid your seams dragging along the ground and transferring dirt and germs from one location to the next. Top off your uniform with an antimicrobial warm-up jacket, which doubles as a warming layer and is easy to remove without changing your entire uniform. Some Hospice nurses choose to skip them, but a bouffant scrub cap is a must-have if you want to keep your scalp and hair free of debris (and sometimes lice). Finally, always top your scrubs off with a highly visible retractable badge reel. Always be sure that patients, families, and facility staff can quickly identify who you are and know why you are present.
Fill Your Travel Bag
Once your vehicle is stocked and ready, you'll need to stock your nursing bag. You can choose any style you'd like, including a backpack, but the best option for a Hospice nurse is the Nurse Mates Ultimate Medical Bag. It is the perfect size and fits everything you need to provide end-of-life care. It's also water resistant, so you can thoroughly wipe it down before and after each visit.
Inside, you'll want to pack whatever electronic device your organization provides. This varies from a laptop or tablet to a handheld phone, but regardless, you'll need it for your documentation and access to medical records. Next, a compact carrying case is handy and lets you quickly retrieve commonly used tools such as your pulse oximeter, sphygmomanometer (or Writstmate BP monitor), penlight, and thermometer. Alongside your carrying case, pack your stethoscope, a stethoscope watch since clocks are increasingly rare, and a stethoscope light so you can see in the darkest rooms.
Choose another pocket of your medical bag to fill with wound care necessities. Here, you'll place a wound care guide for identifying wound stages and best treatment options. Also, a pair of scissors, medical tape, paper tape, basic bandages and gauze, safety goggles, and a measuring tool.
Always carry some extra chuck pads in your bag's largest pocket. These help protect the bottom of your bag from surfaces in the home, for creating a work surface when performing wound care, and for patient care. Additionally, you should always carry at least one brief of each size so you can grab it for a patient in a pinch. Also, stock up on disposable gloves, surgical masks, and biohazard bags. Something many nurses only think of once they need them is pill organizers. The little plastic rows of boxes labeled with the days of the week, or even those that include sections for AM, Noon, and PM, are fantastic for patients and their families struggling to track medications. If you want to go above and beyond for your patient, offer to fill the pill sorter during your visit.
In some of the smaller pockets of your bag, toss in a few other miscellaneous necessities, starting with a gait belt. You'll be assisting patients of all mobility levels, so you'll find you use this frequently. A section dedicated to office supplies will be helpful, as pens and notepads are perfect for taking notes and writing down reminders. At the same time, blank cards are ideal for leaving notes of encouragement and sympathy. Remember to toss in some spare batteries for your equipment. Finally, keep hand sanitizer and sanitizing wipes within easy reach to maintain good infection control practices throughout your shift.
Remember to keep a few self-care items in your bag as well. Some lip balm, an extra deodorant stick (trust me on this one), and your favorite hand lotion go a long way toward keeping you comfortable during a long day or night of visiting patients.
Recognizing a Hospice and Palliative Care Nurse
If you're an administrator looking for a way to show appreciation during this month of recognition, we've got you covered. First, let's talk about what nurses don't want. The following are really bad ideas for making the nurses in your organization feel appreciated.
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Nurses don't spend their days waiting for an incredible appreciation gift. However, receiving one that took no effort has the opposite effect. If you want to truly make your nurses feel appreciated, consider gifting them something that is helpful and requires no effort on their part.
Some great ideas include:
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A small note of appreciation with a thoughtful gift goes a long way toward letting your staff know you care and recognize how hard they work each day to care for their patients.
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Tammy McKinney, a seasoned Registered Nurse, distinguished healthcare writer, and founder of HelpfulHospiceNurse.com, is committed to using her medical knowledge to educate, inform, and entertain healthcare workers and their patients. To connect with Tammy directly, check her out on LinkedIn.
