Dear Barbara, As a professional caregiver I see a lot of the “hands-on” side of our industry.  I am side by side with the client in the home, but what kinds of duties does the Nurse do?  I see them come into the homes to interview the client and their families, ask about their medications, offer informational resources.  I am wanting to learn about the full scope of the Hospice Nurse.  As a caregiver, you form close bonds with your clients and families and mourn with them.  Do you see this much as a Nurse?  What are some of the challenges that are faced as a Nurse when working?  I realize it is not glamorous, it can be really hard work.  But what kinds of things should I be aware of that I may not have thought about yet?  What are some of the rewards (non-monetary)?

A very interesting question and perspective. The perspective of the caregiver as being “up close and personal” and the nurse as being more regimented and clinical.

For hospice nurses I think we need a blending of both aspects of care: personal and clinical. What kind of duties does the hospice nurse have? Physical assessments, then teaching. I think education is the primary role of a hospice nurse after having determined the physical status of the patient. Education in nutrition, comfort management, the dying process, and symptom control.

Taking care of someone at end of life is different than caring for someone who is going to get better–but most people don’t know this. We in hospice are judged by “getting better rules” unless we educate our families otherwise. That is why teaching is paramount to the work that we do. Without teaching our work of neutralizing fear and creating an environment for a gentle death cannot occur. As part of our teaching, reassurance and repetition become key tools.

To me a major part of a hospice nurse’s role is to connect with the patient and family, to support them during this challenging time and create a bond and a trust. When the connection is established then the assessment and education will be received and understood. ( This is why primary care hospice nursing is so important. You cannot bond and develop a trust if you have a different nurse every visit.)

I used to say I could teach any nurse the skills needed for end of life care, but that it was the nurse’s ability to be supportive and their people skills that were either within the nurse or not. I couldn’t give them that skill, and it is that skill that makes hospice nursing different from most nursing positions. That said, it is that skill of connecting with people that makes any nurse an outstanding nurse.

What are some of the particular challenges faced in hospice nursing? Learn how to not carry your patient/family’s emotional pain. Develop a ritual for taking care of yourself in regards to grief. Balance the physical tasks  of charting, meetings, and driving with the lack of quality patient/family time. See my new booklet You Need Care Too, Self Care For the Professional Caregiver.

What are the rewards? The satisfaction of a job well done. The knowledge that you have been able to support and guide a patient and family during a challenging time that most people don’t even understand. The knowledge that you have neutralized some of the fear that most of us bring to end of life. The satisfaction of turning an often frightening experience into a gentle, meaningful experience. As with birth there is a something special, spiritual, existential, whatever word you want to use, about being present at the moment of death, that same feeling that accompanies any monumental life experience.

Something More about What It Takes…

Often, the first thing that caregivers put on the back burner is self care.  Just like putting the oxygen mask on your face before helping others when flying, nurses need to make self care a priority.  Hospices around the country are using my DVD Care for the Caregiver  as a tool for avoiding compassion fatigue and nursing burnout.  They set aside an hour (lunchtime?) to watch the DVD together and discuss the suggestions I make for self care.  The staff feels proactive and uplifted.  The mood shifts in the environment.