Dear new hospice nurse,
Congratulations. For whatever reason, maybe you have decided quality of life is important or maybe you have had a first hand experience, your path has guided you to becoming a hospice RN. Welcome to a whole new way of nursing. On this side we are able to actually get to know patients and families, we become an integral part of the most difficult of journeys and learn to treat symptoms and not numbers.
I was thinking about what I would have wanted to know as a new hospice RN. Honestly, I still sometimes feel a bit wet behind the ears even though I have been doing this for over 3 years. A very seasoned hospice RN once told me she didn’t get comfortable until year 5. Now, that’s not to say that you will feel clueless until then. Your prior nursing experience will help you so much. My prior nursing life included med/surg, stepdown, icu and pacu. Since my background was a good amount of critical care, not treating numbers and values was a difficult step for me. You will find your own challenges and will find your own unique ways of facing them.
What advice could I possibly give you?
What will help ease those butterflies?
I thought about this for a while… these are just a few that I thought I would have liked to have heard when I first started
First off, please please please give yourself grace and understanding. This isn’t a role you will be proficient in within a week. Each day, each visit, you will learn something new.
Do not beat yourself up for mistakes. Surprised I said that? Yes, mistakes will happen. They probably happen more than you and I care to admit. Even the most diligent and experienced nurse will make them. Instead of taking them as negative, use them as learning experiences. My biggest mistakes are always my biggest wisdom gainers. As long as your mistakes were not done intentionally, remember that you are human and we err. Take it, learn from it and move on.
Be prepared to have families or patients that just do not like you. Yes, it’s happened to me and guess what? I totally took it to heart. But, at the end of the day, who knows why? If you continue with them, remember that they are going through a bitterly difficult time. Be patient and kind. If they want to, they might reveal why. If not, remember that you could be the most perfect strawberry in the bunch, but, if someone doesn’t like strawberries…..
Sometimes, families begin to depend on you maybe a little more than they should. Yes, you are such an important factor in the care of their loved one, but, getting pulled into their every problem can become exhausting. Protect yourself by gently laying out boundaries. I am not saying don’t listen to their issues, but, try to limit your involvement. Remember, your other patients need you, also. You cannot expend all of your emotional energy on one visit.
It’s ok to touch people, as long as they are ok with it. I don’t just mean for assessments or baths. Hold a hand. Listen to the patient actively. They are the one that you are there for. Sometimes, those that are passing yearn for just a touch or someone who cares about their day. It’s so important that we never forget that they are not just our patients, but, fellow humans.
There will be moments that are overwhelming and harder than you could have imagined. Let me tell you that it is ok to cry. Try to be discreet with it, but, a family might sometimes find it comforting to know that you aren’t made of stone.
If you cannot find the right words or you don’t know the answer for something, say it. Yes, they are looking to you for answers and perfect words, but, saying “I don’t know, but will get you the answer”, is far better than leading them down the wrong path.
Do not forget yourself. I admit that I am still so guilty of this. Drink your coffee. Eat your lunch. Take breaks to just breathe. Don’t always take your charting home with you. Set a hard time deadline because it’s easy to spend all night working. But, Wednesday’s patients need you just as much as Tuesday’s. Your family needs you. You need you.
When someone is transitioning, it is never a straight and easy path that is easily predictable. Those patients will make you out to be a liar all of the time. I tend to use this expression with my families because it helps me not feel like such a clueless goof when a patient surprises us all and hangs on for days. You don’t have a crystal ball.
Find your work tribe and lean on them. I have my go to girls – my work wives. I ask them the questions I would almost be embarrassed to ask anyone else. I gripe to them. I cry to them. Their support allows me to do my job. I know that they feel exactly the same way.
Be sure you speak to your families in a caring but direct manner. When the patient dies, say just that – he/she died. Don’t say that they passed on or are gone. This may seem harsh but, it is actually much kinder. It allows them to start grasping the situation and begin healing. Do this even before the patient passes. Don’t be afraid the word dying or death.
There will be patients that you will never forget. There will be patients that make you cry even when you are away from the situation. Congratulations, you are human and can feel things. This makes you a more caring nurse.
I feel like I could just go on and on, but, will not. You are about to embark on a journey unlike any other. I honestly never felt what real nursing is like until I became a hospice nurse. It is holistic, all encompassing and challenging nursing. You will get to know the intricacies of someone’s existence. This is an honor that occurs with each patient that you care for.
Take care of yourself. Take care of your heart. Take care of your mind. The universe put you in the place for some specific reason. You can do this. You will do this. There will be days where you will feel on top of the world and days where you feel the world is crushing you. It’s about finding beautiful moments amid the difficult days.
Enjoy your journey because you are on one. Your heart and soul will be touched in ways you never thought possible. Your views on life and death will never be the same. When you sit with a patient as they take their last breaths, the bitter beauty changes you.
So, my dear one, enjoy it. Savor the moments. All of us are cheering you on and are so here for you. Welcome to the the most unforgettable of nursing and life experiences.
I just started late December as a hospice nurse . I was a home health nurse and an RN case manager since 2005. It’s difficult changing my thinking from push to improve to embrace the decline and provide comfort. Thank you for the encouragement and that yes I’ll make mistakes and to forgive myself.
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