So, You Want to Be a Hospice Nurse?

nurseNursing is a field that continues to be in high demand across all aspects of medical care from pediatric wards to emergency rooms. As the role of palliative care grows, the need for nurses within hospice is growing, too. A model of care built around the end of life, palliative care works to help alleviate suffering for patients with a terminal diagnosis. Through pain and symptom management as well attending to the unique needs that emerge in a sickness where recovery is not the goal, nurses, doctors, chaplains, grief counselors and other caregivers work to make the experience of impending death as kind, pain-free and loving as possible.

 

Hospice care is one of the main ways that palliative care is administered within the United States, and as with all health care, nurses are vital to its mission. If you’re wondering about the variety of careers available to nurses, hospice is one of the more specific and challenging, and while much of the job of being a nurse is the same within a hospice environment as it is in a more traditional hospital setting, there are some distinct differences that set the hospice nurse’s job apart.

Pain and Symptom Management

Nurses have always engaged in patient care at the level of managing pain and symptoms, and their work has been instrumental in the field of palliative medicine ever since the hospice movement began in the 1960s. As a hospice nurse, your goal will still be to help a patient manage pain and difficult symptoms, but because of a terminal diagnosis, pain and symptoms — not cure — are the central focus of patient care.

An Interdisciplinary Team Approach

Good medicine has always required the work of a skilled and well-functioning team, and hospice care is no different. However, hospice environments place a much greater emphasis on the patient’s overall well-being, not just physical health. The psychological, spiritual, emotional, familial and therapeutic needs are all taken into account — even the family and community of the dying person are within the realm of care. To that end, a hospice nurse will find himself working alongside team members from a more diverse professional field than a nurse within a more traditional care setting. Hospice team members will often include:

  • Doctors
  • Social workers
  • Grief counselors
  • Chaplains
  • Nurses
  • Nurse assistants
  • Volunteers

Degree, Certification and Other Requirements

In order to be a hospice nurse, you are required to have the same credentials as a nurse within any care setting, but the requirements get steeper from there. Most hospice services will want nurses to have their RNs and to have at least one full year of acute care service. From there, skill sets and temperament come into play. A hospice nurse must be able to provide excellent assessment and have good communication skills so that the interdisciplinary team can provide seamless care.

Compassion Fatigue

People within the caring professions have a higher incidence rate of burn-out than other fields. In hospice nursing, compassion fatigue can set in and wreak havoc on a nurse’s life. Coping with the stress and emotional difficulty of working with patients, and their families for whom all hope of recovery is gone can be exceedingly taxing. Not every person — regardless of the quality of their education, their intelligence level or their abilities as a nurse — will be able to handle the hospice environment. If you are a nurse who already struggles with burn-out, it’s possible that a hospice position could worsen how you’re feeling. That being said, many nurses find hospice work and the team approach to care rewarding and relieving in other ways. Struggling with the emotional toll exacted on you within a traditional health care setting does not mean you aren’t fit for hospice work. But caregivers within a palliative environment must always be alert to the symptoms of compassion fatigue:

  • Isolation from others
  • Depression
  • Excessive complaining and/or blaming
  • Substance abuse
  • Compulsive behavior (overspending, gambling, overeating, etc.)
  • Poor self-care
  • Nightmares

Being a nurse who provides care to patients and families at the end of life is an incredibly rewarding experience, but it isn’t for everyone. While nursing is a profession full of meaningful challenges, hospice is unique in the field. When faced by someone with the experience and temperament to thrive in the face of death, a nurse can help lessen the pain of dying for individuals and those who love them.

About the Author: Clem Aaronson is a contributing writer. A long-time volunteer for hospice, she just recently completed her nursing degree.

 

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