Nursing is a second career for Derek J. Flores, RN, CHPN, BS, a hospice nurse in Colorado since 2012.
In 2020 Flores was a featured guest on the TV Show, The Doctors, sharing his expertise on end-of-life hospice care. He’s also written two books to increase knowledge of end-of-life care. Flores’ first book, Seven Keys to a Peaceful Passing, walks patients and families through common challenges and decisions they must make during their hospice journey. His second book, Letter to a Hospice Nurse, celebrates the lives of hospice patients and gives a format for surviving family and friends to process grief.
Flores has a Spanish mother and Mexican father and credits his background, education, and experiences for helping him connect with his patients to provide good outcomes.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Derek Flores, RN, CHPN, BS, and hospice nurse in Colorado.
Talk about your role in nursing.
I’m a hospice nurse case manager in the Denver Metro area. I work with a varying census of patients facing a terminal diagnosis. Besides regularly visiting my patients, I coordinate care between other disciplines, including CNAs, social workers, chaplains, and volunteers. Our team serves a widely diverse community of beautiful people from various backgrounds. Many of my patient visits can be considered ‘routine,’ others unexpectedly are filled with urgency to treat symptoms at the end of life. I work in the world of the ‘dying.’ It is a place and space where the dignity of each person is cherished and celebrated.
How long have you worked in the nursing field?
I earned my LPN in 2011, then passed the NCLEX-RN in 2012 after graduating from Laramie County Community College in Cheyenne, Wyoming. Nursing is a second career for me. I graduated from Colorado State University in 1991 with a BS in business administration. I spent a dozen years working in various industries in marketing and sales departments. I even had my own business for a few years.
Why did you become a nurse?
The seeds for me becoming a hospice nurse were sewn while observing both of my parents care for their aging, then dying parents. The love and compassion I saw from them was an inspiration. My mother, whose name is Crisela, has family roots in Spain. The Archuleta family arrived in Mexico in the 17th Century, then migrated to northern New Mexico, where they were farmers and ranchers. My mother’s first language was Spanish. She worked as an elementary school teacher in Pueblo, Colorado for many years before retiring. My earliest memories are of my mom and grandma speaking Spanish in the kitchen while the smells of a delicious dinner were in the air. The love, devotion, and endurance she showed in the care of her parents moved my heart. My mother and her siblings cared for Grandma Rita and Grandpa Ambrosio for fifteen years before Grandma passed peacefully at the age of 103.
My dad’s family was from southern Texas and Mexico. My late father, Jim, worked as a teacher specializing in special education. He was also a former Green Beret, champion runner, and weight lifter. He showed compassion for his students and the tenderness he had in the care of his parents at the end of their life. My parents were the first generation to earn bachelor’s and master’s degrees, breaking down societal barriers during my formative years in the 1970s and 80s. Their example set a standard for pursuing higher education and service to others.
I began the journey to become a nurse during a difficult period of my life as I turned 40 years old. During this time, I began to work as a CNA. My experience as a CNA helped form me into a well-rounded nurse. I learned how to provide basic care to my patients, who often lived in difficult conditions. After watching some of my supervising nurses do their work, I realized, ‘I can do that’! The next thing I knew, I was in nursing school. My family’s example of hard work and never giving up helped me make a career change.
What are the most important attributes of today’s nursing leaders?
In the hospice environment of today, a nursing leader has many hats to wear. In nursing school, we are taught to become multitaskers. As a hospice nurse case manager, I lead my interdisciplinary team by being responsive and communicative. If someone asks me a question, I respond as quickly as possible. I like surprising people with very quick responses. This level of communication sets a ‘Nursing Leader’ apart.
A hospice organization is multi-faceted with clinical, administrative, and management pieces. The clinical part of my work is also just as important because our patients depend on us to manage symptoms in often very stressful situations. When this happens, everyone looks to us for good nursing judgment, a cool head, and a soft heart.
What does being a nursing leader mean to you, and what are you most proud of?
I have been and will probably always be a bedside hospice nurse because my personality makeup doesn’t do well behind a desk or in the same location all day. I work out of my car, driving to each patient’s location. I lead my hospice team as a case manager by being attentive to my patients and team. My hope is they are inspired and motivated by my actions.
I’m most grateful for recognizing that nursing is a vocation I have been called to do. It’s rare that I don’t feel I have contributed to someone going through the most difficult time in their life. I’m most proud that I live out the legacy of my parents, Jim and Cris. Their example of serving others drives me each day. I’ve always wanted them to be proud of me.
Tell us about your career path and how you ascended to that role.
I’ve alternated throughout my career in hospice between case management and on-call roles with both for-profit and not-for-profit companies. The caseloads in some hospices can exceed twenty patients, so my career path has been marked by individual experiences with patients in difficult situations and measured by how I assisted them to be free of the symptom or symptoms they were struggling with.
Hospice nursing can be very emotionally trying, so I have taken sabbaticals by working in pediatric home health. I found that medically challenged children bring joy to everyone around them. They have helped heal my heart when I needed it most, preparing me to return to hospice nursing to do the work I’m called to do.
What is the most significant challenge facing nursing today?
My nursing work must be completed within a limited amount of time. There isn’t any wiggle room for this, so I can’t even list this as a challenge. It simply has to get done, no matter what. I never have a day like the previous one, so planning every moment of my week is almost impossible. I always have to try and stay ahead of the next patient emergency or death by pushing to get tasks done in the moment. I know if I don’t get something done now, it might not get done at all.
My family is most important to me. I am recently married at 54 to a wonderful woman, Kirsten. After many years alone, I now have a wonderful and kind companion. We enjoy our life together, including time with three adult daughters, one lovely granddaughter, and another who is making her debut in a few months. Our hearts are full.
I share my professional challenge of having enough time to meet all my work and personal responsibilities because it is common for hospice nurses to quit after their job takes over their lives. It’s not uncommon to work a full day, kiss your loved one as you arrive home, then head to your home office to work another few hours before you go to bed. It’s super easy to have hospice take over your life. Quite often, hospice nurses are paid on salary, so at some point, you may decide you’re working for a much-reduced rate than you thought you were. Then you choose to leave. The result is that patients get shortchanged by nurses who are rushed to get everything in their day completed. I encourage hospice nurses struggling with situations like this to ask their manager for adjustments. Caseloads can be lightened, geographic work areas can be shrunk to decrease time driving each day, and changes can be made if a manager wants to keep a nurse. Don’t be afraid to speak up if you have difficulty getting everything done.
In the end, if nurses and their managers don’t find solutions, the result can often be rushed nursing visits or nurses who aren’t fully present to their patients because they multitask. Our patients aren’t aware of all of the demands of our positions. They want to share what is happening with themselves on that particular day – needing us to meet their needs.
As a nursing leader, how are you working to overcome this challenge?
I try to put my patients first by being present to them. If I were to fail them by supporting them with my full attention, then not much else matters. I think my efficiency and proficiency in this role have improved over time. I also get up very early in the morning when I have work to do so I don’t take time away from my family.
I also have a mission outside of my bedside nursing practice. I write and publish books to increase knowledge of end-of-life care. My first book is Seven Keys to a Peaceful Passing and my second is Letter to a Hospice Nurse. I’ve also created journals that nurses and families can use to communicate with each other and keep track of important tasks like medication administration.
What nursing leader inspires you the most and why?
I had a colleague named Ted in the first years of my nursing career. I identified with him in several ways. He looked a lot like my dad with his black wavy hair and chocolate brown skin and had a similar background. Seeing another person like me, with Spanish and Indigenous roots, gave me the strength to look outward to solve our patients’ challenges. Ted is one of the most knowledgeable hospice nurses I’ve known. I still use his recommendation to help patients suffering from chronic nausea.
What inspirational message would you like to share with the next generation of nurses?
I’d encourage anyone considering a career in nursing to look deep and find the one thing that fills their heart. If it is helping those in need, you’ll never have a day in nursing where you don’t take away a feeling of satisfaction for your hard work. If you are a young nurse struggling to get traction in your career, please reach out to an experienced nurse to find a solution to your challenges. I’d also suggest that once you have a few years of successful experience, you realize you are a hot commodity. Don’t be afraid to ask for a competitive wage or salary. Negotiate the time off from work you need for your family and yourself. You are in high demand!
Is there anything else you’d like to share with our readers?
Nursing should be a vocation for everyone who chooses to do this work. By finding the intersection of your heart and mind, you’ll never work a day. Instead, you will have a life filled with purpose, struggle, and satisfaction for the benefit of others. You’ll have a life that matters.