Of all the various facets of the nursing field, hospice, many people think, is the most emotionally difficult to work in. But Connie O’Malley, RN, a hospice nurse for the past three years at Gilchrist Hospice Inpatient Unit in Towson, Maryland, loves her work.
That’s not to say that the work isn’t challenging; it often is. But it also holds a lot of rewards.
How long have you worked in hospice? Why did you get into this area of nursing? What drew you to it?
I’ve loved hospice for more than two decades. I was a geriatric nursing assistant about 25 years ago and worked on one of the medical nursing home floors. A patient with metastatic bone cancer could no longer live at home, and there was no space on the inpatient hospice unit. His prognosis was approximately four to six weeks. He was 60 years old an army veteran and a really wonderful, beautiful human being.
When I first met him, I didn’t want to bond with him because he was dying. And so I put up a barrier around my heart and gave him good care, but was not my normal self like I was with other patients. I found this exhausting after only a week.
One day when his hospice nurse came to check on him, we spoke about this. I told her that I was holding back from getting to know him and love him because he was dying. But at the same time, I felt like maybe our paths have crossed for a reason. This hospice nurse said, “Don’t think that we don’t love our patients and grieve for them when they die. When we care for people in their homes, we are invited into their families. We sit in their favorite chairs and interact in their lives in a way that is different than any other kind of health care. We grow to love them, and when they die, we are sad. You are allowed to love him, and it is okay if you cry when he dies. You can’t have a meltdown where you need to be sent home or take a bereavement day. But if you go take a 5- or 10-minute break to cry on the patio, that is okay. You will find your own way to grieve the patients you lose—whether it is a special song you listen to on the way home or if you drive home silently. You will make your own way to grieve them and honor them. But please love your patients.”
Some people might say that working with those who are dying is depressing. Do you feel that way? Why or why not? What do you think you bring to people who are dying?
Working with dying people is an honor and completely humbling for me. I get to care for people when they are at the very end of their life, and for their families in one of the hardest parts of life’s journey. The majority of families open themselves up and allow me not only to provide my nursing expertise and care for their loved one, but also love the patient and their family.
When you care for someone for several weeks, nurses and staff become family to the patient and their loved ones. It is an honor that I am aware of every day that I work. It is much like being with a friend who is giving birth—it is a special place between this world and the next. To be able to help someone’s body be comfortable through the process and provide education and support and normalcy to their loved ones is an amazing thing.
When I first came to hospice, a dear friend told me he thought that it was such a depressing job. I don’t allow myself to focus on the fact that I lose patients. I feel the exact opposite—I get people. I get to care for people at their absolute most vulnerable state of being. I get to hold their families’ hands and help them learn how to let go. I get to give them education to make a terrifying situation less scary and a little bit easier. Every family changes my life, and I don’t feel that I lose them when they die. I feel fortunate that our paths have crossed and that I have been able to be their nurse at this time.
How do you keep your spirits up?
Being a hospice nurse is exhausting—especially in the inpatient setting. We care for people of all ages. Young people are especially tough on our hearts and minds, and sometimes when families are struggling, it wears on us.
To combat the heaviness that I carry, I make sure that when I am off work, I do things that make me happy and are relaxing. I’m a creative person. I like to crochet, and I make sure that I have projects to work on. I spend time with family and friends enjoying them. Simple things like getting coffee at a diner or spending the night at my mom’s apartment and watching movies together are priceless.
What kind of skills do nurses need to be able to work in hospice?
I came to hospice with four years of cardiac telemetry hospital experience. Despite our patients being at end of life, we use all of our nursing skills daily. We still have patients that have complicated care that needs to be given, so anyone with any kind of nursing background would do well. Very often a lot of people have the idea that everything is very low-key in hospice, but honestly there are nights that I am clinically busier than I ever was on a cardiac unit.
What are the biggest challenges of your job?
Families who fear medication interventions for comfort. Even though hospice has been around for 30 years, there is still a lot of fear around administering morphine and other comfort medications to patients. My biggest challenge is to educate families in what pain looks like and reassurance that medication does not accelerate death. The second biggest struggle is educating people about normal end-of-life occurrences—mainly the truth that everyone stops eating at end of life and that it is normal. A lot of families and visitors struggle when our patients stop eating.
What are the greatest rewards?
The greatest reward is to meet a family on their first day who is struggling with a terminal diagnosis for their loved one, and who are so resistant to any comfort measures and any education about what happens at end of life, and to watch them walk the path and see their minds and hearts change and grow in this process.
A lady was with us for 10 weeks, and all of the staff grew to love her and vice versa. When she was in her last few days, I approached her husband to ask for a good time to come say goodbye to her as I did not want to intrude on his and their daughters’ time with her at the end. He put his arm around my shoulder with tears in his eyes and said, “You come when you want to and as often as you’d like; you are family. Please tell all of the staff too. You have loved us all and become our family, and you are welcome at this time just as much as the last 10 weeks.”
If nurses would like to work in hospice, is there any specific training, certifications, or experience that they would need?
A valid nursing license in whichever state you want to work in. I would say that hospice is a field that a nurse has to be drawn to. It is intense and there is a lot of psychological and emotional weight that we carry on a daily basis. A large number of the nurses that I work with have had family members—parents especially—who have died under hospice care, and it seems that we seek out this work to repay that care that we received when our loved ones were dying.