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A Day in the Life of a Hospice Nurse

Hospice nurses perform many traditional nursing duties such as observing, assessing, and recording symptoms, and they still work closely with physicians, administer medications, and provide emotional support. Hospice nurses have a particularly tough job because, from the outset, they know that the patient for whom they are caring is terminally ill. The medications that hospice nurses administer and the symptoms they record aren’t intended to aid a patient in his or her recovery, but rather to make his or her remaining days as comfortable as possible. Most of the nurse’s duties involve minimizing pain. Although being a nurse of any kind is very difficult, dealing every day with a dying person requires an exceptional temperament, one that embodies great caring, patience, and resolve. Hospice care is what is known as comprehensive palliative medical care, i.e., treatment to reduce pain and other troubling symptoms as opposed to treatment to cure. The hospice doctrine states that terminally ill patients have the right to spend their last days in the comfort of their own homes, with their families, and hospice care provides professional medical care as well as supportive social, emotional, and spiritual services to accomplish this. The hospice nurse’s duties fall somewhere in between all of these ideals, with emphasis on medical care. Because they essentially act as home-care nurses and spend several hours a day with their patients in their homes, they become emotional caretakers as well. The majority of hospice patients have cancer, but others suffer from AIDS, Lou Gehrig’s disease, heart or lung disease, and other fatal conditions. Patients can be any age, race, or creed, and it can be especially trying on hospice nurses to attend patients who are as young, or younger, than they are. Hospice nurses coordinate the care of every hospice patient through an advising physician, provide direct patient care, evaluate the patients’ conditions, and serve as the liaison between families and physicians. A hospice nurse may also work with a patient’s social worker, home-care aide (who may do housework and provide hygienic care to a patient who is incapable of bathing and caring for him- or herself ), and physical, occupational, or speech therapist.

Paying Your Dues

All hospice nurses must be registered nurses (RNs) in addition to being certified by a state health department as a hospice worker. The first step is obtaining a bachelor of science degree in nursing (BSN). Although RNs aren’t required to have bachelor’s degrees, many nursing career paths are only open to those with a bachelor’s degree or even a master’s degree. Nursing education includes classroom instruction and supervised training in hospitals, as well as courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, behavioral sciences, and, of course, nursing. On top of the recommended bachelor’s degree, all states require prospective nurses to graduate from an accredited nursing school and successfully pass a national licensing examination. Then, to become a certified hospice nurse, you must have a current license as an RN and at least two years of full-time experience as an RN in a hospice-nursing practice, and you must pass the exam administered by the National Board for the Certification of Hospice Nurses.

Present and Future

The first hospices were founded and operated by volunteers to help the ill with everyday tasks like shopping, baby-sitting, and car-pooling, almost any aspect of a common family routine that may be impeded by illness. Hospice care has evolved into a nationwide network of health care professionals, volunteers, and social service professionals whose goal is to help the terminally ill live out their illness with dignity. Today, hospice care is a benefit of Medicare and is also covered by Medicaid. Private insurance companies, HMOs, and managed health care plans are also starting to offer hospice care as part of their benefits. Employment in home health care is expected to grow exponentially over the next several years and opportunities will be best for nurses with high levels of education and advanced training.

Quality of Life

PRESENT AND FUTURE

For those registered nurses attaining certification as a hospice nurse, the first two years mean gaining the experience to become certified. As such, earnings won’t be great. Many RNs will work additional nursing jobs, and hospice nursing can be a part-time occupation. The hours can be long, and the hazards of the job are plentiful. There are physical threats (nurses can throw their backs out moving patients); nurses can, and often do, become attached to their dying patients. Hospice nurses, however, are often of a superior strength who fervently believe that what they learn from their patients and can give back to them and their families far outweighs any emotional suffering they must endure.

FIVE YEARS OUT

At this point in a hospice nurse’s career, he or she is certified and can expect to enjoy higher earnings. Responsibilities change little for a hospice nurse, however, and physicians still oversee patient care and expect nurses to carry out their orders to the letter.

TEN YEARS OUT

At this point, the hospice nurse’s salary has probably leveled off. Having experience, however, can lead to a higher-level administrative job within a hospice. For example, hospice nurses can become the executive directors of an agency, the directors of nursing or clinical services, or quality assurance managers. These positions will take a nurse out of the field, away from actually caring for patients, and place him or her in an office, where the nurse will make ethical, financial, and administrative decisions that focus on the patient in a different realm. Hospice nurses who choose to make such a move can increase their annual incomes to as much as $63,000.


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