Supporting someone with a life-limiting diagnosis or talking about death can be difficult for many people, but not for a hospice nurse.
What’s it like to care for patients and their families in the end-of-life process?
Maryette Williamson, RN, BSN, knows firsthand from working as a Nurse in Fayetteville, North Carolina.
We asked her about her work. What follows is our interview, edited for length and clarity.
Maryette Williamson, RN, BSN, is a BAYADA Hospice Nurse in Fayetteville, North Carolina.
How did you get interested in working as a home hospice nurse? What drew you to it? How long have you been doing it?
I had a home hospice rotation in nursing school, and I loved it. Shortly after graduation, my mom passed, then my sister, then my dad. I was working through my grief at that point. Both my dad and my sister passed away in hospice. That was pivotal because it was such a beautiful experience. It was the best situation a bad situation could be, and I realized then that I wanted to provide that for other people. I’ve been doing it for a year and nine months.
Briefly explain what you do as a home hospice nurse. What types of patients do you serve? What ages are they, and how are they approved for the program? What do you provide for them?
I have several facility patients, but I also have patients in their homes. Building on what patients and their families already know, I provide a lot of education on what to expect near the end of life.
I provide nursing care to manage symptoms and prevent complications, such as positioning, skin care, respiratory, and hydration support. I may also identify and treat an infection. I provide both physical and emotional comfort care—anything from ordering a wheelchair to promote mobility to holding the phone up to a dying patient’s ear so they can hear their family member say, “I love you.”
If I have a relatively stable patient who hasn’t had many changes, I go in and talk with them. I reconcile their medications and make sure they’re still on the same medications we have listed. Then, I check their vital signs, do a head-to-toe assessment, and ask if they have any questions. I chart most of my visits, then go to my next visit. I see about five patients a day.
I’ve had a patient who was 57, and I’ve had a patient who was 106. Hospice can run the gamut in ages—younger patients typically have cancer.
Patients qualify for hospice if their doctor gives them a life expectancy of six months or less. Specific Hospice Local Coverage Determination (LCD) guidelines consider different disease processes, functional limits, and co-morbidities when referring someone to hospice care. We have recertification periods, so every six months, their doctor can recertify someone in decline to comfortably remain in hospice care for the remainder of their life.
Did you need to get additional education to become a hospice nurse?
No, I’ve done long-term care for most of my nursing career. I became familiar with many disease processes people face at the end of life. In long-term care, I did a lot of end-of-life care, even though patients weren’t necessarily in hospice.
However, there was a learning curve from long-term care to hospice. The most significant difference in hospice is our focus on quality of life rather than a cure. That was the most important change for me. Even in a facility, people look for ways to treat a progressive disease. But when a patient has chosen hospice, we prioritize making them comfortable. We treat anything to optimize their quality of life but don’t try to cure their life-limiting disease.
In hospice nursing, you have to meet people where they are.
What do you like most about working in your job?
I like the fact that I get to be with the whole family. It’s almost like you become part of their family; they trust you, and you comfort people through your presence. It’s rewarding to educate a family so they know what to expect and how to help, so they’re not scared and can make the most of their time together with someone they love.
What are your biggest challenges?
I have a great team, but at the end of the day, you’re out there on your own. You don’t have anybody standing next to you to chime in. You can’t draw a blank, so the biggest challenge is the autonomy of it. I’m grateful for the experience and clinical skills I learned in long-term care because they made me more confident in hospice nursing.
What are your greatest rewards in your work?
When the family wants and trusts you to be there and says, “We couldn’t have done this without you.” I want to be that calming presence and provide the knowledge so they can be present for their loved ones’ passing. That’s the biggest reward.
Is there anything else that is important for our readers to know?
Death is a part of life. We’re all going to die. I don’t find that depressing when I am in a place to make that as positive of an experience as possible. Don’t let the idea of hospice scare you away from becoming involved. People think it’s doom and gloom, but there’s so much more than that.
If you decide to become a hospice nurse, don’t think you’ll learn it all in a month. I’m still learning. It’s a different kind of nursing, and there’s a lot of room to grow your skills and experience. Getting your bearings and building your confidence takes time.