What's It Like to Be a Palliative Care Nurse?

Lisa J. Webster, RN, BSN, CHPN

Disclosures

July 14, 2017

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Would Palliative Care Be Too Sad?

I became a palliative care nurse, I like to say, not by intent but as a result of "unseen forces."

Figure 1. Lisa Webster, RN, BSN, CHPN. Courtesy of Lisa Webster.

My last semester of nursing school was on the acute medical and surgical oncology unit at Virginia Commonwealth University Health Center in Richmond, Virginia. I felt passionate for caring for these oncology patients who were struck with newly diagnosed, life-threatening cancers of all types. They showed such courage and strength in the face of the unknown. In May of 2000, the Palliative Care Unit opened, which at that time was a new specialty at the hospital. Several of my coworkers transferred to that unit and urged me to do likewise. At first I resisted because I believed that working in that environment would be too sad. I had just experienced a sudden and traumatic loss in my own life and needed time to heal. But the patients I bonded with most were those who were facing their own mortality, so the following year I transferred to the palliative care unit, where I have worked for more than 16 years as a bedside nurse.

My training for this specialty has come from many sources. I learned about pain and symptom management from our nurse specialist, Patrick Coyne, who was instrumental in opening our unit. I learned about the signs and symptoms of impending death from a hospice nurse. I took the End-of-Life Nursing Education Consortium (ELNEC) training and became a certified hospice and palliative care nurse.

A Day in My Life as a Palliative Care Nurse

Every day is different on an acute palliative care unit. It is never boring, and frequently the energy required to "get the job done" is overwhelming. We always start the day with our "safety huddle" where we briefly review all of the patients on the unit, highlighting their safety risks (fall, skin, seizure, aspiration, and contact precautions), code status, and other major concerns. Then we grab a COW (computer on wheels), obtain individual "bedside" reports from the previous shift, lay eyes on the patients, and begin. Mornings are very busy as patients and their families have many needs. Some patients are very symptomatic and in distress, and you have to prioritize who gets seen first and what to do when. We have a high prevalence of patients experiencing delirium, pain, dyspnea, nausea, vomiting, constipation, and incontinence, among other symptoms.

Figure 2. Left to right: Lisa, nurse manager Jessica Grey, and volunteer Barbara Greer posing with Rennie, the "palliative care pooch." Image courtesy of Lisa Webster.

We have a very supportive and diverse staff who work together to care for our very complex patient population. Nurses, physicians, bereavement coordinators, chaplains, social workers, physical and occupational therapists, dietitians, and others all play a part in the palliative care setting . Our newest and most beloved member is a dog named Rennie (Figure 2), who is our palliative pooch. She is a facility dog who works Monday through Friday from 9 to 5, making patient and family visits and emanating her canine karma to soothe souls and frayed nerves, as well as to channel grief.

What I Love About Palliative Care Nursing

Why do I stay in palliative care nursing? My passion for my patients and their families is unwavering. I get to know many of my patients on a very intimate level. I find their stories fascinating. Staring death in the face is not a job for the faint of heart; it takes courage, compassion, determination, and faith. My personal belief is that our lives do not end with physical death. My spiritual beliefs sustain and comfort me, and when appropriate, I encourage and support that belief in others. I find joy in the beauty of nature, the love shared by patients and their families, the companionship of pets, and the awesomeness of the arts. My coworkers are a large part of my "family" and we support each other in many ways. I am blessed to be given this opportunity to be a palliative care nurse.

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