Specialty Spotlight

Specialty Spotlight: Hospice and Palliative Care for Empowered Nurses


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Offering a unique career path, hospice nurses provide care to both patients and family in a holistic setting that many nurses find empowering, according to Janet Snapp, RN, MSN, OCN, CHPN, president of the Hospice and Palliative Nurses Association.

Snapp, who also is the vice president of clinical services at Hospice of the Bluegrass, in Lexington, Kentucky, has spent 17 years working in hospice care. Here, she shares what she enjoys about the specialty and offers advice for new nurses and new graduates interested in pursuing a rewarding career in hospice nursing.

What do you enjoy most about being a hospice nurse? What is most unique about the specialty?  

When I first came into hospice nursing, I had been a nurse for 14 years and had really done every other kind of nursing. I found hospice care to be much more holistic than any other area. It gives more autonomy, allows nurses to do the things they learned in nursing school and allows them to care for the whole family in their own setting.

What else is unique? 

The other thing that is unique is that in hospice and palliative care the patient has a diagnosis where they know they have a life-limiting illness, but what you do in this type of care really makes a difference. Some people think this would be depressing, but you go into it knowing you can’t change the outcome, but you can help them have a much more meaningful or symptom-free journey and do the things they want to do. It gives you the opportunity to help the families engage in a way that’s meaningful. There’s a lot of growth potential at the end of life where people can do a lot of reconciliation with problems or issues, making peace with the past.

It’s a very empowering type of care, and I’ve always felt it was an honor to be in that situation with patients and their families when they’re so vulnerable.

What can a new hospice nurse expect in the first few months or the first year on the job?  

Hospice requires a lot of pharmacology and a lot of pathophysiology to understand what might be happening with the patient. Whereas you have other professionals in a hospital setting, you don’t have as many people you can bounce things off; you really are the eyes, ears and hands and the only one who’s interpreting the patient’s symptoms. You have to be competent and mindful as far as what drug interactions are possible, and you have to establish trust and intervene in a setting where it’s the patient and family driving care. You are an advocate for them so they can have things how they want them. It may not be how you want it, but you have to respect their choices.

What is the most challenging part of the role of a hospice nurse? What are the keys to overcoming those challenges?  

What you have to keep in mind is that you are in someone else’s home; whether it’s the nursing home, the long-term-care facility or the hospital, this is one of the only specialties in which the nurse follows the patient. New nurses sometimes can get overly involved and the most challenging part is finding out how much of your own personal self to invest. You cannot go into someone’s home and not have an intimate relationship with them and not become involved, but you have to make sure you are mindful of your professional role without going deeper and doing things that are really the family’s role. People think they’re being helpful, but they’re stepping over boundaries. Keep in mind what the family wants, but also what is appropriate for the nurse as a professional.

You usually find out how that is by going too far and then backing up and say you’re not going to give that much of yourself. You do have to give some of your self, but it’s a matter of finding that balance of sharing. Know what’s appropriate to be sharing and make sure you’re always conscious of the power imbalance because you are the provider.

What is one critical piece of advice you would offer a nursing student or new graduate interested in pursuing a career as a hospice nurse?  

We talked about having good pharmacology and pathophysiology, but some past life experience and maturity are also essential. It’s good to have a general med-surg background before you go into hospice and palliative care. However, we have trained nurses for longer extended periods if they have potential to grasp the essential elements of hospice care.

Maturity and the capacity to operate autonomously will help a person with less experience be successful in hospice care, and practicing in a general med-surg unit helps build that experience level.

What are the important steps to take to prepare for the hospice nursing career path?  

As a student, partner with hospice organizations in community. Where I work we have students who come and rotate for a semester to work with an experienced hospice or palliative care nurse, in a clinic or consult service, and see how they like that type of care. Students might also like to volunteer in a hospice setting while they’re in school. Hospice is the only health-care system in which our government mandates that a percentage of care provided has to be provided by volunteers.

Hospice began as a grassroots way to have the community care for the people dying in their community. Now, 5 percent of the service provided in hospice care must be provided by volunteers in order to maintain and enhance that connection with the community. It helps to keep that grassroots component.

For more information about hospice nursing, visit the Web site of the Hospice and Palliative Nurses Association.