Why this nurse left the intensive care unit to go into hospice

Earlier this year, I made an announcement that may have made a few people think I was half a bubble off level.  I’m leaving CCU.

I’ve worked in CCU (and CVICU) for 14 years.  5 years ago I had a baby, and reduced my hours to one day per week.

It took me just about all of those 5 years to fully comprehend that one just can’t keep up with all there is to learn working only one day a week in CCU.  The basics come back to you if you have enough experience with them (ventriculostomies, for example) but the new stuff is coming in droves and is being implemented constantly – new therapies, new monitoring machines, new procedures.  When you can’t make the in-services given during the week, it falls to the weekend coworkers to bring you up to speed, and I was feeling very guilty about that.

“Why not just put the kids in daycare and work more?” one could ask.  And one would have a point.  But …

I recently had a patient that almost any CCU nurse would thrive on – unstable, many drips, lots of titrating.  In years past, I enjoyed the dance we do when trying to stabilize a patient, my brain happily bathed in adrenalin.  But this time, although my brain was still bathed in adrenalin, I found the dance … boring.  Tedious even.  Now that is an interesting feeling – all jazzed up and bored about it.

Thinking about it later, I realized that although my last several employee reviews were good, I could never come up with “new goals for the next year.”  I had no desire to be an open heart nurse, take care of patients on balloon pumps, get my CCRN, or learn anything else, really.  Although I have plenty of skills, I just didn’t want to learn any more about critical care.

So although I had a great-paying job with great flexibility and seniority, I found myself contemplating leaving it all behind.  But to do what?

Over the course of my career, I realized that I enjoy working with the patients that are close to having or are having life support removed.

Why?  I’m not sure.  Why does anyone like anything?  All I know is that I felt a great deal of satisfaction when I was able to see a patient through to passing peacefully.  You form an almost instant bond with others when in that situation, and not just the patient, who was usually unconscious by that point.  I have always enjoyed working with family members.

So I decided to become a hospice nurse, and there was a company out there nice enough to hire me despite my total lack of any actual hospice experience.

When you tell someone you’re a nurse, they usually ask “what kind; what do you do?”  When I would respond, “critical care,” they’d say, “Oh! Wow.”  When I told my coworkers I was leaving to become a hospice nurse, I got a few “Oh … uh, interesting …” and lots of “oh, you’ll be great at that.”  But the prize for best answer goes to one particular doc:

Me: “This is my last weekend.”

Doc:  “Oh, why?”

Me:  “I’m going to hospice.”

Doc: “… but you don’t look sick.”

Ah, hospice humor.

I have nothing but the highest respect for my former employer and my former coworkers.  They are a huge reason why I stayed so long and I consider several of them family.  But every time I think of the new direction I decided to go in, I feel a little thrill of excitement to learn something completely new.  Hopefully with enough tweaking and HIPAA-nating, I can share some of my experiences with you all.

“Gina” is a hospice nurse who blogs at code blog – tales of a nurse.

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  • http://www.facebook.com/kcmccausland Kathy Coombe McCausland

    I went from ICU to homecare then to hospice and I would not trade any of it for anything. ICU made me the nurse I am today with skills I will treasure and use daily (now a special needs nurse). In hospice I learned to live!! The dying taught me to listen, experience life (I heard a lot of I wishes), and have the least amount of regrets ( I heard many). I taught my kids that life is an adventure to live and experience it all. Nursing has been great to me and I am sad in the changes that are occurring.

  • DrRona73

    Growth and new experiences are important. Change can be scary for many. Kudos to you for having the courage to do something different. Its wonderful to be in a field that allows flexebility and diversity. Sounds like you will do well as will your family.

  • Hugh

    I was a Hospice Nurse for seven years. A good nurse is always a benifit to a family that’s about to lose a loved one. Critical care or expected end of life. We bridge the gap and help the “family” with the transition.
    Go for it girl! Your skills are needed in Hospice.

  • http://twitter.com/dfntvmaura Maureen Rudden

    I was a Hospice patient for 6 months and the care I received, both physical and mental, was excellent. I am one of the few that is alive and able to tell how these wonderful people assisted in saving my life. Thank you to all the Hospice people that, daily take care of patients not expected to survive and yet are able to help promote a healing attitude for the ones that are not ready to go.

  • StephenModesto

    …Thank you for sharing your personal
    perspective. It would seem that even 7 years ago, if a person suggested that
    you would `find’ yourself becoming involved with hospice, you most likely would
    have considered that alternate application of your acquired skills as being
    incomprehensible. There is indeed an incremental self-transforming process
    within the considerations of health care. It is fortunate that the opportunity
    for this transition smoothly presented itself….It is reinforcing to hear your
    story. I am still waiting patiently for that closed door to open. Regrettably,
    the truism that `Death’ is a chapter in living life is still poorly integrated
    within the modernity of contemporary understanding. A hospice nurse is as a `spiritual’
    midwife, assisting that individual to give birth to that Spirit within the
    personality of the `self’.

  • James Sinclair

    I can’t thank you enough for joining the hospice family. I am an Hematologist-Oncologist and a hospice medical director. As an Oncologist I hope my patient never need venture into the ICU but greatly appreciate the care they receive when they do. As a Hematologist I am afraid most of the cytopenias and coagulopathies I see in the ICU are not reversible and only warn that the end is near. Once again I am grateful for the ICU nurses who prepare the patient and family long before the ICU docs “get it.” It is the hospice RNs I have learned to appreciate most. They must undue all of the harm that my colleagues have done and prepare a patient and family for the inevitable! The skills you are learning are just as important if not more so than how to monitor an LVAD patient. There is a reason we don’t hire new grads in hospice.

  • carolynthomas

    Congrats Gina on your career move – I hope it will be a rewarding and challenging one for you. I’m not a nurse, but I spent many years working in Communications on a large hospice/palliative care unit alongside my nursing colleagues. Our nurses were often called “the hospice angels” by patients and their family members – and for good reason.

    Several times over the years, I heard our nurses say that this kind of bedside nursing care was what they’d originally gone into nursing for in the first place, but this kind of care had become, sadly for them, a fantasy out there in much of the “real world” of hospital ward nursing. But at hospice, they found that they actually had the luxury of time – time to sit beside a patient, hold a hand, offer a bedtime back rub, have a gentle moment and a hug with a worried family member, laugh along with a visiting grandbaby, consult about important quality of life/symptom management issues, master a given body of clinical skills and end-of-life care knowledge, be considered a valued member of a committed specialized team – all while becoming a companion on the inevitable journey out of this world.

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