It was about 25 years ago and Katheryn Gordillo was raising three children, working part time, all while caring for her dying mother in her home. One night, after countless hours of not sleeping or eating, Gordillo got on the phone and called her hospice nurse for help.
At 1 a.m., in the middle of the worst snowstorm that part of Illinois had seen in years, the nurse drove out to Gordillo’s home, made her breakfast, got her settled on a couch so she could sleep and promised to stay by the mother’s bedside.
Gordillo knew her mother didn’t have long, so she asked the nurse to rouse her if it became time to say good-bye.
“And that was huge,” Gordillo said.
Her mother died the next day but because of the nurse’s help, because she was fed and given the chance to rest, Gordillo was able to be there for her mother at the end — and it is a gift she will never forget.
“It was the worst snow blizzard in a decade and there she was at my door. … I tell people all the time my hospice nurse made me blueberry muffins and scrambled eggs in the middle of a snowstorm.”
Years later when Gordillo was considering a change in her nursing specialty, she thought back to the kind woman who had gone above and beyond the call of duty. She became a hospice nurse.
“It’s not pleasant work but it’s the most rewarding work I’ve ever done in my whole life. If you’re supposed to be off at 5 and you’re not off at 5, that’s just the way it is. … I honestly believe hospice is a calling,” said Gordillo, who has worked the past seven years with Creekside Hospice in Las Vegas
“Hospice” is the term used for care that is provided to patients who have an illness that cannot be cured and are facing the end of life. Depending on the hospice, the services can be provided in the home, long-term care facilities, assisted living and group homes, and inpatient facilities specifically created for hospice patients.
It means providing medical care for symptoms and pain management, as well as emotional support to both patients and their families. It is usually accomplished through a team approach with professionals such as nurses, social workers, counselors, certified nursing assistants, chaplains and specialists in alternative therapies working together to provide a holistic approach to care, according to local hospice representatives.
“Our vision is that no one ends the journey of life alone, afraid or in pain, and I believe that pretty much tells you what hospice is about,” said Carole Fisher, president and CEO of Nathan Adelson Hospice, which provides care both in the home and at its two inpatient facilities.
No matter what the job title, hospice employees require extraordinary compassion and empathy, according to hospice administrators. In fact, when asked to choose their ideal job candidates, most of them put those exact qualities at the top of their lists. The hospice workers themselves, they add, seem to be the kind of professionals who are not just looking for a paycheck but want to make a difference in people’s lives.
“I have such great respect for people who work at the bedside. I can tell you they work selflessly and it’s amazing what they do,” Fisher said. “The rewards are continuous. I think that nurses and social workers and physicians and certified nursing assistants and clergy, they got into these roles because they want to make the world a better place and they wanted to help people to make the world a better place, and in doing that it’s rewarding every day.”
Another important quality is the ability to work as part of a team, both with the family and fellow hospice employees who are providing the various kinds of support. As Jerry Bolyard, executive director of Creekside Hospice notes, the team approach ensures that the entire process is about the best quality of life possible for the patient, and meeting the different practical and emotional needs of the family.
In terms of hands-on care for the patients, employees such as nurses and certified nursing assistants are, essentially, educators working with the family to ensure the patient is receiving the best possible care.
And the idea that the actual medical care given to dying patients is anything but intricate and comprehensive is a misconception, Bolyard said.
“What we have to remind our patients and our families is the fact that we treat the patient and that’s where the misconception comes into play,” he said. “We treat pneumonia, we treat urinary tract infections, we treat any symptom that is exhibited by that patient so that’s what we want the community at large to realize is the fact that we do treat symptoms.”
Hospice nurses, in fact, should be able to work independently since they are usually visiting patients on their own, have an understanding of pain management and disease progression, and possess the ability to think outside of the box, said Creekside’s Director of Clinical Standards Dana Spragg.
“We’re looking for nurses that are very progressive in their thinking and understanding how diseases are going to progress,” Spragg said. “So, certainly a background in medical-surgical, even ICU (nursing) because they have to be critical thinkers because they’re working out there in an environment where they’re going to see things and they’re not going to have somebody available and they’re going to have to know … what’s happening when they’re calling the doctor about things that are going on.”
Aura Truelove, clinical director for CompassionCare Hospice which provides services in the home setting, notes that one of the benefits of being a hospice nurse is the ability to take a holistic approach to a patient’s care that includes the family, as opposed to a traditional hospital setting where the idea is to treat the illness and “get them sort of through the door and on their way.”
“It’s the opportunity to truly address the patient and their family as a whole and all of their various needs,” she said.
As far as employment opportunities in hospice, locally there seem to be openings for an array of positions including chaplains, social workers, nurses and certified nursing assistants. Ellen Trevarthen, Las Vegas administrator for Medical Services of America Inc., which provides hospice as well as home-health services, said the company has been in Las Vegas for about three years and has grown “very, very quickly.”
She believes the biggest need in the future will be for employees providing hands-on health care for patients, although hospice social workers are hard to find in Southern Nevada so there is often a need for their services as well. Certified nursing assistants, who provide daily care for patients such as bathing and grooming, are continually in demand.
“They’re the backbone of every hospice, the CNAs,” she said.
She points out that the need for end-of-life care is growing and there are opportunities for advancement. She, in fact, started her career as a certified nursing assistant, then progressed to medical assistant, registered nurse, a director of nursing and, now, administrator. Not all of her experience was in hospice, she added.
While hospice requires top-notch employees, preferably with experience, she will hire solid new graduates who show other qualities such as compassion and the ability to connect with patients, she said.
Creekside will be opening its first inpatient hospice facility soon and will be looking for dozens of employees, mostly nurses and certified nursing assistants, as well as secretarial staff, a chaplain and social workers, Bolyard said.
“I’m happy to say that Creekside Hospice is an employer that in the economy that we have, we’re still able to hire people and offer good working conditions, good benefits and good pay. I’m very proud of that,” Bolyard said.
Employees normally receive training when they are hired by a hospice. CompassionCare, for example, has online training that all employees take and formal in-house training that includes 40 credit hours of education for nurses that follows the guidelines of the Hospice and Palliative Nurses Association, and 30 hours for certified nursing assistants. New workers also shadow experienced workers for several days before they are on their own.
“The reason why they need all this specialized education and training and what makes hospice different from other fields is they have to understand the dying process, both the physical and emotional, spiritual, psycho-social aspects of it, so we provide them training on that so they can help the patient and their families to prepare for what’s coming,” Truelove said. “And there’s also a strong pain and symptom-management emphasis because naturally we have patients that are dealing with a great deal of pain and discomfort related to their disease.”
Nathan Adelson, a nonprofit which opened the first inpatient hospice in Southern Nevada in 1983, offers ongoing education through its Learning Institute at the Center for Compassionate Care and launched a Web page at the end of September for nurses, social workers and caregivers who want to take on-demand courses.
Finally, one of the best pieces of advice for those considering a career in hospice comes from Gordillo, who first saw the devotion it takes to work in the field all those years ago. She recommends spending about a month in a hospice setting and getting a feel for what it’s all about before taking that step.
“You have to be very, very alert to what people need. … If you’re just performing medical duties, then you’re not doing hospice work.”