Every type of nursing has its own challenges, but nursing in a hospice requires not just technical skills and temperament, but a dedication to a difficult and emotional task.
Barbara-Ann Kubb is a nurse and manager of the Cedar Hill and Maple Hill long term care facilities at Langley Memorial Hospital, which also house the 10-bed Langley Hospice centre.
Patients at the end of life come to hospice for management of pain and symptoms and time to say goodbye to their families in a more home-like environment than the typical hospital room.
“A hospice nurse is someone who needs to be calm, especially under pressure,” said Kubb.
They have to be able to think quikcly on their feet, and have the ability to multi-task, she said.
Symptom management can be difficult, and that’s the main medical task faced by hospice nurses, she said.
Expertise with continuous application of medication and the management of painkillers are the key technical skills needed.
That means that often nurses who come into hospice are already more experienced, having worked in other areas like medical or surgical hospital wards that require similar skills.
“I would never say no to a new graduate, either,” Kubb said. If a young nurse felt they wanted to go into hospice care, they would be mentored, she said.
While every nurse and doctor faces the posibility of losing patients, hospice care is set apart by the fact that no one entering hospice is expected to recover.
“It’s very much a difference between treating to cure and treating to manage symptoms,” said Kubb.
“How do we manage their symptoms, to give them the quality of life for the time they do have?”
Then there’s the people skills.
Families are always present as part of hospice care, and Kubb said navigating family dynamics while keeping patient care central is key.
“It’s a huge part of hospice nursing,” she said.
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It can be an emotionally taxing job.
The presence of very young patients in hospice can affect nurses emotionally.
Also very difficult is when, despite their best efforts, nurses can’t manage a patient’s symptoms effectively, Kubb said.
“It does take a certain heart, it does take a certain person to work in that environment, and it’s not for everybody.”
Kubb herself didn’t plan to go into working with long-term care and seniors. She started her career studying for the other end of life – training in a neonatal ICU, working with prematurely born infants, or babies with serious medical issues.
But losing children was difficult for her.
“When babies die, it really hit me as not being okay,” she said.
A temporary job in long-term care became permanent, because she grew to find the reward in caring for people near the end of life, making sure they were comfortable and cared for.
A hospice nurse is in some ways the extension of that level of care, Kubb said. It’s about knowing you did everything you could so a patient doesn’t die in pain, or alone.
“That’s the calling, to be providing that care and companionship at the end of life.”
The new Langley Hospice, a freestanding facility on the grounds of Langley Memorial, opens later this fall. It will have 15 beds, up from the 10 currently in place, and has been designed from the ground up for its purpose.
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