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Hospice nurse Deborah Houston-Schrenzel remembers her first significant experience with death. She was 4 years old and visiting the grave of her friend's father.
"I was there kneeling on the ground, and all of a sudden everyone was crying and hugging," she recalls. "Everyone felt better, and I thought, ‘This isn't hard. People should be there for each other.'"
Houston-Schrenzel thinks that experience helped propel her into a career serving the ill and dying. More than 40 years after that day in an Ohio cemetery, she landed her first job as a hospice nurse.
A Growing Field
More patients are choosing hospice care. While 246,000 elected hospice in 1992, by 2002 that number had risen to 885,000. Accordingly, the ranks of the country's hospice nurses have increased. In 2002, nearly 25,000 hospice nurses were employed by members of the National Hospice and Palliative Care Organization.
Hospice nurses cite compassion, comfort with dying and a desire to help make a person's death peaceful as the top criteria for those seeking to enter the field. Hospice nurses are generally registered nurses who receive additional training in pain and symptom management and other end-of-life issues throughout their careers. The National Board for Certification of Hospice and Palliative Nurses offers voluntary certification.
Inge Corless, PhD, a former hospice nurse who is now a professor at the MGH Institute of Health Professions in Boston, advises those who are interested in hospice nursing to gain at least one year of non-hospice nursing experience to hone clinical skills and determine how comfortable they are with death. Experienced hospice nurses can advance to supervisory roles or go into teaching like Corless.
While some regard hospice nursing as depressing, others see it as rewarding work. "The reward is helping someone truly live until they die and in providing an opportunity so they can enjoy the time they have left," Corless says. "There's satisfaction in helping someone to die well."
Part of the Healthcare Team
Hospice nurses are part of a patient's healthcare team, which can include other nurses, physicians, clergy, home health aides, volunteers and others. Some hospice nurses are assigned to patients in home settings, while others work in tertiary care centers or inpatient hospices.
Houston-Schrenzel works for the Visiting Nurse Association (VNA) of Greater Philadelphia, a member of the Visiting Nurse Associations of America. After a varied career in healthcare, she took the VNA job to fulfill her longstanding desire to work as a hospice nurse.
Her routine is typical for hospice nurses. She starts each day by checking voice mail to find out how her patients fared overnight. Then she plans her workday, deciding which patients require visits and which need medication adjustments. Depending on a patient's needs, a visit may last for 15 minutes or an hour or more. The patient's comfort is her main focus.
"We treat each patient as an individual," she says. "Our goal is to keep them at maximum comfort so they can do the things they want to do."
Helping Patients Experience a Good Death
Helping the patient and his loved ones come to terms with death is a momentous and rewarding undertaking.
Houston-Schrenzel watched a 12-year-old boy with cancer carry out the wishes detailed in his will, doling out favorite possessions along with wishes for his parents to take care of each other. Houston-Schrenzel marveled at his devotion to family and friends.
Houston-Schrenzel was at the boy's bed when he died. His death was the peaceful, loving experience she desires for all her patients.
"Not everyone can do this, which is why I think very few of us end up in this field," she says. "You have to have done a lot of work emotionally, spiritually [and] psychologically to handle this sort of thing. While there is sorrow, it's tremendously satisfying for someone to be able to leave this world comfortably and smoothly."