A nurse is defined as a person who cares for the sick or infirm. Infirm (for anyone else who didn't know) is defined as being of poor or deteriorated vitality. In our opinion, hospice nurses rank highest among the most grueling and difficult nursing professions. With such a challenging job of caring for the dying, we wondered why on earth anyone would choose to be a hospice nurse. So, we asked one - Sandy Bowen from Heart N' Home Hospice and Palliative Care of Fruitland, Idaho. Sandy was kind enough to open up about her life and experiences with hospice nursing. This is her story.
Family is a big part of hospice care, would you please tell us a little about your family?
I will be celebrating my 50 year anniversary with my husband Jerel this coming new year’s eve.
I have 6 biological children, 7 foster children,15 exchange students, 37 grandchildren, and 1 great grandchild - we love children. We actually just had a Christmas in July this past summer and we were able to get everyone there with the exception of 4. It was a blast.
How did you end up working in hospice?
I BECAME A NURSE RATHER LATE IN LIFE ACTUALLY.
Nursing was always a dream of mine ever since the time I was a little girl. Growing up, I can remember taking care of animals, of grandparents, of elderly parents. I even sewed up frogs and dogs, only occasionally in the same day. And when I finally became a nurse, I introspectively thought “You know, I could work in an oncology unit. I could work in an infusion suite because I could be a great cheerleader when people are fighting for their lives.” It wouldn’t be my first rodeo.
Deep down I believed that I could be a great asset to anyone who was losing that fight for their lives. So I ended up getting an interview at a local hospital that was looking for help in the oncology unit and I quickly discovered that the individual who was interviewing me would also be my unit manager. She was great.
She conducted an incredible interview. I remember thinking,
“I CAN DO THIS. I CAN DO THIS”
While it was 60 miles from my home, they were willing to work with me to have 3 days back to back. And I knew I could do that.
At this point, I thought I had it figured out. I would go work under this incredible unit manager and make a difference in people’s lives who were fighting cancer. But, I had a friend who was working in hospice and urged me to at the very least interview for an open position at a hospice before accepting the oncology offer.
She thought that I would absolutely love the work. I mean really love it.
The phone rang on the day I had my interview with Heart N Home and it ended up being the individual who conducted my interview for the oncology position at the local hospital. As excited as I was to get the offer and have the opportunity to work under this lady who I had such admiration for, I had promised my friend that I would not accept the position until I interviewed with Heart N Home hospice. So I explained my situation to the oncology manager and she was very understanding. We talked about the interview I had with Heart N Home that afternoon and she actually encouraged me to really give hospice some serious thought as she thought I would be a great hospice nurse. I remember her telling me that my heart is right for hospice. She said that anyone who carries as much sunshine as I did belonged in a place like hospice.
I went on to my hospice interview with Heart N Home that afternoon and walked out the door with an offer of employment in my hand. I felt incredible. I knew I could do the work because I was comfortable with my own mortality and my own immortality.
So that is how I started with Heart N’ Home over 12 years ago.
In your 12 years of working in hospice, what has been your biggest struggle?
MY BIGGEST STRUGGLE IS THAT I WISH THERE WERE 42 HOURS IN A DAY INSTEAD OF 24.
This work is so, so incredibly important to the patient and the families. I wish there were more hours in the day to be with my patients and their families. I am really selfish because I can walk into a patients home and give everything that I’ve got in me, yet, when I walk out, my bucket is fuller than when I walked in.
I feel so lucky to be a part of such a remarkable chapter in one’s life. So to answer your question, I really can’t complain about any challenges. I just wish there were more time in the day.
What fills your bucket more? Helping the patient or helping the family?
THE PATIENT IS THE BOSS. THEY ARE THE PRIMARY REASON THAT WE ARE THERE...
But, our mission is to keep the patient comfortable, and in order to do that, we must also teach the family how to care for the patient and keep them comfortable. We don’t move into the home and we are not there 24/7, but guess who is? The family or primary caregiver.
We provide spiritual and emotional support. In order to be successful in our job, we must serve both the patient AND the family. The two go hand in hand when it comes to writing a beautiful final chapter in life.
Sometimes the patient will decline social work or spiritual care and when that happens, we have to step up to the plate and fill that role. The greatest joy comes from the really tough situations. For example, situations in which a patient receives a terminal diagnosis and there is nothing more that they can do and the family is devastated pleading,
“DAD, YOU HAVE TO TRY SOMETHING! YOU CAN’T JUST GIVE UP!”
But the reality is, sometimes giving up is all that you can do. But the family is often devastated when they receive this kind of news. Part of our duty is to get the family to the point where they believe that they can do this because that’s what the patient needs. The beauty is found in the situations when the death takes place and the family can live on knowing that they were with their loved one and were there when they took their last breath.
This is something I never thought I could do. But one of the most rewarding parts of my job is being able to see how happy the patient’s families are after being able to have such a significant positive impact during the last chapter of their loved one’s life. And a big part of my job is teaching families how to provide truly exceptional care in the last stage of life.
Long story short - It is a package deal. Success in our job requires helping both the patient AND the family.
What is the best part about working with the patient’s families?
I REALLY ENJOY VISITING WITH PEOPLE AND BUILDING RELATIONSHIPS WITH THEM.
Winning the families’ trust then turning around and delivering on that trust. Keeping the patient comfortable and keeping their symptoms managed. Even loving them without crossing boundaries - you know you can love a patient on a professional level. I wholeheartedly believe that you can love people professionally. And if there were 42 hours in a day, I would get to see 12 patients in a day instead of 6.
It is a selfish thing because our work is in relationships and my whole life is based on relationships, not on stuff. In this work, you give everything you’ve got but that is what makes it so great because all that love comes right back at you.
The respect comes back at you.
The appreciation comes back at you.
You get gratitude.
You get hugs.
The big thing is that you cannot create a dependence. The family needs to know that they can take this walk with the patient. And there is nothing better than seeing the love and appreciation on a family member’s face after helping to empower them to care for their loved one.
What made you decide to be a nurse at age 51?
MY GRANDMOTHER DIED RIGHT BEFORE I TURNED 3.
She was a midwife. Little did I know that when I was 5 years old picking up baby birds off the ground after winds storms that I was actually being a hospice nurse, because not one of those babies survived.
But I tried to fix them.
I sewed up dogs and frogs and I’ve taken care of grandparents and parents and booboos. I had this dream ever since I was little, and it showed in the things that I cared about even at such a young age. So at age 51 my baby graduated from high school in May and a month later I started a CNA class for the purpose of being able to apply to the nursing program and get extra points for taking the CNA class.
What did you do before you were a nurse?
WE FARMED, WE RANCHED, WE HAD COMMERCIAL CONSTRUCTION BUSINESSES.
So my background is more business oriented as opposed to the normal things that a momma does. I discovered that by going to school at 51, I was able to bring life experiences with me and that proved invaluable. I never needed help with my classes because I lived so long and had all of these experiences. I had already seen everything in the social sciences. I had perspective. It was a perfect time for me to work hard and make my last dream come true.
I knew that God wanted me to be a nurse and that is what sustained me through all of this. Between hard work and divine blessings, we got-er-done.
How did you make the decision to do Hospice as opposed to Oncology?
I KNEW I COULD DO EITHER ONE.
I think the difference maker was the confidence that the manager of the oncology unit expressed in my abilities and alignment with the heart needed for hospice. She had immense amounts of credibility in my mind. In just that short interview time, she saw things in me that I didn’t know I had.
I remembering thinking “Man, if she saw those things in me then surely it must be in there”. It turned out to be a great fit.
What advice would you give to someone who is considering becoming a nurse in hospice?
TO PUT IT SIMPLY, YOU MUST BE COMFORTABLE WITH MORTALITY.
You must be comfortable with the death process and sending someone away. There are some that are not comfortable with mortality and I think that if you are not comfortable with mortality, then you need to really explore that within yourself.
I think that hospice nurses have hearts that are 3 sizes too large because it is such a.. well.. you just need one that big.
For all your patients and families. Get ready. If you decide to take this journey, get ready for an incredibly spiritual and fulfilling ride. You will have probably never worked harder in your life because you become so invested in these families. But you will have never received so much back.
The continuity of care in hospice is incredible because the care that is provided by a hospice nurse is so much different than the care provided by a large organization. Doctors trust our ability to make decisions on the things that are going on with our patients. This autonomy and trust is incredible. I am confident in my abilities to care for the patient and make decisions, and that confidence is shared by the doctors as well. And that makes me feel confident and competent.
Has your view of hospice changed since becoming a professional in the field?
I HAD TWO EXPERIENCES PRIOR TO EVER GOING TO NURSING SCHOOL.
The first involved one of my aunts dying of cancer and the second involved my mother who was sick of being a cardiac patient and flying in and out of the emergency room - so she elected to transition into hospice care. My mother was on hospice care for 12 days and I was lucky enough to be right by her side when she crossed the finish line. While both experiences were very brief, they led me to believe that I could do it.
I was comfortable with those last breaths. And I was able to feel the joy that a person must have felt when they crossed their finish line.