QUESTION: As a new hospice RN, I would like to thank you for your contribution to hospice. Your booklet "Gone From My Sight" was so touching to read and gives my patient's families so much comfort. I am sure you are a very busy woman, but if you have any advice to provide a new hospice RN it would be greatly appreciated! After working in several areas of nursing, I truly feel that hospice is my calling, and I want to do it right.


Welcome to the world of hospice nursing and finding your special place. So few find their special place anymore. For too many workers their job is just a job with a paycheck. How lucky you are to have found both.

I don't know about advice but I'll give you something to think about. My philosophy is that end of life care is not about medical interventions, treatments, procedures, pills or morphine. End of life care is about teaching, guidance, support and nurturing. It is about reassuring the family that nothing bad is happening, that their loved one is doing exactly what a person who is dying does and they are doing a good job doing it. End of life care is all about neutralizing the fear everyone brings to this experience, the family and the patient.

How do we neutralize fear? By teaching the normal process of dying to the family, by encouraging the family in the care they are giving, by being available, by bonding with the family. Only by bonding with the family can you earn their trust to guide them through this uncomfortable experience. (That is why having primary care nursing is vital in hospice nursing. Families can't trust if every nurse they see is different, which is happening in way too many agencies.)

Your key teaching areas will be around eating and not eating. Explain why the body doesn't want the food. Do the same with hydration. Being dehydrated is just going to sleep and not waking up; all normal and part of the natural process. You will teach mouth and skin care, bowel management. Explain how the patient is withdrawing and sleeping more. Of course if pain is an issue teach how we are the experts in pain and comfort management and why addiction and overdosing is not going to happen.

Remember that dying is not painful. It is disease that causes pain so if pain is not part of the disease history there is no need for high doses of paim medicines at end of life. A very small amount of morphine often does help with difficulty breathing.

If you teach your families well about the approaching end of life there will be no problems with them understanding the labor of dying. Having someone you care about dying is very sad but it doesn’t have to be a bad experience. It is our job to see that their experience is a sacred one.

As I write this I realize I could go on and on. Maybe I need to write another book for professionals. You might find my new DVD New Rules For End of LIfe Care helpful in your work with families. It includes Gone From My Sight and its companion booklet The Eleventh Hour. Blessings to you in the work that you are doing!