Nurses who choose to work in the twilight between life and death often consider their profession a mission. But anyone who loses too much of themselves to an almost missionary zeal can become overwhelmed, especially in an era when the number of patients dwarfs the supply of hospice nurses.
“Folks who who are committed to their work also have a high vulnerability,” says Ashby Watson, a psychosocial oncology nurse specialist at Virginia Commonwealth University’s Massey Cancer Center. Nurses, at times, may start to feel as if they are the only ones able to care for their patients, rather than allowing family members or coworkers to assume those skills, she says. By becoming too immersed in their patient’s lives—or craving that feeling of being needed—nurses place themselves at risk of burnout, psychological calluses and compassion fatigue. Indifference can become a means of self-preservation.
Hospice organizations have increasingly recognized this emotional exposure and enlisted mechanisms for employees to absorb and process stress, grief and loss. Supervisors and colleagues look for signs of unhealthy coping, like eating too much or sleeping too little—symptoms also seen in family members with caregiver burnout. While a family member’s identify may become enveloped in the caregiver role, hospice nurses must manage the delicate art of reaching out within limits to patients, and not blur the boundaries between personal and professional motivations. “The nurses are much better prepared now than they were even 10 years ago,” says Ron Panzer of Hospice Patients Alliance.
Experts have also devised specific programs to help workers heal after patients die. Sometimes hospices hold weekly staff meetings, where the names of patients lost that week are read and honored. Nurses are urged to have lives outside work. They go to funerals—or avoid them. They take yoga. Anything that recalibrates the psyche.
“A lot of people in hospice do gardening, because it’s important for them to see life,” says Shirley Otis-Green, a senior research specialist in the Nursing Research and Education Department at City of Hope near Los Angeles. And that is the elegance of many hospice caregivers, she says. Surrounded by death and grief, they seem uniquely able to understand the joy of being alive.