Some staff in-patient facilities, conduct hospice admissions or assist families calling a 24-hour line. Others work daily shifts.
When Latisha Newkirk left a corporate banking career in the 1990s, she discovered her calling as a registered nurse, eventually finding her niche in hospice nursing.
“The biggest reward to doing this work is that you learn so much about living from each patient and the experience,” says Newkirk, who is now the King County clinical division manager for Tacoma-based Franciscan Hospice and Palliative Care.
Hospice care, for anyone expected to live six months or less, focuses on comfort and quality of life. Registered nurses who work as hospice case managers provide nursing care and support to their patients. They educate family caregivers and coordinate the hospice team that may also include a social worker, home health aide, chaplain, pharmacist, therapists and volunteers.
“We focus on health and wellness and making each day the best it can be within that individual’s health problems,” says Lana Bolton, a case manager and longtime registered nurse who has worked for EvergreenHealth Hospice Care in Kirkland for 15 years.
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Some 23,000 people in the state were admitted to hospice care in 2012; the demand will accelerate as baby boomers continue aging, according to Deborah Whiting Jaques, executive director of the Washington State Hospice and Palliative Care Organization.
As an important part of the hospice team, registered nurses are needed to fill a variety of jobs. Some staff in-patient facilities, conduct hospice admissions or assist families calling a 24-hour line. Others work daily shifts when needed.
Bolton, who manages a caseload of about 12 patients, typically begins each day on her laptop, checking patient records for any calls or nursing visits overnight. Then Bolton heads out to two assisted living facilities to visit three or four clients, also making time for “tedious” work like calling and faxing pharmacies and doctor’s offices.
Special training isn’t required to do hospice work, but local professionals say candidates should have varied nursing experience, emotional maturity and a solid set of skills that include critical thinking, patient assessment, time management and the ability to work as part of a team as well as independently in the field.
“They’re not down the hallway from another nurse if something comes up,” says Melinda Papen, hospice director for EvergreenHealth. “Their critical thinking skills are an absolute must to navigate any situation that they can encounter out there in the home.”
Between them, Franciscan and Evergreen employ nearly 200 registered nurses who provide hospice services to some 1,100 patients in King, Pierce, Kitsap and Snohomish counties on any given day.
At EvergreenHealth, nurses hired with a two-year degree are expected to obtain a bachelor’s in nursing within five years; new graduates go through a special mentorship program, Papen says.
At Franciscan, hospice nurses can earn $70,000 to $100,000 annually, and per-diem rates range from $36 to $48 an hour, Newkirk says.
Obtaining a national hospice certification typically boosts a nurse’s pay by $1 to $2 an hour, says Newkirk.
Working in hospice has its challenges. Nurses have to be ready for anything — including tricky family dynamics — when they walk into a patient’s home, Papen says. Patient needs are very high and the rapid turnover in clients can be difficult, she says.
But nurses often develop a strong bond with their patients and families. Jeff Baker of Bellevue and his two grown daughters experienced that close relationship last year when EvergreenHealth Hospice cared for their wife and mother, Linda Baker. “It was beyond what we could have ever expected in the way of just genuine love and caring, for not just Linda, but for her entire family,” Jeff Baker says.
Setting emotional boundaries is the biggest challenge for hospice nurses, Bolton says. They need to mourn in their own way when a patient dies, “but we can’t let that overtake us,” she says.
Still, the rewards are great: “It’s an honor and a privilege for someone to invite us to be with them on their last journey,” Bolton says.