[00:00:00] Hello, and welcome back to the pulse check podcast. I am Mandy. Hey, and we have an awesome guest today talking about the hidden world of hospice nursing. That’s right. We’re birth workers. You always hear HeHe and Mandy talking about the world of labor and birth and L and D, but we have nurse Allie today to dive into hospice nursing.

[00:00:28] Hey Nurse Allie! 

[00:00:29] Hi. How are y’all y’all yeah, we’re going from the start of life to the, to the end of life. That’s right. 

[00:00:40] That’s right. And first, can I just ask, how did you get into hospice nursing? 

[00:00:45] So when I was in nursing school, I ended up having a lot of hospice patients.

[00:00:50] And I would spend a lot of time with the hospice nurses when they came in to check on my patients. And I was like, this is amazing. Like, I think it’s the greatest thing. And I watched my, my Volvo, my grandmother. She didn’t have any real advanced directives put in place. She had a healthcare proxy and all that stuff, but her wishes at end of life were not known.

[00:01:09] So when she had her second stroke, you know, they did the full workup on her. And the last time I saw her was she was on a ventilator. And, you know, when you see that pumping of the chest, I’m like there has to be a better way than this. There could’ve been, we could’ve put her on hospice a long time ago and she would have had an easier transition out of this world.

[00:01:28] She probably would have qualified for hospice, you know, a little while ago. And maybe this would have been a little bit easier of a transition into you know, the next life. So it’s kind of things like that. Like that image is still, I don’t know how I see nurses do it. You know that because she was in her eighties at the time too.

[00:01:46] So it’s not like she, to me, that’s not old because I see people living so much longer, like another decade, but yeah, I know a lot. I’m like, and these were our world war II people, you know, they weren’t really things weren’t as regulated. And they were like our world war II vets got pumped full of like amphetamines going into war and they’re like back in my day, like a hundred telling me all these stories, like they were yesterday, I’m like, okay,

[00:02:15] So your early, early nurse part of your career, early career, you saw something that needed to be different or something that didn’t really sit right with you. 

[00:02:25] Right. 

[00:02:26] And did you start in hospice right out of school? 

[00:02:30] I didn’t. So, normally across the board hospitals look for BSN nurses.

[00:02:35] I’m like, I’m not one of those things. I’m like, I’m working on that now. But back then I was not. And in hospice, you don’t need to have a BSN, really, if you want to do education it’s good to have your BSN. That’s what they want for our nurse educators in hospice. But so your options are pretty much like two things like long-term care, or I could go work in a prison.

[00:02:56] My, in my gut was telling me from seeing my sister working in longterm care, when she first graduated with her ADN degree, I’m like, yeah, that doesn’t seem safe. I’m like, I feel safer with my license in a prison than I do in long-term care these days because their ratios are just, they don’t, I shouldn’t say they don’t care, but the nurses care.

[00:03:16] Yeah.

[00:03:16] The ratios are not appropriate. 

[00:03:18] It feels like they don’t care. 

[00:03:20] So I, I started, I was like, you know what, I’ll go there. It’s like a little mini ER almost, but you get a lot of med knowledge and deal with a lot of chronic issues. You get it’s like a smorgasbord of things, you know, and it’s a different environment. So when I got in there, I was just after about six minutes, I think I started applying to hospices smaller ones, because I knew like the larger ones wanted a lot more experience. And so I basically just kept bothering them. And about two years into working at the prison, I got the, like the go ahead, like we’re going to hire you. And I started out originally part-time because that’s what they had. I was like, I’m going to take whatever they can give me. 

[00:04:04] And that’s how I got, I was, so I always recommend when people ask me, like, how do you get started in hospice? I’m like, well, you have to look at what they’re asking for, for experience, but I’m like, if you really want start out per diem, part-time maybe at a smaller hospice where you can get a little more hands-on, one-on-one, it’s a lot easier to keep track of people.

[00:04:22] Now I work for a very large hospice, which I’m thankful for. Cause we have a lot more tools in our basket, but I’m really thankful that I started at a smaller one to kind of get my, my ground route, you know, because hospice is different. Our charting is different goals are different. charting is a lot, it’s a lot of charting our, where we go provide care is different, you know? 

[00:04:42] That helpful I think for new nurses and nurses wanting to make a transition, they’re like, oh, it’s an whole nother world. How do I even do that? But you’re, you’re saying be persistent and just like any other nursing job, go see what it’s about. 

[00:04:56] If people are like, I’m not sure about it, you know, per diem might be a good place to start. Cause you only have to do really, you get the training and the base training, and then you only have to pick up one shift. So we’ve had nurses do that and they decided, you know, this is not for me, it’s too much. Or I experienced death recently and I can’t do this. And it’s understandable to kind of figure out what you can handle and that’s okay to say, you know what? This is not, not for me. It happens. It happens. So, you know, always try to do what you can and know, there’s some hospice agencies that do have nurse residency programs for new grads, which is huge, which is what I would like to develop more across the country, because that’s what we need, because I feel like in nursing school, you get like a blurb about it in med surge, and then it’s gone.

[00:05:43] Like, I remember reading like a page or so like, and I know I hear from a lot of BSN. I think it’s more so BSN programs, but they might do a you know, like one week at a hospice house, but like hospice houses are different than actual hospice, like home health, you know, home hospice, where we go to longterm care. ALS we go to people’s homes. We go to group homes for when we do, when we send patients to a hospice houses for symptom management, usually, or respite care, or if your family is really well off, you can have private pay and be there for your entire stay. Wow. Yeah. Yeah. Wow. I’m like, wow. That’s not. I mean, I, if I could choose, I would also live in the hospice house. Cause they have great coffee machines. The best , these are like I think it cost like 1200 bucks for this coffee machine. They have quartz countertops everywhere. 

[00:06:37] Yeah. Well, if your house is bougie and you feel comfortable in your house, Kind of like the same, but it feels like 

[00:06:43] it’s more organized versus like when you’re out in the field, it’s chaos. Like I always compare the hospital is like almost a controlled environment, you know, versus where bringing ourselves and just, yeah. Controlled in some way. But you have a place to there’s places to put things and there’s places that things go versus we’re working out of the trunks of our cars and like, are our wow. Or cow is like our lap in our car. You know what mean? Or like it could be our patient’s pile of books in the corner. 

[00:07:11] What a great visual though, because I was thinking of myself as the patient and I would think, well, if my house was bougie and I was comfortable on bougie, I would just stay in my house. Or if my house wasn’t so bougie because I’m old and you know, not able to do all the things that I was able to do and the people that I hire, aren’t doing it right.

[00:07:29] I’d love to go to a bougie house where, you know, they can. And I can be taken care of, but for the nurse, the hospital part, the hospice house is the controlled area and the home feels less control. 

[00:07:43] cause like, imagine, I think Nurse Penny, she’s a great, she’s another hospice nurse to definitely follow. And she did a one tick tok of trying to put, like, this happens a lot, trying to put a Foley catheter in sterile, right. Has to be sterile. Imagine doing that on a recliner or a, a non-hospital bed. Like I’ve been putting in Foleys on patients where I’ve had the daughters holding up the legs or a flashlight and I can’t move the bed. So you get out and your back is like ‘oh crap’. And I’m like, ah, I did it guys. I got. Exactly. 

[00:08:18] I want to ask about, I want to ask about your like self care and your Psych care and all of that, but I want to go back to your work environment and that’s what we kind of want to highlight. Well, part of what we want to highlight today is the difficulties, the struggles, the rewards, the gifts.

[00:08:38] Outside of the hospital, because as you just kind of mentioned, and I’m so curious about I’m already imagining, I always imagine nurses like sitting on recliners, brown recliners with like brown or green carpet. I don’t know if that was just my home health nursing school experience, but I feel like 

[00:08:55] I think there’s a lot of recliners. They love their recliners. They love ’em like some of them, some of them, we don’t like we encourage getting a hospital bed at a certain point because it does make care easier. And that’s what you want to do. But like if a patients want to stay at, if they want to stay in the recliner, I am not going to move like Joe, from his recliner that he’s loved for like the past 10 years . Not going to happen.

[00:09:20] No. 

[00:09:21] Yeah, right. Not what are you going to do about that? He would not be comfortable. And if anything, switching them to a new environment sometimes may make them more restless. They may not get as, but, you know, they might not. It’s like, you know, trying to teach somebody a new habit at the age of 80 or 70, especially when they’re at that process of end of life. Why are we going to do that? 

[00:09:42] You’re not going to know your goals. You’re not going to be comfortable, familiar. So you’re saying what’s so interesting to hear is your goals are different, which you mentioned and your environment is different. How are you supported as a nurse to support advocate for and help your clients and your patients meet their goals. When like you already kind of touched on you’re working out of your trunk, you’re in an unstable environment or kind of like chaotic nurse world. There’s no control ,unpredictable. 

[00:10:16] And when you had the nice table to open your gloves and stuff. Okay. 

[00:10:22] Look at the monitor. You might have monitors. I’m not quite sure what it, what it looks like, but how are you supported? How are you able to do your job outside of the hospital or not able to do your job outside of the hospitals? 

[00:10:34] So, I mean, it’s kind of hard because we’re alone.. You know what I mean? It’s us. So like when we walk in, we can’t just like grab a nurse buddy and be like, Hey, can you help me? Sometimes we don’t, we don’t usually ever aids there either. Or our patients don’t have somebody that can help, you know, so you have to be independent in assessment and kind of a MacGyver in a way to figure out how things can go. If maybe you don’t have that supply that you need. Can we wrap up a bandage or do a wound dressing per the orders as close as we can. Sometimes if wound care doesn’t get delivered because we’re the supply closet, if the patient doesn’t get supplies shipped to them while we’re there. So we have a whole team kind of behind the scenes that we call. We have triage nurses who I know in my job they’re 24 hours. That’s not in every single hospice.

[00:11:24] Like I said, I work for a larger one. So those girls help order. Or, and guys, I usually talk to the girls. They help us order like DME things like that. They’ll help us figure out numbers for physicians that we’re trying to reach, because usually we, we keep in contact with the primary care or whomever. They deem their primary care. Just to keep everybody on the same page, we don’t just kick them out because they’re on hospice. We want everybody to be involved in the care. So we’ve tried to get orders from them that are like non hospice related as much as we can. You know, we also have our own pharmacists who do med reconciliation. They breeze over the, the med list of our patients every once in a while. And upon admission to make sure that these medications are consistent with the goals of care and the patient’s wishes. And then we also have music therapy. We have pet therapy, we have massage therapy, we have medical social workers, chaplains.

[00:12:17] So like we really, as a nurse, we do handle like, you know, we handle every single week handle, psych, social, emotional, physical side of everything, but we’re lucky that we, I can delegate a lot to those. And they’re very all the team members are very well versed in there. 

[00:12:34] We have NPs that do they do house visits. We have MDs who do house visits t o our patients? 

[00:12:42] I don’t know if I knew that. 

[00:12:44] Yeah, it’s not, I don’t, I don’t know if it’s in every hospice. I know in my previous one, if we, if a patient was really struggling and we were like, we needed eyes on this person, the MD would do a visit. Sometimes. I mean, they have to also go with like the goals of care and also what they were taught as well.

[00:13:03] And sometimes they just need to put eyes on the patient to see and get a story for it. Cause like we can do our best, but sometimes I’m like, you know what? I don’t know. Like we have a wound care nurse. She’s actually a nurse practitioner who goes out and does home visits. If we’re like, you know, we’re really stuck.

[00:13:20] Like people think hospice is just end of life. We’re basically home health up until a person starts, you know, transitioning. Like I said, our goals of care are different. We’re not going to go and go for curative care anymore. But we will still continue with wound care. We’ll treat acute things like UTI, you know, respiratory flare, whatever we have to do to get them comfortable. Cause you know, UTI is painful. Why are we going to let you know? And if the antibiotics are consistent with the goals of care, if the antibiotics are going to have more benefit, then we’re going to put them on antibiotics. But we’ll always have somebody around that can go lay eyes on the patient who has the power to prescribe, as I like to say. So I love our wound care nurse. So she goes out and she’ll be like, yeah, this is what we’re supposed to do. 

[00:14:11] So she can get you back on the track of change something. We need to update this. 

[00:14:17] Cause like we can. Only have so much knowledge as to also what is, of course, because money always comes into everything what’s on the roster of things that we can order and the hospice will pay for. So if hospice orders something like medication wound, care supplies, hospice covers it. You know, and so she’s more in tuned to like, oh, we can try the things that we might not have thought of because like we’re like, yeah, like a calcium, silver algenate dressing, like Opti foam is like $25 for the one.

[00:14:51] So like, we’re very hesitant to order those things sometimes, but if she’s like, yeah, let’s do it. I’m like, okay. Order twenty-five 

[00:15:01] oh, that’s interesting

[00:15:02] I’ll just call her and I’ll be like, yo, this is what it looks like. She’s like, yeah, we need that. I’m like, yes, we do need that. We do.

[00:15:09] Are your it’s part of the planning for your goals because you talk about goals a lot and it almost feels like everyone has to kind of make sure here’s our primary, everyone get back on track. That feels good to me. But is that reality? 

[00:15:23] Well, it depends on how cognitively aware our patients are know. Cause we do have a lot of Alzheimer’s, but say somebody is fully, you know, this was, they signed themselves onto hospice. This is, was their, their goal. Yeah. They are the main driver of everything that happens if they don’t, if they say no, we’ll educate them on to why we think this is the best course to go. But if they say no. That’s it. We’re going to go with whatever. Yeah, that’s it. We go and we’re going to go with whatever makes them feel comfortable, you know, and after let’s say they start actively dying. That’s when they, you know, they’re not really of sound mind and body that’s when the healthcare proxy will most likely get activated and take over from there. But we’ll stay in line. Our goals of care are completely made around the patient’s wishes. So I don’t know if you’ve ever heard of something called the five wishes before.

[00:16:17] Yeah. So that’s, that’s something that will patients can use and it is a legal document. So at that, you know, define spiritual, personal, medical, and financial around what this person wants to have. And it’s very specific and it also can, the person can write in things that they want. And that’s why I like it because it’s more personal versus like a MOLST or you know, something like that. It’s just like check off boxes. The five wishes is a lot more personal. So I think if people go over that with their loved ones, before things take a turn and you express to your loved ones, how much that means to you, that your wishes are carried out, it makes it easier for everybody. And also for your hospice team.

[00:17:04] Cause we always have to educate the families, remember what the patient would have wanted, what were their wishes for this time in their life. And I have to say most families respect their, their loved one’s wishes. I would have to say, you know, they understand because they’ve seen their loved one going through whatever disease process for a long time. And not only is the patient tired, but the family is, you know, being a caregiver is, and even just being a family member of somebody who’s had a chronic illness and now is terminal. You know, they also know that deep down they want their loved one to be you know, they don’t want them to suffer anymore.

[00:17:41] So I would have to say every single plan of care, like I know care plans, the nursing school, we all hated them and we’re like, we’re never gonna use these again. 

[00:17:50] Guess what? In hospice we do. 

[00:17:56] You just lost all your new nurses. 

[00:17:58] I know, but they’re not like the ones in nursing school. They’re like pre kind of done. You check off a lot more boxes versus like writing out like a 32 page care plan. It’s not that, it’s different. It is a pain in the butt sometimes. But what I like about the care plans, you can also put orders in there so you don’t have to type them somewhere else. You know what I mean?

[00:18:18] And it’s like a good snapshot of what is going on. And we’ll put in their spiritual stuff. We’ll put in their personal stuff, everything goes in the care plan, ambulation, nutrition, all of it, everything. 

[00:18:30] I don’t hate it. I actually don’t hate it. I mean, I know the process is super redundant and really hard to conceptualize when you’re in nursing school, also hard to conceptualize because you don’t see it in real life. And like no one fucking reads them. They don’t have any merit. 

[00:18:47] I mean, you’re yeah. You’re telling me that a, professor’s going to read a 1 32 page care plan for every single nursing student. 

[00:18:54] No, but in, in the hospital, who’s reading my care plan.

[00:18:56] I didn’t like the charting in the hospital either. I was so confused. I was like, oh, oh no. 

[00:19:04] Like if the care plan mattered

[00:19:07] I think it’s different when you’re doing acute care, because even in the hospice house, we don’t really, we don’t do the same notes that we would do out in the field. You know what I mean? It’s different because it’s, we’re, we’re managing an acute situation versus like a care plan I feel is more long-term where these are our goals of care until X time, versus you’re trying to like manage a patient sometimes like by the hour. 

[00:19:32] Ever-changing. 

[00:19:33] A care plan doesn’t really make sense. It’s a care plan, not a care snapshot. You know what I mean? It’s the situation. Yeah. It’s supposed to go. It’s a longevity thing. 

[00:19:44] I that’s how I would describe it because we’re looking for a, long-term like we don’t always have to change every single care plan every time we go over the care plan. Or like we do INR on patients to if they’re on a blood thinner, obviously we still have to do that. I don’t think people think of those things when they think of hospice, they’re just like, these people are on their death bed. This is it morphine, go. Like, no.

[00:20:08] That’s exactly what I sometimes I’m like wondering, but it’s cool, you have tons of skills that you’re doing. You’re still the detective. You’re still like a puzzle piece sorter. 

[00:20:19] So much detective work so much to figure it out. Because it depends on like how much, cause when you go and like, say you go up, we have special nurses.

[00:20:28] I should say there’s very special because they do admissions only bless their hearts. Cause the admissions can be like three or four hours sometimes. And they go to the homes too. And you know, I imagine that like being in a house, sometimes the smells like cigarette smoke, other times there’s like cute dogs and that can be a huge distraction. I love the dogs. 

[00:20:47] I’m thinking of like that transition that the family is doing alongside the admission of like, like when I need to do something that I know I need to do, but I’m putting it off and it’s not the same as dying, actively dying or dying with dignity or coming up with a plan, but it’s still like, oh shit, now? You know?

[00:21:09] Yeah. Some of them, I think it’s been a long time coming and they’re more prepared for the next step. They’re like, yeah, this is grandpa he’s 98 years old. Like we understand. But like then we get patients who are like our age and they just got the word that there’s nothing more that we can do. And so we deal, we have special clinicians who are child life specialists. So they deal with grandkids, children. And we have pediatric patients. So they especially are prevalent in our pediatric hospice patients for the parents and the child themselves. 

[00:21:41] So I would say those are a little bit harder because our older people have been living with chronic conditions for a long time. So the families do you see the back and forth from the home to this, to that, and you know, their goals of care other than maybe possibly being a DNR. I mean, some of these people have been a DNR for a while. They’ve just literally. Come back. Like we have people on hospice for like a year, two years sometimes. Cause they keep requalifying something keeps like, requalifying means maybe they had a fall, they lost a little bit of weight. They had another UTI. Like you can get re qualified for hospice. We send in our nurse practitioners to see if our patients will still be considered qualified for hospice and we have to get permitted Medicare, Medicaid, that’s part of the hospice benefit.

[00:22:27] So they will do as much digging as they can to keep people on because it’s just an another you know, toolbox, these families have another support system. And on average patients in hospice live approximately 23 days past their prognosis because of the extra care that hospice provides. Because like I said, it’s psych social, emotional, spiritual, and physical. And that’s huge, we have hospice aids going in five days a week to help people. You know, we have all those other support staff that I mentioned before. So for these families, it’s like care in home that they’ve never like who gets a doctor’s visit at home anymore. The United States, at least not, not anybody.

[00:23:08] Our team is very much involved. You know what I mean? It’s not like you’re going to hear from our MDs, in a month with results. We have them on phone. We text, we call I’ll call a million times. It’s hard. It’s easier to get ahold of our mDs because they’ll pick up every time versus like the primary I might not hear for them until two business days later. 

[00:23:32] Tell us about how staffing impacts this. So if we’re seeing a shortage and you know, staffing is already unsafe, what implications does this have on the polity of care? If the care is so acute and so tedious and needing a lot of attention to detail that staffing shortage must collide somewhere with that. And I expect on the, the quality of care side. 

[00:24:01] So for us, I would say, we will do whatever care we need to and be as thorough as we need to. We will just hold off on the charting. So we will chart on our breaks we’ll chart at home. I know. And I tell people always try as much as you can in the house, even if it’s just little blurps in your narrative. So you are not stuck charting until like 12 at night. 

[00:24:23] And so, you know, it’s very important when you’re also looking to a hospice agency, what is your caseload going to be? I feel most case managers feel comfortable at 10 to 12. Do they all have more than that? Most likely. 

[00:24:35] Yeah. And it’s, you know, we’re spending about an hour, at least sometimes with these patients, if not more, if they need to be comfortable. So like when we’re, short-staffed at least in my agency and my previous one, our clinical managers would go out and start doing visits, but we would still somehow have to put off some visits for the evening staff. Or like, you know, in nursing, we won’t take a bathroom break or we won’t eat or something.

[00:25:03] That was hard at the beginning of the Panorama because of the fact that most places didn’t want you using their public restrooms. We were not really supposed to use bathrooms at people’s houses, but I gave myself a kidney stone and I’m like, I am not doing this anymore.

[00:25:18] I can’t do it. And like, especially like when you’re sitting in your car and you’re trying to like, not pass out and you’re like, I need to drink water, but , I’m going to explode.

[00:25:27] oh my God. And like postpartum or pregnant or any other medical condition that requires you to be healthy and use your bladder and kidneys regularly.

[00:25:38] Yeah. It takes also, it takes time out of our day to stop somewhere, to go to the bathroom. If you, you have to park, get out of your car, go into the gas station, wherever you choose. And you know, I’ll pretend I’m looking at something and then I’ll just go to the bathroom. Or, you know, grocery stores are a great place to go. But yeah, it does take a little bit of time too. And you’re like, you have to bring in like a bunch of, you have to make sure your laptop is locked up securely in your car. And then you have to bring, because we have work phones. So we’re like bringing all of our crap, like these phones in plus your personal phone. And you’re like, this is not fun. And, you know, going in with scrubs anywhere at that time was like, yeah, like for Boden, I’m like, I don’t have a choice. I’m going to pee myself.

[00:26:24] Oh my gosh. So no peeing. 

[00:26:29] So we try to eat when we drive, but I’m like, if I choke I’m screwed. So like soft things like bananas, Slurpee, yogurts, things like that. And so a lot of us will chart while we eat. So it’s kind of, and that wasn’t when the pandemic first started, I was like, I’m not even touching anything that goes into the home before. So I made my own little like hand washing system with using like a pump that is meant to pump water out of those like Poland Springs bottles that you have delivered to the house, but I attached a hose to it so I can, clip it to the side of my car with a magnet so I have my own little hand washing system because I will not eat. If I don’t get to wash my hands.

[00:27:10] Nurses are macGyver. 

[00:27:13] The pump was like 10 bucks on Amazon. It’s in my link tree, in the Amazon list.

[00:27:19] Of course we need to go there and get that bulb. 

[00:27:22] I’m like, you know, and it’s great for like anything too. Like nowadays, it does get little chilly. So you want to warm it up. Like you want to fill it the morning of work. There’s a lot of prep that goes on before work, because we don’t, we don’t just show up and our stuff is there. We have to charge our laptops, charge our mi-fi, which is our, our wifi. We have to charge our work phones and we have to get every, like my, like I’m like a police officer cause my passenger’s seat is my office. You have to make sure you have everything you need for the day before you head out the door.

[00:27:54] You don’t just go in, clock in, clock out and you’re done. Where I always was like, that’s such a benefit. I’m not like a teacher where teachers are expected to like, get their stuff done on outside hours. 

[00:28:06] I don’t because I try to work as many weekends and evenings, so like I don’t do case managing. Because I have a little one and I’m in school now. I’m like, I can’t take that on because it is, like you said, a lot of, kind of behind the scenes work. And a lot of follow up I just, I don’t have the commitment for that, but I love working. I call the weekends, like it’s like, ER, of hospice. We’re just going from one place to the other, as things kind of pop up. And then we also have routine visits going on in between the things that pop up. So it’s madness, but the team is amazing. We just fly. Like if they’re like, we need you to go see this person. Now we’re going to take this other person off your list. I’m like super awesome. I’ll go, that’s fine. 

[00:28:47] Yeah. 

[00:28:47] And they’re understanding, they’re like, we understand you’re only working. I’m going to work until this time today, you know? So they’re like, okay, so we’ll give you this, this and this patient and I can be honest and say, I think that’s too much for me for the day.

[00:29:01] Can’t get there and do those things. 

[00:29:03] I can’t, I’m like driving wise in between patients. Like you have to calculate it in, it’s not going to work out if I need to really solve issues for patients. And like we have to call pharmacy, then we have to chart that we called the pharmacy and then we have to chart that we contacted the family or the patient and educated them when the meds are going to show up. And what’s the medication and dah, dah, dah. And then we have to send emails to the case managers and the clinical managers about everything that we did at the visit. So it was a lot of, and then before we talk out, we have to put our mileage in, of course, And then we have to find an, hopefully we have good reception because if you don’t have good reception, you have to drive to a spot that you do have good reception. So like, and we, when we put narcotics in, we have to finish our, our note, our visit, and then sync the computer. We’re not on a live network. If you’re on a live network, it’s a little bit different, but we’re not. So you have to sync and then get everything and then triage can send the narc prescription to the position to get signed, then send it to the pharmacy to get them. And then you have to chart that you did all that .

[00:30:12] Synching takes time. All of that takes extra.

[00:30:14] It does. And like, I know our patients will be like, there’s no reception here. I’m like, yay. I’m going to have to drive somewhere and find somewhere to park. And like, if you’re parking in a parking lot for a while with your laptop, charting, you look suspicious. 

[00:30:28] Yeah. My mother-in-law my mother-in-law would do that. She talks about home health PT, and she’s like the number of times a cop comes up to me and I’m like, I’m here because I felt unsafe everywhere else. I’m safe. 

[00:30:41] I thought we were good here. I know. Like note to everybody. If you join home health or hospice don’t park in front of a bank, that’s a bad place to be.

[00:30:52] It’s nice and quiet. 

[00:30:54] I did that once. It was hot, it was shady, smaller towns, or, you know, the cops are just around. 

[00:31:01] Yeah.

[00:31:01] Can I help you? 

[00:31:04] They’re knocking on your window and you’re like, no, I’m alone in the car working. I’m safe. 

[00:31:08] Yeah. I’m like, no, I don’t want your number. No. Oh, that’s not why you came. I’m so sorry. 

[00:31:15] Oh, we’re okay. You’re working.

[00:31:16] Like backtracking. How embarrassing? We get the tap, tap, tap on the window. Why have you been here for so long? Because I need to chart. I guess you could use the fire department or the police station because they’re public entities, legally .

[00:31:36] Like a library.

[00:31:37] A library is another good spot. Super quiet though. So if you have to have the farts, don’t go into a library , not a good place for that. Do it in the fire station. Cause you can just blame it on the firefighters. 

[00:31:50] That’s right. 

[00:31:51] I know in the hospital though, you guys can have a specific pooping bathroom. I’ve heard that there’s specific bathrooms.

[00:31:56] It’s right across from the manager’s office.

[00:31:59] That’s a great idea. 

[00:32:00] So you don’t actually have to say, where’s your other bathroom. You can just say, where’s your manager’s office. And then you go find the bathroom around there and that’s the shitter. 

[00:32:07] That’s a good idea. 

[00:32:09] I haven’t even worked for many places. I just know that’s pretty universal. 

[00:32:14] I only go to the hospitals every once in a while, because if you send a patient to the ER, sometimes we’ll go check on them or we have to go sign relocation paperwork.

[00:32:24] And we have to like, I’m like, if anything, this person just got sent out to the ER, and now we’re going to be like, Hey, can you sign this paper for us so we can take you off of hospice. Because of Medicaid, you know what I mean? They don’t want to bill hospice and other day when this patient is admitted to the hospital, but if they get admitted, we can just readmit them when they get discharged.

[00:32:45] So I’m like, don’t be scared. You can just come back on. Don’t be scared. We’ll welcome you back. We’re still here whenever you’re ready. 

[00:32:52] So much rigmarole. Well at the end, I want to ask just a few like quick fire questions that I still have left for you. Is that alright Allie? 

[00:33:00] Yeah.

[00:33:01] Okay. A couple of quick fires and then we’ll tell everyone your handles and we’ll also have it all linked down below so you can, everyone can follow your work. The first question was one that I alluded to earlier. So I really like hearing all of the ins and outs of the job and I think we don’t get to hear a lot of this. Social media is great for that, but also it’s really nice to hear from a nurse who’s like living it and doing it. What it’s like for hospice nursing, what other nursing skills you get to use some of the best parts of nursing? I, I feel like are coming up when you’re talking about your job, what do you do in your life?

[00:33:35] You already said you have boundaries around your hours and boundaries around your time. 

[00:33:40] Which is huge.. 

[00:33:41] And having other priorities in your life that are kind of max the max, like you said your children, your education you’ve prioritized over. Your work family, whatever that looks like your team, right? You know, your patients, like you prioritize your patients and you prioritize your team, but when you prioritize other things in your life, you can be like, okay, I can be here for this amount of time.

[00:34:05] And then my other priorities are here. What do you do to help with your self-care with your own body, with your own trauma, with your own feelings, emotions, psych the, the toll that it takes physically on your body, because you’re saying you’re sometimes alone and there’s a, there’s a level of like awareness, always being aware, always being safe. 

[00:34:25] But I feel like our families, I feel like home health is like way. I shouldn’t say it’s way different, but like, I feel like they go anywhere. You know what I mean? Versus like hospice has kind of like a little more selective. They will go anywhere. Like I’ve never once run into bed bugs, knock on wood because now it’s going to happen. But like our families are always, like, we always have a pretty, you know, good admission process and we have a bunch of people who go in before, like the actual case manager. Everyone else starts to kind of trickle in. So we kind of vet the whole thing and we’re more aware of our surroundings. Like this is what you’re going to experience. Family has a large dog, only has a cat that likes to hiss at you, or, you know, and they’re in this area park here. Sometimes the parking isn’t always obvious, which gets me. I’m like, can you just, it saves so much time with people can just tell you, this is where you should be parking. You know what I mean? 

[00:35:24] You have to figure out your route as well during the day. And that’s another thing, because you can call your first four patients everybody’s on board with the time. And the last one is like, Nope, that doesn’t work for me. And so you have to figure out how to rearrange everybody else that you just set up visit. 

[00:35:43] So, you know, self care for me, it looks a lot like boundaries, but especially in hospice, because you know, nursing is a female dominated field. We’re very empathetic creatures by nature. And especially in hospice because our patients are going through such a change in their life. This is such an, you know, an important time. And it’s very, you know, it’s completely different than anything else. So we like to give them our full attention and, you know, that can, I think weigh heavy on a lot of nurses who already feel that need to be overly empathetic and present.

[00:36:21] And, you know, it’s almost like not really a guilt trip, but I would say a lot of people in hospice do get almost addicted to the job because of the fact that they love what they do so much. So I feel like it’s important to set those boundaries and say, you know what, my phone’s going to go off after five, I’m going to need triage to handle whatever comes up after I sign out for the day. You know, I’m not going to do any other and if you know, work doesn’t get done, I don’t feel that it should be put on the case manager because the fact that obviously there wasn’t enough time in the day to do everything that they needed to do. You know, and I’m honest about it. And I work on the days. Usually I try to work extra, when she’s at her dad’s so then I have a little bit of wiggle room, but like, say you’re trying to go get your kids or you have to come home and be there to relieve the sitter at a time. That can be stressful for a lot of people have a visit runs over.

[00:37:12] So I wish there was more of a safety net, you know, I know we have it. We run kind of almost like a hospital. We have nurses who specifically work 4 to 12, like a group. And it’s almost a skeleton crew sometimes depends on people who call out and you all know that thing. But you know, sometimes we’re able to say, you know what, I wasn’t able to do that. Or they can reschedule their visits. We have also have case managers who work four days a week. They work 10 hour days, four days a week instead of, you know, so they’d get one more day because I know, you know, I need to babysit on that day or I have this on that day. You know, they want one more extra day of the week to themselves. So I think doing things like that you know, and learning your boundaries, like I said, shutting off your phone or not answering emails until like 10 o’clock at night. It’s very, very important. You know, physical health is super important, but like, to me, that’s like eating my favorite food or like, if I’m exhausted from a day’s work, I’m like, I’m not going to cook dinner today. I’m going to get takeout. Like, you know, people will be like, don’t eat so unhealthy. It’s bad for you. I’m like, I take my daily vitamins. It’s fine. It’s, it’s better for my mental health. If I don’t have to go through the rigamarole of cooking and then having to clean the dishes some days if I truly had a mentally or physically exhausting day, because you know, some days are more mentally, but you have more mental fatigue than you do have physical fatigue because your brain just had to work through so much stuff.

[00:38:33] And a lot of hospice is emotional and it weighs heavy on your shoulders sometimes. Cause you think about what the people you’re interacting with. I look a lot of my patients and I think of all the patients that I’ve seen over the past six years, I’ve been in hospice, and none of them are with us today.

[00:38:50] And you think about those numbers and you think about all the lives that you’ve been a part of for that small blip, you knew these people, you knew their families you’ve been inside their homes. You’ve shaken their hands. You’ve given them hugs, you’ve held them. And you seen them at their last moments, take their breath sometimes. =And it really sometimes when you think of that and it hits you at the most random times you know, and the other night, I think it was a couple of weeks ago, I started crying. Cause I started thinking about this one patient and I was like, what the heck is going on? All of a sudden it comes, but sometimes you just need to cry and we don’t cry in front of the patients. I don’t cry in driveways. I don’t, you know, it’s not my moment to be comforted. It’s not, not about me. It’s not about any of us. It’s about that patient and their family at that moment. And we have to be that rock. So if we want to take time to ourselves to grieve- it’s normal. We can turn to our chaplains, if we need to, they have a lot of great coping skills. I know for a lot of our pediatric patients, I’ve only been a part of maybe like, I’ve only seen like two pedi patients since I’ve been working. Because it just doesn’t come up. We have a whole team for pediatrics that are on call 24/ 7, and we have specific nurses who are hospice pediatric nurses.

[00:40:04] I mean, I can’t even imagine. I don’t think I could, could do it that much. But I think grieving in your own way, it’s important. As long as you don’t stay in that moment for too long, you know people say grief never ends it just ebbs and flows. Like the amount that you feel. You know, some days you might feel sadder than the others, but I don’t think the grieving process truly ends.

[00:40:27] I don’t think there’s that those stages of grieving, like we’re all taught. I think grieving can be a lifelong thing. You can always grieve the loss of a loved one, but it does get easier some days and some days it might be a little bit harder and that’s how we look at it with our patients. You know, at least I do some days I look at them and I know they’re comfortable.

[00:40:45] I know they’re safe. I worry more about the families than I do about the patients. Cause they’re left with that void. Right. They lost the patriarch or the matriarch or that staple of their family, you know? And that is the hardest because then they’re the ones grieving. The patients they’re okay. They went home, they got taken home. They’re good. I’m like, they’re they’re home now. And that’s what we do. It’s just hospice is the process of just walking them home at their own pace. Whenever they’re ready. They get called home and you know, it’s very, it’s not like what you see in the hospital. It’s not traumatic. It’s like a candle in the wind. I have to literally stare at people sometimes like this. I’m like, are you there still? It’s like a candle in the wind and I have to listen for that minute. And I know they’re okay now and they’re going to be okay.

[00:41:35] The ones I usually worry about as the people left the families, the kids, the, you know, especially the kids, the kids usually take the passing the hardest. You know, and it’s just, you have to take that time as a nurse to grieve yourself because a lot of us get close to our patients especially case managers and the aides too. They’re the ones seeing these patients day in and day out, you know, and we can see the bond that they create. We’re in their homes. We’re in their lives. They become like a little part of our family or they treat us like family too. Like, do you want some of this? Do you want a cup of coffee? Drive safe. Make sure you drive safe. It’s crazy on the road. I’m like, okay. There’s so sweet. I had one patient. She used to be a music teacher. So we used to sing while I did her wound care. And it was amazing. 

[00:42:27] And she used to sing ‘goodbye alison’. It’s like little blips of your patients that stay with you for so long. You can hear their voices. You know exactly like their softness of their voice and the little things that made you laugh about them. And those are the things that I try to carry when I feel a little bit sad and like the good things are always so much better.

[00:42:50] I know that one day, like when I go to heaven or wherever it is next, cause I know I take care of a lot of variety of spiritual beings as I like to call them. And everybody has their own version of what kind of comes next. And it’s interesting because before people pass, everybody sees somebody or they feel somebody or, you know, so we’re going somewhere. But since everyone believes in a different afterlife, I’m like, which one is it? Know what I mean. Where are we? It’s it’s great. It sounds fantastic because people see somebody, you know, and I hundred percent know their pets are there. They’re a hundred percent there. Cause people see their pets all the time who have passed away. I had one lady she passed away a week after her dog. And she’s like, so-and-so is here. 

[00:43:39] So, oh, I love the themes around death. I love the stories, the like pre death moments, experiences, exercises, activities that happen. Oh my gosh, the patterns. It mirrors life. 

[00:43:55] Yeah. And they have their rally day. So like, I know a lot of hospice nurses experience this. We have the talk with the family they’re transitioning, you know, usually, you know, time sensitive. Blah, blah, blah. And then the patient rallies, and they’re like, you were wrong. Sometimes we are wrong because especially with our Alzheimers patients, they’re like this, they can seem like they’re transitioning one day and we’ll be like, this is gotta be it this time. The third time they’re transitioning. They’re like, oh no. Alzheimers is a roller coaster. When I, I say it the long goodbye, because it truly is the longest goodbye because you see this person from who they were going into almost a shell, but they stay in that shell for such a prolonged period of time. If I have to find another job because we have to lose half of our patient population and that means Alzheimer’s gets cured. I will find another job. I have no problem with that any day, any day. But like, you know what? I love hospice. We get to spend time with their patients and, you know, I know at bedside, well, the true bedside hospital, you guys try as much as you can, but it’s like…

[00:45:14] we love that part. 

[00:45:17] We’re literally like one patient at a time to one patient to one, you know? And it’s not that we’re not rushed or we’re not busy enough. It’s just that in that moment, the patient is that’s it. They’re our focus. They’re the star of the show. I don’t have to worry about going to pass meds to another patient. I don’t have to worry about an antibiotic that needs to be hung or a drip running out.

[00:45:38] Well, Allie, thank you so much for your time. I got a bunch of questions answered and just that I got to like brief Allie at the bedside, Allie, the hospice nurse, like I could feel it coming through and I love that you love your work and I can tell and 

[00:45:56] oh God, I love it so much. I’ve met so many cool people, so many, and I know like we all do. Because I had felt like I can’t be like, you know what? This person invented this. Like, I meet a lot of people who change our lives, but are like, they’re behind the scenes. So we don’t know their names. And like, I’ve met a lot of world war II guys, like how many people can say that they’ve met that many people who have been in, like, I feel it’s so cool. These guys are the coolest people in the world. And like, they’re all, I mean, amazing. I’ve met a lot of fabulous ladies. One lady was like, she got her degree in biology and, and back in that time, it was like a big deal to get a bachelor’s as a woman. Nevermind biology.

[00:46:40] Science 

[00:46:41] It’s a big deal. I’ve met nurses. I can’t even tell you about us. I, when I say some of them are the best patients, they’re probably the best patients. It’s when the family members or the nurses, sometimes

[00:46:58] People who aren’t nurses, but think that they are?

[00:47:04] You nailed it. Yeah. I would have to say, I have had a lovely time with patients who are nurses and most of the nurses who are family members, it’s the ones who come in from like out of state. And you know what I mean? I’m like, where have you been? 

[00:47:18] Banging the boss’ drum. Like I know 

[00:47:22] Or medics, medics who aren’t the healthcare proxy. You know, their family they’re concerned. I understand. I’m like, but we aren’t the same. Like I know what you’re trying to do. And I understand what they’re taught is completely different than what we are taught. Like I get it. You’re driven emergency medicine, you know, a lot of stuff that I would have no idea on what the hell to do. You can put an airway in. I can not do that, nor would I want to, but I’m like, sometimes they can be tough cookies. Cause they’re used to working in such a tough environment where versus where like hand-holding, you know, like, I’m like, do you want me to massage your hand? One thing I like to do is I like when I go into facilities, I take the hair out of my patients, brushes. That doesn’t get attention enough. I’m like, I hate hair. I hate loose hair in general. And they see you want to vomit. But if I see it in my patients brush, I’m going to wash the brush and take out the hair. I’m like, those are the little things. Like if you don’t think about, like, I had one of our aides, who would my patient, she dyed her hair for her. She was unable to do it herself and she hated roots, hated it. Our aid dyed her hair. She went out and she bought her favorite foods cause she didn’t like the food at the facility either. And she got dye and dyed her hair. 

[00:48:44] Awesome. 

[00:48:46] When I tell you we know our patients and we see them as, because we know we’re in a, like I said, this is why hospice can become dangerously addicting because we’re in their life for this small blurb and we want them to feel like they’re the star of the show because that’s what it is. Imagine you just found out you have only six months. You would want that specialized. 

[00:49:09] You get to dye your hair. Yeah. 

[00:49:10] Shave your armpits. Shave the mustache. I don’t even care. Like I will, whatever you got, let me, if you want to put on a full face of makeup every day, we’ll put on a full face of make up everyday. You want to eat cheesecake, eat your cheesecake. I don’t care if you’re a diabetic, eat the cheesecake. Do you want to smoke a cigarette? And you’re on for lung cancer. Don’t do it on an oxygen, but go ahead and have the cigarette. We’re not gonna, we’re basically not going to say no, unless I put them in like a really dangerous situation, because it’s like, why does it matter at that point?

[00:49:46] I love it. That’s why I love it. It’s it’s the goal. Our goals are different. We’re not about like, you know, how are we going to fix you? We’re like, this is quality care, you know, for whatever quantity of life we have left. And it’s a little, you know what I mean? It’s a little bit different and that’s why I like it. Cause we can kind of like, well they’re on hospice. Oh, okay. 

[00:50:08] Right. Get away with a lot more in the name of the patient. 

[00:50:13] In the name of the patient. Exactly. Yeah. I’m like, they want this. I’m like, you know what, because I remember I had one, you know, you have patients who have the hospital, they’re NPO because of swallowing issues because they’re going to aspirate. I’m like, we, what we do is we explained to the family, the risks, you know what I mean? And then we kind of guide them as to what foods may or may not be better, like cheesecake, key lime pie, shakes, things like that, that are thicker thickening stuff. And we explain the risks of what may or may not happen, but they’re on hospice. Are we going to deprive food? No, not their favorite. Just give them a little taste, see how it goes. You know what I mean? When I tell when people are like, they’re not themselves and like, you know what, they don’t feel like, you know, just cook something that, you know, is their favorite food, because sometimes that olfactory sense triggers and it will make them salivate and maybe want them to taste at least taste their favorite. It’s all about that moment, savoring that moment of them being taken back to their favorite food or that favorite food brings them back to their time in their life or playing music that brings them back to their favorite time in life. You know, looking through pictures, things like that, anything to, to relive and you know, memorialize and kind of, you know, just have them relish, what is left of life and remember all the good things cause chemo can change a lot with patients taste too. And they don’t love any of the same things they do anymore. I’m like, well, try cooking something. Try to stay away from super strong stuff. Like we don’t want like onions sometimes that can make people nauseous. But like savory things, people love the desserts ice cream, huge. This is my next pitch Ensure, but make it ice cream. High protein ice cream because I’m like, that’s what they need. Especially Alzheimer’s patients who are losing that ability to even chew sometimes the ice cream will melt. Right? You know, and the problem comes when they lose the ability to remember, remember to properly swallow that’s when we run into issues, but anything to bring them back, anything, I will try anything to literally make them smile for a second.

[00:52:30] It’s tough to figure it out. Cause some of these patients are not, you know, most of them I say are accepting of their diagnosis if they’re fully aware, but you do I think every once in a while, I’ll have somebody whose really not happy with the fact that there’s not anything else that can be done. And I’m like, well, who says that you have, I’m like, you don’t really have to. I wouldn’t say you don’t have to be on hospice. We have palliative care too palliative is another side. Like our patients sometimes transition over from palliative to hospice. Palliative you can still continue with maybe an aggressive treatment, but they’ll manage your psych social, emotional, and pain which is huge pain team specializing in pain management for people who are going through any sort of aggressive treatment is huge.

[00:53:13] I think people associate like hospice. We’re gonna manage all your symptoms, including including pain. And that’s one of our goals. We want to make sure you’re comfortable, it’s comfort care. But if you want to have that same level of control, you can always have a palliative care consult and see if maybe if you don’t want to, you know, if you’re not terminal yet, or you’re not diagnosed with terminal with the six month or less prognosis palliative can be a helpful hand, another tool in your basket. They also have medical, social workers. They have a lot of the same tools that we have in hospice. It’s just the goal of care is different. You’re still looking for a curative treatment and you’re still driven to have aggressive treatment and that’s okay if you’re not okay with your diagnosis, you know, or your prognosis.

[00:53:59] It’s all about the patient and what their goal is at the end of this. We just want to make sure they’re comfortable and they’re freaking happy. That’s huge. 

[00:54:07] Oh, love it. Thank you, Allie. Thank you for bringing us into your world for a little bit and sharing about it.

[00:54:13] Thanks for asking. I love it. I love what I do, and I feel like it’s such a hidden gem of nursing and you know, I wish there was more ways for people to get in because it’s like, it’s hard in a lot of places cause they want X amount of experience.

[00:54:25] And like I said, nursing school, isn’t that experience. So people are always like, I’m a new grad and I want to go into hospice really bad. I’m like try applying per diem because then you can just kind of get a feel for the ropes and you have something on the books, at least if you’d want to apply. Yeah. You have a little bit of, and you can learn at your own pace, essentially pick up shifts as you go. And yeah, if you’re hesitant about it, you can try it out. And you know, sometimes people realize in training, like it happened a lot in prison. People would last like 24 hours. 

[00:54:57] Because it’s all it’s intense and it’s not something that you can test out. And it’s not something that you get any behind the scenes in any other capacity, you don’t get to just go visit and like shadow for awhile. That’s a good last tip. Try per diem.

[00:55:11] Try per diem and see if, you know, I always say reach out and see if or google and like nurse hospice, nurse residency programs, because that’s your tip to go and shadow and you get trained in. For us and my agency, I believe is six months. So you get like a long residency. Our training is a month. 

[00:55:32] Wow. That’s cool. 

[00:55:33] Yeah. 

[00:55:34] Well, we’re going to put your link in our description. So folks can find you and watch you on Instagram and tik TOK. 

[00:55:41] And my YouTube, I do for new hospice nurses. I do a lot of like charting verbiage things. Cause the verbiage we use is different too. Like words like actively dying things like that you don’t normally use when you’re in a you know, a curative environment. 

[00:55:57] Yeah. That’s super helpful. 

[00:55:58] Yes. So I do a lot of that for, and I think it helps families too, because the verbiage we use sometimes is like, you got to put it into layman’s terms, but it can be big, bold and scary for a lot of people. You know, hearing even some of the medications. I feel like educating is the best way to go about to learn that hospice isn’t the stigma that people think it is. Like, we’re not Dr. Kevorkian. We’re not looking to do that. We just want to help you live your best life for however long you have left. That’s it? 

[00:56:27] Mm. So good. Well, thank you, Allie. And everyone, who’s listening. Be sure to follow, because this is good. This is juicy. This is great information. I love the behind the scenes and that hopefully will help others feel like they have a little bit of another stepping stone to get into the profession and around the profession, because I think this is some of the best parts of nursing. 

[00:56:48] Yeah, it is. It’s a one-on-one patient. It’s that care that. Taught you to kind of take the time in and the basis, like when I say make nursing good again, it’s bringing it back to the part where we used to be able to do a lot of the handholding and patient care, like the psych social, emotional care that nursing is the foundation of not just passing meds and calling physicians and things like we need to get back to the good part of nursing where we, we loved being a part of people’s lives and changing them in that way so that they remember not only you hanging that IV bag, but you also talking to them at midnight about an issue, you know, or something taking a little bit of time. Nurses in the hospital don’t have that time anymore.

[00:57:35] That’s the epitome of putting the human back in medicine like this really? It just encompasses everything that medicine was founded to be. Not what we have in the hospital system. 

[00:57:48] That’s why I love it.

[00:57:50] Well, thank you so much, Allie. We’ll talk to you soon and we’ll see you on social media. Thanks y’all for listening to the Pulse Check podcast. We’ll see you next time. 

[00:57:59] Bye.