Something Unexpected

I’ve been a licensed Registered Nurse for 7 months now and so far very little has been what I expected. For starters I work in one of the two areas of nursing that I thought I would never venture into. The first is pediatrics and the second was long-term geriatric care.

I, like most new graduate nurses, assumed I would be working in a hospital. Probably a med/surg floor to start and possibly (hopefully) ending up in critical care. Instead I ended up working in a nursing home. It isn’t where I pictured myself working – and in many ways it is the polar opposite of what you spend the majority of your time learning in nursing school.

The nursing home clinical rotation is usually the first semester rotation in most nursing programs. It’s the “easy” rotation because you don’t administer medications, you don’t start IVs, you don’t do a lot of the modern day nursing skills that you will eventually be learning to do.  In the nursing home rotation you do bed baths, linen changes, and you talk to people. The problem is that they usually pair you up with the residents who are a bit further from death.  The ones who are a bit more self-sufficient, the ones who are aren’t late stage dementia, the ones who aren’t likely to cuss you out, spit their food/meds on you, or hit/kick/bite you. The ones who aren’t as likely to die while you’re in clinicals. So you, the fresh faced, idealistic, hope-filled nursing student leave the nursing home thinking, “Wow! That was easy. That was too easy! I want to do something important.”

The reality is that working in a nursing home is harder that you’re led to believe by a quick and easy first semester clinical rotation. It’s much more emotionally draining than that first semester shows you. When you’re paired up with an elderly person who is still fairly capable of having a conversation you don’t see what Alzheimer’s dementia really does to a person, or how hard it can be to care for someone with that disease. When you spend your days talking to and taking care of people who are still relatively healthy it doesn’t prepare you for the emotional toil of caring for someone who is actively dying.

And because the first semester rotation is the only time you’re going to set foot in a long-term care setting you’re not going to get that experience or perspective.

Nursing home and hospice care is the antithesis of everything you learn in nursing school.  Oh sure you talk a bit about death and dying (particularly the 5 stages of grief and how to do post mortem care after the patient has died) in school.  But most of what you learn is focused on how to care for people who are likely to get better. How to “save lives.” The focus is on diseases that you can actually do something about.

Combine that educational focus with the modern day expectation of nurses created by such unrealistic shows as HawthoRNe, Grey’s Anatomy, Nurse Jackie, etc. and you end up with a picture of nursing that is focused solely on healing people and saving lives.

So imagine my surprise when my two most gratifying moments as a nurse – the two experiences that actually made me think that nursing school was a good idea – were with residents who passed away. I’m becoming familiar with death. I work in a nursing home, it’s hard not to. These two residents are not the only residents I’ve worked with who have died, and they certainly won’t be the last. But both of these residents were hospice patients and my sole role in their end-of-life journeys was to make them as comfortable as I could. Essentially I was to help them to die peacefully.

My role for their families was a bit more complicated. It was to help them be comfortable with what was happening. To explain that process of dying, to explain how what I was doing would help, to educate them on what to expect as the end drew nearer, and ultimately to offer them comfort when their loved one did die.

It’s not a role I pictured myself in. It’s not a job I imagined doing. It certainly isn’t something I thought would be rewarding. But somehow it was. Not in the “it made me feel great!” kind of way. But in the, “Wow, I did something that actually made a difference for someone” kind of way.

All too often we tend to think that making a difference as nurse means helping to heal someone so that they can go home and keep on living. I am as guilty as the next person of falling into that trap. It was very unexpected for me to realize that helping someone die with their human dignity in tact (not as easy task as so much of the practice of medicine strips our patients of their dignity and often ignores their humanity) matters and it makes a difference.

I don’t know how much of a difference it makes to the person who has died because I don’t pretend to know what happens at the time of death or after death (if there is anything after death), and most people who are at the very end of their lives aren’t going to be able to tell you if what you’re doing matters to them or not. But I know that what I did for my residents in the last hours of their lives made a difference to their families.

It was something unexpected to realize that there is so much more to nursing that just making people feel better. I’m still not sure that this is the field I will spend the rest of my nursing career in, but I’ve learned to respect the job that long-term care and hospice workers do. It matters. It matters a lot.