Two years ago, I became a hospice nurse, after spending 20 years in labor and delivery. When I tell people about my transition, the response is often the same Wow, thats quite a switch, or, Gee, talk about the complete opposite.
But there are surprising congruencies between the specialties. They both are the most significant of life events, and both are natural processes, for which we can provide only assistance along natures course. Whether the birth or death is long or short, easy or complicated, there are many opportunities for a nurse to provide care and support.
Both of these events involve varying levels of discomfort for patients. Each case is different, and the challenge lies in assessing what is needed and then trying to meet those needs. Fear and anxiety often pervade both of these life events, so emotional support is a key component of nursing care.
When I worked in L&D, I prepared the pregnant woman and her partner for the birth of their baby by explaining each aspect of the process, hoping to reduce their fears and help them cope with the stress of the event. In my new position, I also prepare the patient and family for what may lie ahead. Its interesting that in both specialties, the most frequently asked questions are, When? and, How much longer, do you think? People have an understandable desire to gain some control over these intense experiences, and it is difficult when I dont have answers for them. Sometimes, all I can do is offer emotional support through my consistent presence and ability to listen to their concerns.
Of course, there still are plenty of differences between these two fields of nursing. In L&D, I would spend only a few hours with a new mother. As a hospice case manager, I often spend several months with a patient and his or her family.
I now see families in a new light. When I worked in the hospital, I viewed the patients family as visitors. They were naturally concerned about their loved ones, and I answered their questions as best I could, but my involvement with them was limited. In my new position, the hospice philosophy considers both the patient and his or her family as the focus of care. It is a holistic approach based on the belief that the patients death affects everyone in the family. In fact, there are many times when family members need more of my guidance and support than the patient does.
Also, in keeping with hospice philosophy, the family members are the primary caregivers and I am now the visitor. A welcome visitor most of the time, but I am always aware that I am on their turf. I realized early on that when I step into these peoples homes, I am also stepping into their lives. I try to respect their values and beliefs, and it is interesting and fulfilling to become so closely involved with them.
In L&D, I was accustomed to using electronic monitors and other types of high-tech equipment. In hospice, the focus shifts away from aggressive interventions. Our goals are to manage the symptoms of our patients, and to try and keep them comfortable for the remainder of their lives.
The most obvious difference in these two specialties would seem to be about the nature of the work. People used to remark about my former job, Oh, that must be such a happy place to work. But L&D nurses see their share of complications and unfavorable outcomes. They sometimes have reasons to cry with patients and families. These days, people say, That must be so sad. How can you do that job? Besides the satisfaction that comes from helping others, I have the honor of being a witness to the strength people can find within themselves when faced with the loss of a loved one, and to the depth of compassion and caring that humans can show for one another.
It occurred to me recently that a dying person has something in common with a baby coming into the world. Both are traveling from a familiar home into the unknown. For both an L&D nurse and a hospice nurse, part of the work is to try to provide safe passage.
Cindy Heffron, RN, BSN, is a case manager for Jefferson Hospice in Radnor, Pa.