The day in the life of a hospice nurse

    Editor’s note: This is the second in a series of three articles for National Hospice Month.
Jane Zimmerman, a registered nurse has been in home health care for 18 years, 10 of those years in hospice with the Visiting Nurses of Aroostook in Houlton.
    “Sometimes my day begins the night before,” says Zimmerman. “It depends on the status of my clients.” “If I know that death is imminent, then I get my clothes ready, so it won’t take me long to get dressed if I should get a call in the night,” she added.
“If the night goes well, then I am usually on the road early in the morning. I often leave in the dark and come home in the dark, especially in the winter. My territory starts just south of Mars Hill and goes to Bancroft,” she concluded.
Her destinations include: in-town, in the country, at the lake or deep in the woods. She goes where the patient is and wants to be.
Zimmerman likes to get into the home and meet her families as soon as possible. Once hospice is introduced into the home, the team consisting of the primary care nurse, the medical social worker, the home health aides, the spiritual director and the volunteers do their parts.
The nurse and the social worker educate the caregiver or the family on the transition from life to death. They along with the home health aides educate the caregiver not only in the care of the patient, but the care of the family. Some families are small and some are large. Every one is different. For those clients that do not have family, or many close friends to support them, they offer the volunteers. The volunteers are able to come into the home to give the caregiver time to go to appointments, get groceries or do errands. They can be there so the caregiver can get some rest or just have some companionship.
The primary care nurse goes to the home two or three times a week for an hour to an hour and a half. The aide usually comes at least once a day or sometimes first thing in the morning and again at night.
The social worker stops by or calls once or twice a month. The spiritual director will come as often as needed.
Zimmerman gives her phone number freely to her clients. It is so important for someone to be at the other end of the telephone when they call with questions and the need for reassurance. She often hears a voice saying, “Thank you for answering, I am so glad you are there.”
When a patient’s wish is fulfilled, no matter how small it is; it makes her job worthwhile. Zimmerman says that she has met many wonderful families in the work she does. It is a sad time, but in those sad times she often sees incredible joy.
Zimmerman recalled the man who was on oxygen and wanted to take a ride in his ‘gator’. Even though he may not have been physically able to go for that ride, just seeing it was enough.
Sometimes she has joined her patients in a venture.
“It is great to see a smile,” she said. “They like to hear stories and often times like to tell stories of the early days of their lives.”
If there is a way to get to the patient, the hospice nurse will be there. It is not uncommon for them to travel through storms.
Zimmerman recalled going to Brookton during a major storm.
“I went 25 mph following two tire tracks,” she said. “I met no traffic. I sat with the patient’s wife and prepared her for the stages to come. He passed away in the night. The funeral director came in the storm, too. Everything went smoothly because she was prepared.”
“Another time I had a patient five miles out in E Plantation, just west of Mars Hill,” Zimmerman went on to say. “There was no electricity only a generator. There was hardly a road. Death happened at night and I sat with his wife until the doctor and funeral director came. The removal was the hardest part, due to the remoteness of the area, but he died in the place he love the best.”
Other daily tasks for the primary nurse include; returning phone calls, keeping up with paperwork that needs to be completed each day, and a variety of other office responsibilities.
Depending on the condition of the patient the visiting nurse may need to call in orders for medication, or call for equipment such as a hospital bed, a wheelchair or a walker. They are also in touch with a special hospice pharmacy. This pharmacy deals strictly with the hospice service and provides user-friendly medicines for the patient and caregiver. They are excellent at trouble-shooting and have consultants ready to answer questions that may arise.
Some days the nurse not only checks on her patients, but also must attend meetings at the local office. The day I interviewed many of the team members they were having a memorial service for one of their own volunteers that had passed away. Deacon Al Burleigh, spiritual director in the Houlton office spoke to the hospice group. They listened to readings, joined in a song and spent time remembering the life and now the death of one of their own. Even though many of them had attended a public service, having their own time of remembrance was very important to them.
Zimmerman says she often sees many caregivers months later, sometimes while shopping. There are always tears and hugs. They often tell her how much they appreciated the hospice program and wish they had known about it sooner. Some of these caregivers become interested in joining the volunteer group in hopes to help others in the situation they found themselves in.
One volunteer coordinator said that caregivers often make the best volunteers because they have seen the program first hand and know what and how to make a difference in the lives of others while dealing with death.
Often times you will see a request for memorials for the Visiting Nurses of Aroostook listed in the obituary. These donations are used to purchase equipment not covered by a patient’s insurance or other items that are needed for a particular patient.
If you find yourself in a situation where family or a close friend is utilizing hospice and you want to know what you can do, here are some suggestions: offer some time to the caregiver, but if you offer please try to follow through. If you promise to come back on a certain day or time, try to follow through.
The caregiver is there 24 hours a day; they need your support. Think of things that may be helpful to them. Drop off some extra food, take them a meal, do some ironing, take them some magazines, maybe just a bouquet of flowers, drop them a note, or just stop by to let them know you are thinking about them. Tell them they can call you any time, day or night. Let them know you care.
‘The ultimate goal of hospice is for the patient to be safe at home and comfortable. We want the family to look back and have no regrets,”  Zimmerman said.
    Look for the final chapter of this series featuring a family’s experience with the hospice service in next week’s edition of the paper.