HEALTHCAREERS: Hospice nurse

Helping people die without fear

As a staff nurse with Delaware Hospice, Pat Wisniewski helps families care for a loved one at the end of life.

He works with families to arrange for doctors, home health care workers, medication, social workers and chaplains. To the 48-year-old Wisniewski, empowering families to care for a dying loved one is the most rewarding nursing he has done.

"A lot of people go to their doctor's appointment and are told there is nothing more the doctor can do," he said. "Families feel like they're dropping off a cliff. We tend to be the net that catches them before they hit bottom. We are there to ensure there is enough care and support so patients can optimize whatever time they have left."

Typically, he handles eight to 14 cases and visits with patients and their families one to three times a week. His office is primarily his car.

A Newark resident, Wisniewski holds a bachelor's in nursing from the University of Delaware and previously worked as a hospital trauma nurse. He recently discussed hospice work.

What do you find rewarding about hospice work?

When you are around someone who is dying, presumption falls away. They are looking to live their fullest in the time they have left.

When someone is passing, that's a mystical moment similar to birth. I enjoy the ability to help people to experience that transition without fear.

It seems natural for patients and their families to be frightened.

A lot of that has to do with the unknown, which seems to be a lot worse than having a sense of what's coming.

Sometimes we get a referral and death is imminent, say in two days. I call that bringing someone from 0 to 60 in 18 seconds. You've got to do a lot of teaching in a short amount of time.

You can also have a patient for two years as they experience a slow steady decline. The component of teaching is still present.

It's very different from nursing in a hospital?

In a hospital you're one cog in a machine, the medical machinations that we call western medicine. There are egos and many people involved.

When you come to the end of someone's life, the doctors realize they are not going to cure anything. They take that four-letter word 'cure' and take the u out and say it's time to put the a in and make it 'care.'

The I'm-going-to-fix-it attitude falls away. When we call, they want to know what they can do to keep a patient comfortable.

So it feels collaborative in the best sense?

Yes, not only with the doctor and primary nurse, but with the family, social workers and chaplains.

Chaplains attend to the spiritual pain that people go through. Pain is not just physical. It can be existential, physical, emotional and spiritual.

What do patients ask about most often?

The most common question and the least answerable is how long do I have. Everyone who has been given a terminal diagnosis has a pressing need to know this.

There is no good way to answer. There are signs and symptoms along the way. We have a page we give out that talks about the final stage and describes what occurs as a patient is getting close to death.

Do you think people have misconceptions about your work?

People often say "Oh you must have a terrible job. How can you do that?"

I admit it can be emotionally demanding and there can be vicarious traumatization being around so much loss.

You can't go into situations lightly. You've got to really be fully present.

Yet it's very rewarding to be a calming influence and nurturing support. My focus is to say to the family at the end: What great nurses you have become to your loved one. And I mean it. They do a tremendous job.

I'm just a consulting nurse and stay somewhat removed, which is not to say I am cold and distant. But there is a certain clinical distance you maintain out of respect for the family.

Are you on call?

Yes, we take turns being on call nights and weekends so we have two nurses on at any given time. Our number becomes their 911 for any event or crisis.

Contact Gary Soulsman at 324-2893 or gsoulsman@delawareonline.com.

ABOUT THE CAREER

EDUCATION: Typically, hospice care is delivered by registered nurses, many of whom earn a certification in hospice and palliative nursing. However, there are also licensed practical nurses serving in this role. Pat Gibbons of Greensboro, N.C., nursing section leader of the National Council of Hospice & Palliative Professionals, says the best hospice nurses have had experience handling a variety of situations and they are able to deal with the emotions of families facing death.

SALARY: $46,500 was the average reported in a national survey.