Joan Wilder: Journalist, Writer, Editor

Hospice nurtures staff

As the small group of nurses and staff at Hospice of the North Shore (HNS) sits in the homey family room of its Danvers office, one after another tells a story about a patient. Inevitably, someone says something that reminds another participant of something that happened to them — or sparks a memory that leads to the telling of another true anecdote. For one hour, every other week, the “Narrative Group” gathers to do nothing more than tell – and hear – each other’s stories. Often, there are knowing nods, smiles, and laughter.

“One of the chaplains told a story about a visit to a patient who was watching TV when he arrived. Soon afterwards, the patient fell asleep,” said Christine Van Gemert, RN, HNC, CHPN, who co-founded the group with Jerry Schwartz, PhD, the agency’s psychosocial counselor. “The chaplain and this patient normally spoke during their visits, but on this occasion, the chaplain said that he himself ended up falling asleep right along with the patient. Later, he said, he thought ‘oh, no, I shouldn’t have done that.’ But the next time the chaplain visited, the patient said ‘that visit we had last week was the best visit we’ve ever had!’”

The Narrative Group is one of many activities HNS provides to nurture, de-stress, and feed the souls of its nurses. Many activities take place mornings in the office — before the nurses head out to see patients. Activities are scheduled daily, monthly, bi-monthly, and annually, like the agency’s all-day country retreat. And, while some activities are non-verbal – including chair massage and reiki therapy – many are based on the healing power of communicating.

Van Germent believes that there are many ways each of us can find to process work stress and that good self-care is as important to a nurse as caring for a patient well. She likes Narrative Groups for many reasons, including the way they help participants see meaning in what they do.

“The stories remind us of the reasons we do this work,” said Van Germent. “It’s [story telling] very nurturing. It holds some of those exquisite moments up so we can see them…otherwise they would be lost.”

Often, the stories carry teachings, too, in that nurses hear how others have handled particular situations. And, always, they send the reassuring message that no one is alone.

Although HNS nurses make solo visits to patients, each is assigned to an interdisciplinary group comprised of an RN, an LPN, a chaplain, and a social worker – all of whom also treat the patient. The groups meet regularly to compare notes on patients — which fosters further communication.

“The team approach means there’s always internally someone to turn to about a patient problem,” said Jane Bell, RN, MS, director of patient care services. “You don’t have to handle it alone.”

Monthly bereavement sessions are another vehicle that help nurses at HNS take care of themselves. The sessions, which are open to all hospice staff members, are times when anyone can talk about their feelings.

“There’s a lot of cumulative loss… I don’t know if you can open to the next patient if you haven’t had time to process the last,” said Bell. “It’s an honor to be able to participate in end of life care… but if you don’t do the self-care it’s a high-risk area for burnout.”

Rather than burnout, any HNS nurse — who wants to — can burn candles several mornings a week at a 15-minute guided meditation session. The sessions are low-key and often include music and voice recordings that take listeners on a relaxing inner journey.

HNS leadership also encourages its nurses to find out what nourishes them outside of work. Whether it’s dancing, listening to music, walking, reading, or going to a museum, Bell suggests doing it.

“If you start to learn to take time to take care of yourself — when you go back — you have so much more to give,” said Donna Sciola, RN, provider relations co-coordinator at HNS. “I’ve never been happier…probably because I have all this support at work.”

According to projections by the United States Department of Health and Human Services, this country will have a shortage of approximately 125,000 nurses in 2005. With deteriorating work conditions clearly one of the major reasons for this problem, health care providers seeking to recruit and retain nurses may want look to HNS for ideas.

“I’ve never worked anywhere in my life where I’ve felt so nurtured and fulfilled,” said Sciola, who nursed on a surgical floor and in an OR before becoming a nurse at HNS. In June, after 14 months of hospice nursing, Sciola accepted an offer to become the agency’s provider relations co-coordinator. Although she loves her job, she misses patient contact, and said that she “will shrivel up and die” if she doesn’t begin treating patients again soon!

“I love about this job that we take in each person as mind, body, and spirit,” said Sciola. “It’s great to see a patient as a whole. If someone feels good about themselves – spiritually and socially — they almost always do better. Any nurse will tell you that.”

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