James worked on-and-off as an LPN for over 20 years. In 2014 he completed a bridge program and became an RN. James became a hospice nurse in January 2015. He lives in the Kansas City area with his wife of over 30 years, 4 daughters and 2 sons in law.
When I was in my freshman year in high school, my parents moved us from Kansas City, MO to Emporia KS. We lived in a small community that consisted of 2-3 trailer homes and several pre-fab houses.
We only lived there for two years, but during that time I became very close friends with our neighbor, David Whittington. We became such close friends that he fell in love with my cousin and moved to Kansas City when we left the area.
David had a brother who was older than him. Rodney hung out with us now and then. Sometimes we would travel into town and hang out with him at the mechanic shop where he was employed.
Rodney and I were not close, but we were familiar. All of our conversations were in the presence of others. He was always super nice to me. Once We moved back to Kansas City, that relationship ended.
A couple of years ago I was surfing LinkedIn, and I found Rodney’s profile. He was now running an LTC facility in Olathe, KS. I commented a couple times on some of his posts. He had masterfully navigated some of the challenges his facility was facing with COVID.
Shortly after we reconnected, the agency I was working for admitted a couple patients in his building. I was very excited! This was an opportunity to reconnect and reminisce.
I had a nurse with me who was on orientation. We entered Rodney’s facility and followed the procedures. This was in the heart of the pandemic, so it took a few minutes.
We worked our way to the administration offices. Rodney’s secretary greeted us.
“Can I help you?”
“Yeah, I’m a friend of Rodney’s from back when I was in high shook. I have not seen him in over 30 years.”
“Oh wow! Okay, what’s your name?”
“Well, I go by James now, but back when I knew him I went by Stacy.”
“Okay, well, he is in a meeting, but it is almost over. Have a seat.”
Shortly after sitting down, Rodney invited me into his office. We visited for about 20 minutes. I reminisced with him about our time in Emporia. I told him that I see David routinely around town. Our conversation eventually moved to the challenges all facilities were facing at the time trying to navigate COVID. He was polite and kind through the conversation. He treated me like he had all the time in the world even though that was far from the truth.
I left his facility feeling good. It was nice to reconnect with someone after so long.
A couple months later I happened to run into David at our local Walmart. I was so excited to share with him how I got to visit with his brother Rodney after so many years.
“Hey Dave, how is it going?”
“I’m good. How are you?”
“I’m good! Hey, I got to see your brother a couple months ago! I found out he is an administrator at a nursing home in Olathe and went by to visit.”
David looked at me like I was a complete stranger. His stare was so blank that he was almost looking right through me. I almost felt like I was in an alternate universe where I was a complete stranger to David, and we had never met. I almost wondered if I was addressing the correct person in front of me. It was eerie!
“Hello? Dave? You have a brother named Rodney Whittington, right?”
“Yes, but he doesn’t run a nursing home.”
”Sure he does! I just sat in his office a couple months ago, and we, well I, reminisced about our time in Emporia.”
“Not with my brother you didn’t. My brother works in Topeka.”
I grabbed my phone and opened LinkedIn. I found a picture of Rodney Whittington and showed it to him.
David broke out in loud laughter!
”That’s not my brother! I don’t know who you were talking to, but it wasn’t my brother.”
David pulled out his phone and found his brother on Facebook and showed me his picture. These two Rodney Whittingtons resembled each other like a chihuahua resembles a bullmastiff.
To this day I wonder what Rodney Whittington in Olathe, KS thought of me that day. He handled the whole thing with grace and poise.
I barely know the Rodney Whittington from Emporia, KS. Apparently, I knew the Rodney Whittington from Olathe, KS even less!
At the end of the episode I take a few minutes to address leadership. It is my belief that leadership holds the greatest power over the culture of the office.
A good leader will take personal accountability for how staff treats each other. I believe that organizational staff will emulate their leaders both consciously and subconsciously.
Hospice nurses are in high demand. We could leave one company today, and have a job at a new company tomorrow. It is really that easy.
I am very public about what I do for a living. If you’re reading this article, then you are well aware of how public I am. Because of how outspoken I am, I get a lot of hospice questions from friends, family and complete strangers.
One of the most frequent questions I get is, “Which hospice should I choose?” Now, if you live in the area of the hospice I work for, I’ll suggest my hospice. Many times I get this question from someone who does not live in my area. I have a simple response to this question.
“It doesn’t matter as much which hospice you choose. It is more about the team that you get.”
This is a very truthful statement. For the patient and family, the nurse and the team you get could easily be the difference between a good hospice experience, and a less than ideal hospice experience.
I always recommend that someone find a really good hospice nurse in their area, and then choose the company that nurse works for. It is a much better way to find the hospice of your choice. The nurse doesn’t work alone, and the chaplain, social worker, and home health aide are absolutely essential.
The nurse is still the central case manager for all hospice cases. You need a really good one for your best hospice experience.
Don’t try to pick the best company. Try to pick the best team. It will take some work, but you’ll love the results.
In this episode I review the last year and which episodes were the most popular. I discuss what those episode tell us about this community and what it means for the coming months..
The top 6 episodes from this last year are as follows.
I also discuss solutions that include my PRIVATE community, this show, and something even more powerful….personal accountability.
I review some of the private group services available at The Hospice Nursing Community. Specifically, I discuss the private groups only for hospice leadership.
In closing I discuss the importance of changing habits to achieve more success. I also encourage everyone to find ways to avoid burnout and have more work satisfaction. I encourage a review of my “Avoiding Hospice Burnout Series” I wrote in 2021.
“He did last night. I have not tried since we all went to bed. I think he might be wet.”
Conversation is simple. The daughter reminisces about the life she had with her father.
“Has he had anything to eat or drink recently?”
“Not since Saturday night. Will you help me change him?”
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is soiled. Together, we put on a clean brief. He barely makes a sound during the procedure.
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’ll be back in the morning.”
Tuesday
“How was the night?”
“He moaned when we tried to change him last night. Did I hurt him? I was so scared that I was hurting him.”
“Sometimes, patients just don’t want to be moved much when they are dying. Right now, he looks comfortable to me.”
“Will you help me change him?
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is soiled. Together, we put on a clean brief.
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’ll be back in the morning.”
Wednesday
I visit before our normal team meeting, so it is early.
“How was the night?”
“James, I could not stay awake last night. I fell asleep in this chair. I’m so tired.”
“I know you are. I’m really proud of you. This isn’t easy.”
“Can you listen to him and tell me when he will die? I want to be right next to him when it happens.”
“I wish it worked that way. Nobody can predict an end of life event. I really need you to be careful when trying to decide to sign up for something so impossible. You will eventually need to go take a shower. You will need to use the restroom, or you will need to go pick up a family member to make a final visit. Don’t set yourself up to do something that is impossible. Be at peace with yourself if your father dies when you are not in the room.”
“Will you help me change him?
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is soiled. Together, we put on a clean brief.
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’ll be back in the morning.“
Thursday
“James, here is my granddaughter. Her mom had to drop her off this morning.”
The granddaughter looks at me with hesitation. She is probably about three years old. I smile at her and wave. She has a blank stare on her face and crawls into her grandmother’s arms. After a few minutes she is fast asleep even though it is nine in the morning.
“My son is here. He’s sleeping in the other room. He cried most of the evening. He spent every day of the week after school here when he was growing up. He loves his grandfather so much.”
“I’m glad he is here to help and support you. How was the night for your dad?”
“He doesn’t respond to anything. We changed him before everyone went to bed. I’ve been in this chair all night. I don’t know how much longer I can do this. I wake up every hour and check on him. I just want him to pass so this will all be over. Am I a terrible person?”
“You are not terrible. You are amazing. I wish all of my caregivers worked as hard as you do. You love your dad. You honor him with your presence and care.”
“Will you help me change him?
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is soiled. Together, we put on a clean brief.
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’ll be back in the morning.“
Friday
“Have I told you about my mother?”
“No, not really.”
She goes on to share some of her experiences with her mother. He has never discussed her mother before. At first I’m surprised. Her father is dying and now he wants to talk about her mother?
“She needs a break from reality,” I tell myself.
She pulls out her phone and shows me some YouTube videos and some Wikipedia pages. I discover that her mother is somewhat of a celebrity. Nobody fancy to the average American, but a really big deal to her. I look at the pictures and watch the videos.
After a few minutes she returns to her regular chair. After a few more moments she sits up.
“Will you help me change him?
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is soiled. Together, we put on a clean brief.
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’m putting you on the daily visit list for the weekend. They will take great care of you until I return Monday morning.”
Saturday & Sunday
On-Call staff makes visits over the weekend. The reports are almost identical to my visits. Encouragement and help with cares. Weekend staff tries to increase visits to twice daily. The daughter declines. She has this covered. She is amazing.
Monday
Both daughters are present for this visit. It’s a very tear filled visit. It has been a long seven days and they both report irritability when out in the public.
Their father’s respirations have slowed. He does not respond to sound or touch. The daughter providing most of the care struggles to stand without help. She grabs her cane for support and limps across the the room to the kitchen.
“I’m so worn out, James. I never imagined this would last so long. I lose track of time, and I forget to eat.”
“This is longer than most. Your father is going to cross over when he is good and ready.”
The sisters tell stories. I listen quietly. I am like an invisible observer at one point as they reminisce and have a few quiet laughs.
“Will you help me change him?
I gather all the supplies needed. I put on some gloves and pull back the sheets. After a check of his disposable brief, I discover that he is dry.
“He doesn’t need to be changed. I think his kidney’s have stopped working.”
“Will that cause pain?”
“No, not at all. Just keep doing what you are doing.”
The daughter gives me a big hug before I leave.
“I don’t know how I could possibly do this without everyone’s help.”
“You are doing great. I’ll be back in the morning.“
Tuesday
This was like any other morning. I checked the on-call report before leaving the house. There are no changes or updates. After about 10 minutes in the car I send my caregiver a text message.
“I’ll be there at eight-thirty.”
“I need you now,” is the reply I get back. I respond with, “Okay.”
I know what this means. I’ve been doing this for too long. Her father has either passed, or he is very close. Something has changed in a dramatic way.
I pull into the driveway, and most of the family is on the front porch. As soon has his daughter sees me she breaks out in tears. I step out of my car, grab my nurses bag and head for the front porch.
His daughter embraces me in the biggest hug I have ever received from a family member.
“He stopped breathing about five minutes after I sent you that text message,” she whispers into my ear.
Her hug feels like it will last forever. She is devastated.
“I’ll go in and make it official. Take your time out here. I am not going anywhere.”
It is obvious from the moment I enter the home that her father has passed from this world to the next. I listen to his heart for the full minute just like I was taught in nursing school. After sixty seconds of listening, I have my official time of death. I sit on the sofa and let things unfold naturally.
For the next thirty minutes I say nothing, and I do nothing. This is their time not mine. I need to become completely invisible.
The daughter gets out her phone and starts playing his favorite songs. I watch as everyone listens to the songs. There is crying, stories and laughter. The tension must be broken, and his daughter has all the right solutions.
Once the room returned to silence, his daughter looks at me and says, “Will you help me bathe him?“
I gather all the supplies needed. I put on some gloves and pull back the sheets. Together, we give him his last bath.
In this episode I discuss my communication strategy when communicating with patients, families and facility staff.
Instead of trying to discuss specific scenarios, I review my overall 6 strategies I use to communicate effectively.
I don’t describe these strategies as the umbrella I function under. They are more like a roof. A roof is complicated. There isn’t just one item that provides the cover we need for our home. There are 2×4 and 2×4 wooden supports. There is also plywood sheeting that needs to be applied before the shingles can be attached.
The six roofing supports are as follows.
Be Non-Confrontational
Listen, Validate then Communicate
There is nothing wrong with a quiet room
Let people be wrong if it helps them feel better
Stop feeling pressure to know all the answers
Be like a four-year-old kid
Please don’t forget to complete the “Your Opinion Matters” survey being conducted by Shelley Henry.
I don’t get asked to pray very often. We have chaplains in hospice. That is their job.
William was just different. He didn’t do anything like anyone else. I had a feeling his story would be different than any patient I had ever had.
William lived his life by the facility smoking schedule. He would wrap himself up in his warmest clothes and go outside with his two cigarets to light up.
Facility staff would escort all the smokers outside several times a day. I would see William between smoke breaks. He spent most of our visits talking about his pain problems. I worked with facility staff to get it under control. It took almost a month to really get it managed.
After about a month of seeing William, he started talking about is faith with me.
“Jesus is my lord and savior,” he told me one day out of nowhere..
“He’s mine too,” I replied. “I know I’m not the chaplain, but can I pray for you?”
Without hesitation he replied, “Yes.”
I sat down next to him, grabbed his hands, and I said a prayer. When I was done the most amazing thing happened. He said a prayer over me! I’ve been doing hospice for a while. I have never had a patient pray for me. It was overwhelming to say the least. I left his room in tears.
Over the next month his health started to decline. He was sleeping through his smoke breaks. To help him out, I started taking him out during my visits. He would just share his life experiences with me. He just talked about his family. He loved them all very much.
He got to where he would not let our visits end without me praying. I would pray for him, then he would pray for me. Our prayers were simple. I would pray that his pain would be controlled. He would pray and thank God I was his nurse. I always left with tears in my eyes.
He started getting confused towards the end. I was visiting him one day, and he was very confused. He was terrified of me. He didn’t know who I was, and he no longer trusted me. He went from hugging me to total terror of my presence. I went home that day totally dejected.
I didn’t know what to do next. I wanted to continue to take care of him, but I didn’t want to cause him to be scared. I didn’t want to contribute to his fear and anxiety. He had not been eating for several days, so I knew I needed to see him again the next day.
The following day I made a visit. It was a Friday. I remember walking down the hall and peering into his room from outside the door. He was sitting on the edge of his bed with his eyes closed. I quietly walked towards him making sure I was completely silent. I sat down next to him and grabbed his hand.
”William, it’s James,” I whispered.
“Hi, James,” he replied without opening his eyes.
“How are you feeling?”
“I’m sleepy.”
“Can I pray for you?”
He was too sleepy and confused to answer this question. Desperate for my own closure, I prayed for him one last time. I asked God to provide him with a peaceful transition from this life to the next with his Lord and Savior, Jesus Christ. He died that weekend with his family at his side.
I try to teach everyone that hospice is not about the hospice nurse. Since going back into the field to be a case manager, I have been reminded how hard it is to maintain boundaries with our patients.
Sometimes, we just meet patients who change our lives in their own way. Instead of avoiding the situation, I think it’s okay to embrace it. The best hospice nurses will eventually make deep connections with some of their patients.
Sometimes, those connections are so deep, we are the ones changed forever.
I wanted to send out a quick message letting all of my subscribers know about some changes at The Hospice Nursing Community.
We have totally redesigned the website to make it easier to navigate. Please watch this short video for details!
You can also click HERE to watch the video on the landing page at The Hospice Nursing Community website.
Once again, I want to thank all of your for your support!
I just learned recently that The Hospice Nursing Podcast is in the top 10% of all podcasts hosted at Buzzsprout.com! They host just under 120,000 podcasts!
This Friday, December 8th, the website will take on a whole new look. I am rolling out a $10.00/month plan that will give you access to 90% of what is happening inside.
This includes my personal journaling of many of the hospice cases I am managing right now. My focus is to give my members an inside look on how I manage my patients in the last 7 days of life, and how I communicate effectively.
As always, don’t forget to call, text or email to leave feedback! I would love to hear from you! If you leave a voicemail I will play it on the air!
