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Where do I begin? More importantly, where do I end?

One nurse's experience with palliative care education, how it transformed her, and how she hopes to transform everything.

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Where do I begin?  More importantly, where do I end?  Not just an existential question about my mortality, but a question about how difficult it is for me to focus on what needs to be changed within our healthcare world regarding life, death, and dying.  As an experienced nurse with the most years of my experience involving critical care, I have seen it all.  I bear witness to suffering every single shift I work.  This suffering involves patients, families, and all members of the healthcare team for a multitude of reasons.  My list of what needs to be changed and addressed is near infinite.  It is overwhelming.  Where do I begin?  Where do I end?

I am one nurse.  How do I make the difference?  My personal experience includes battles with moral distress, compassion fatigue, burnout.  I was a fortunate participant in a Gero-Palliative Nurse Residency program, pairing young and experienced nurses in a group learning about geriatrics, palliative care, and self-care in an effort to better care for a vulnerable population while hoping to reduce nurse attrition.  This was a springboard for me and career changing.  I felt empowered.  My moral courage was heightened, my moral distress reduced.  Most importantly, my transformation has directly benefited my patients and families through advocacy, symptom management, and the courage to address end-of-life compassionately when I see communication lacking.  I sought a Hospice and Palliative Nurse certification (CHPN), because I felt I definitely had two years of experience caring for those with serious illness, in an environment where all nursing certifications involved critical care.  Nursing is synonymous with palliative care.  We prevent and relieve suffering.  We assess and treat the physical, psychosocial, and spiritual symptoms of serious illness.  Why would we not be certified in what we do everyday?  

Nurses are year after year voted as the most honest and ethical profession.  We have 24-7 intimate access to our patients and families, caring for them in the most vulnerable of times.  We are there to pick up the pieces after devastating news has been delivered.  We are there in the wee hours, listening and comforting.  We hear the worries and questions they don't share with physicians.  We listen.  We see. 

There are over 3 million nurses in the United States.  Imagine if the majority caring for those with serious illness (which is the majority of us) were certified in palliative care?  Imagine empowered nurses, educated in symptom management, ethics, communication, spirituality, bereavement.  We could change the culture of health care.  One by one through our interactions with patients and families, with physicians, with each other, we could change the culture.

I started with myself, obtained a certification, enrolled in a Masters and Doctorate program.  I am moving on by developing a palliative care education curriculum for my place of employment.  My dream is for this curriculum to spread from the main campus, to the hospital system, to nationwide.

In a recent Hospice and Palliative Nurses Association membership meeting I addressed reaching out to ICU nurses for CHPN certification, not a commonplace area for certification but one with great need.  Another member responded that it would be "diluting the specialty" of hospice and palliative care.  I respectfully disagree.  It would not be diluting it, it would be embedding it.  Empower nurses, we have power in our numbers.

What is a provocation or insight that might inspire others during this challenge?

Engage nurses to transform end-of-life. We firsthand witness the need for change. We have power in our numbers.

Tell us about your work experience:

20 years of bedside nursing including oncology and ICU. Currently an MSN/DNP student at CWRU, planning to specialize in Palliative care.


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