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I spent much of my nursing career as an after-hours hospice nurse. I would oversee 100+ patients from 5 pm until 8 am. All calls came directly to me. I was assigned one backup nurse, an on-call social worker, and an on-call chaplain. Many nights would start with an after-hours admission which was done while balancing phone calls on pain management, deaths, interpersonal and family system issues, equipment malfunctioning, symptom management, and questions about the dying process.
There were so many shifts where I would recite the ABCs (airway, breathing, circulation). I did this to keep myself focused, even though it barely applied to hospice care. During the more challenging nights, I needed to work hard to be fully present in each conversation, each word of encouragement, piece of education offered, every hug, or a gentle touch. Each was deeply meaningful and even spiritual to the person I sat with, their loved ones, and to me. All this despite my ringing phone signaling the many needs yet to meet.
I am sure all nurses can identify with the tension of being fully present (heart, mind, and body) while knowing the list of needs of others is growing exponentially. I love how Jean Watson's Theory of Caring Science addresses this tension with the analogy of an orange. The outside of the orange (the trim) are those all-important skills or tools that help me care for patients. In hospice, "the trim" looks like charting, managing medication, fixing equipment, answering the phone, and making end-of-life arrangements. The trim is vital however, it only offers half of what is needed of a Caritage nurse. The caring nurse must also be aware of the core. Unlike the “trim,” the core helps me, as a nurse, engage my heart and mind in the present moment. When I engage my heart, mind, and body in the present moment, I am able, like a ripple effect, to invite my patients, their families, and my colleagues into transcendent caring moments.
One of the gifts for the after-hours hospice nurse in the Texas Hill Country is all of the driving. I could choose to receive the ever-present invitation to spend the drive time recentering myself in prayer. This was challenging between visits due to the ringing of my phone. However, once the phones were switched back to the office, I was able to find the space. There is this one stretch of road that I typically drove home after a hard night. It's called the Henley loop. It wound its way through pasture lands, beautiful overlooks, and along the river. As I took this path, I would do as Watson suggested and pause and reflect on each life I encountered that night and each transcendent caring moment or sense of presence. If my weary heart and cloudy mind could find no such anchor, the drive offered the beauty of creation that alone gave me life.