Continued from Page 1

A new philosophy

About 30 years ago, caregivers in England began tinkering with a new approach to dying. They started to offer patients the option of hospice care via residential hospice facilities, where families could send their loved ones. But the trend shifted slightly as it migrated to the United States. Here, home hospice care rose to popularity rather than residential facilities.

Now, more than 3,000 hospice programs operate throughout the country, and 96 percent of those programs provide routine home care, according to the National Hospice and Palliative Care Organization. In order to qualify for hospice, most programs follow Medicare's requirement that a patient must have a prognosis of six months or less if the illness were to run its natural course.

To help families cope with the reality of losing a loved one, hospice programs usually provide not only a nurse, but also a social worker, a chaplain and other volunteers who can do everything from massages to housecleaning.

For many nurses who now work in hospice, this new philosophy is a brilliant alternative to the mentality they've seen in hospitals.

"Hospice acknowledged that dying is as much a medical specialty as birth," said Virginia Shubert, MN, CHPN, RN, executive director of Yolo Hospice in Davis, Calif. "It is about making dying a natural part of the life cycle. Dying is not a medical problem."

About 600,000 Americans died while in hospice care in 2000, which is about one out of every four deaths, according to the NHPCO. But hospice administrators expect this number to swell significantly as the baby boomers continue to age.

Some hospices already are feeling the pressure because demand is increasing at the same time that nurses are harder to come by. Hospice of the Valley in San Jose recently had two nurse openings, and advertised the positions for six months before they were filled. Usually, it takes about a month to six weeks, said Jessica Klinghoffer, MA, RN, executive director of the hospice.

"In the [San Francisco] Bay Area, there are a number of hospitals that are just crying for nurses, so we are all looking at the same candidates," she said.

Although it can be difficult to fill positions, most hospice administrators agree that they have one advantage over hospitals: low turnover rates. Klinghoffer said that once nurses discover the hospice field, few leave.

"It's one of the places a nurse can do what he or she went to nursing school for in the first place," Klinghoffer said. "In hospice, they have the tools, time, respect and support to be treated as professionals. They work independently and can make crucial decisions."

These reasons are why Fabricius never looked back once she discovered hospice nursing. She also cherishes the occasional chance to deliver something unexpected.