Nancy Jackson

Nancy Jackson is a hospice nurse. She began working as registered nurse (RN) at Mary Washington Hospital in 1997 and has worked in hospice care since 2003. She has also worked in palliative care and oncology. Before going into nursing, Jackson worked on Capitol Hill.

Nancy Jackson was interviewed by Jess Rigelhaupt and Grace Mann on November 5, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Typical day as a home health and hospice nurse—Began as a nurse in 1997—Worked on Capitol Hill before beginning a career as a nurse—Decision to become a nurse—Choosing to become a hospice nurse after working in oncology

00:15:00-00:30:00
Working with patients in hospice and their families—Nursing school—Dynamics with hospital administration—Differences between hospital-based bedside nursing and hospice nursing—Team-based care in hospice—Working relationship between physicians and nurses

00:30:00-00:45:00
Working with patients—Challenges with hospice care—Misconceptions of hospice—“The Conversation Project”—Working with and supporting patients’ families

00:45:00-01:00:00
History of organizational support for home health and hospice—Mission and values—New clinical programs and facilities in Mary Washington Healthcare—Business side of health care

01:00:00-01:15:00
Nurses’ commitment to patient-centered care—Effects of computers and new technology—Work with palliative care and pain management—Education about advancements in hospice care—Organizational leaders who have supported home health and hospice—Discharge planning

01:15:00-01:31:34
Role of hospice in the continuum of care—Unreimbursed care—Public health and preventative health care—Magnet Status for the nursing at Mary Washington Hospital—Skills and compassion in nursing—Role of hospice care

Transcript

00:00:07
Rigelhaupt:
It is November 5, 2014. I am in Fredericksburg, Virginia doing an oral history interview with Nancy Jackson on the Mary Washington Healthcare Oral History project. The first voice who will be asking questions as an interviewer is Grace Mann and then later on my voice will come back in. I’m Jess Rigelhaupt and I’ll also be doing some interviewing. But I’ll turn things over to Grace to start.

00:00:33
Mann:
So to begin with, I just wanted to start with, if you could describe a typical day working at Mary Washington Hospital and tell me what that’s like for you.

00:00:44
Jackson:
My day starts at 7:00 AM. I have a list of patients, consults that I need to visit during that day. I work twelve-hour shifts here at the hospital. I usually work three days a week. The consults that I have are generated from various sources, primarily physicians here at the hospital whose patients have a need for hospice intervention. We also have folks that come in from home that already are on our service and have a symptom that was not or could not be managed at home. They come to the hospital, generally for IV medications to help them get over that hurdle and then go back home with hospice still part of their plan of care. The other referrals we have are for just general information about hospice. They may have just received a diagnosis of a terminal illness and they just want to get information about hospice. My day is never predictable. It changes every time I’m here and the patients involved generally change on a rotating, ongoing basis.

00:02:18
Mann:
And can I ask you how long have you been a nurse?

00:02:21
Jackson:
I graduated from Germanna in 1997. So I am going on, if I’m good at math, eighteen years.

00:02:33
Mann:
So eighteen years ago, do you remember your first day working as a nurse?

00:02:39
Jackson:
Here at the hospital? I didn’t start here at the hospital once I got my license to practice. [3:00] I actually worked at Geico as their occupational health nurse for two years and then I moved here to the hospital. It was right after they built the palliative care unit here on 4-North. I came and my first day I was a wreck of nerves and I remember it quite well. (Laughs) I remember how much I didn’t know and how much I wanted to learn.

00:03:15
Mann:
Did you feel the same your first day at Geico?

00:03:20
Jackson:
Geico was a different type of nursing. You know, I did a preceptorship at Geico so I knew everyone there. Once I became licensed, they offered me the position in the medical unit. It wasn’t quite as unnerving because a lot of it was routine, which I had been doing prior to being licensed so it wasn’t quite as nerve-wracking.

00:03:45
Mann:
When you started here did you find that the other nurses were welcoming to you?

00:03:50
Jackson:
Some. Some were very helpful; some were not. I would say overall that is one of the things I think has changed dramatically with nursing. We are much kinder to our young. When I first started nursing it wasn’t quite as open and kind, I would have to say. I felt that for the first couple of years here. I felt that we were not good to our new nurses.

00:04:25
Mann:
Do you have any specific stories or memories of something like that happening to you?

00:04:30
Jackson:
I remember very specifically needing to have procedures explained and the other nurses not having time to explain that to me or even telling me where to go. I remember leaving frequently in tears and going home, saying this was not a good profession for me, and this is maybe not what I should be doing with my life.

00:04:56
Mann:
And so now, today, if there is a new nurse coming into the hospital do you treat them especially with kindness just because of what you went through?

00:05:06
Jackson:
Absolutely. Absolutely. I think in all walks of life, you know, when you have experiences that are negative you become overly positive as a result of those things. I feel that environment has changed considerably from when I started. Part of it is just the newness of this profession. I was older when I went into nursing. I worked on Capitol Hill for years before I went into nursing. I was sort of the older kid and I think people expected more of me because of my age. I was looking at younger folks to help me through that. I think we’re much kinder to each other now and we support each other much better. [06:00]

00:06:01
Mann:
So I want to get back to that but I want to back up a little bit.

00:06:04
Jackson:
Sure.

00:06:05
Mann:
So did you grow up in this area?

00:06:07
Jackson:
No. I grew up in Chicago. Born and raised there and then moved here in 1973. I had a brother, I actually had two brothers, at Georgetown. I came to visit and I really liked it here. I stayed here and worked on Capitol Hill.

00:06:30
Mann:
So before you became a nurse what did you do on Capitol Hill?

00:06:34
Jackson:
I wrote legislation. I started as an appointment secretary for a Congressman and ultimately wrote legislation for education. I went into public broadcasting and met my husband and the rest is history. We had three kids. I thought I was only coming to DC for a year or two and I ended up being here now for way longer than that. With three children, we moved here to Fredericksburg from Arlington.

00:07:03
Mann:
So working on Capitol Hill, writing legislation, what changed that made you want to become a nurse? How did you get into nursing from that?

00:07:12
Jackson:
It was all very spiritual. My mother died and I didn’t know what I was doing with myself or my life. I grieved so heavily when she died and I just stopped sort of functioning. I have three children, though, that I needed to continue functioning for. I remember praying that I needed some guidance as to what to do and I remember very distinctly the Holy Spirit saying you need to go into nursing. I found myself leaving the Spotsylvania shopping mall and getting in my car and driving to Germanna—it was the only school I knew here at the time that I thought had a nursing program. I drove up there and found out they indeed did, and I enrolled. And that’s how it all came to be.

00:08:13
Mann:
Was your family surprised?

00:08:15
Jackson:
Yes. (Laughs) They were all pretty shocked. “Why nursing?” That’s what they all kept saying. “Why nursing?” I come from a family of nothing but lawyers. Brothers, sisters, father—one of my grandfathers was a doctor, but everybody else is law. And so they couldn’t quite get their arms around why I was doing that.

00:08:37
Mann:
So when they asked, “Why? Why nursing, mom?” What did you say?

00:08:41
Jackson:
I said, “I feel the Lord was calling me in that direction.”

00:08:48
Mann:
When you started off nursing I understand that you didn’t start with hospice?

00:08:43
Jackson:
No. No, I didn’t. Hospice wasn’t even on the radar at that point in time. I went into oncology, which is what 4-North is. [09:00] I did some palliative care with the patients in oncology unit, but it wasn’t hospice. What happened was my father ended up with a diagnosis of terminal cancer back in Chicago. I went there to visit and he was very, very sick and was not happy with his hospice nurse. So he asked me—actually he did not ask me. My brother said, “Nancy, Dad really needs you.” And so I said, “Okay.” I called back here and I filled out FMLA paperwork and took a leave from the hospital and spent four weeks with my father in Chicago. The last thing he said to me is, “You should probably be a hospice nurse.”

00:09:53
Mann:
That must have been really special to hear him say.

00:10:00
Jackson:
It was. Sorry.

00:10:05
Mann
No, it’s fine. Do you need a minute?

00:10:07
No. It’s still, you know—I mean my father died ten years ago.

00:10:10
Mann:
That doesn’t make it any easier.

00:10:12
Jackson:
It doesn’t. When I came back here, they had an opening. He died in February and I took a job in September with hospice.

00:10:21
Mann:
And I can imagine that was probably helpful for you in terms of that you were doing what was best for you in terms of becoming a nurse.

00:10:27
Jackson:
Oh sure, sure. I mean, I think I’ll always be my daddy’s girl. You know, do what he says to do.

00:10:35
Mann:
So you did palliative care and then you also worked in oncology. And then after you worked in oncology, is that when you started hospice? Is there any other facet of nursing that you were involved in? That’s what I’m getting at.

00:10:49
Jackson:
No, I did. I volunteered with hospice support care at the Harbor House, which doesn’t exist anymore. But the Harbor House was a place where we were able to take two patients who were terminally ill and it was run by volunteers, and so that was it. I went from 4-North oncology into hospice.

00:11:15
Mann:
Okay, so currently you’re working in hospice. Can I ask you what’s your favorite part of your job? What do you love the most?

00:11:22
Jackson:
My favorite part of my job is at the bedside when someone is dying and being there for them when they take their last breath.

00:11:35
Mann:
Do you mind expanding a little bit on that? What that’s like for you?

00:11:39
Jackson:
Sure. It is the most vulnerable time for that individual. I feel it is what I do best because I’m there for them. [12:00] I don’t try to talk spirituality or push any of my beliefs, but I think being present at that moment so that they’re not alone is more important than anything else. It probably is more rewarding for me than it is for them. I feel that I am doing an incredible service for them by being present at that time. And just letting them know it’s okay to let go. By that time they’ve fought a long and hard battle and they’re tired. I can offer them at least that comfort. The beauty of that is it allows the family to be family. I can be the nurse. I can take care of whatever the needs are, but the family can be a family and just love that person and say their goodbyes. For me, it’s the most rewarding moment.

00:13:00
Mann:
So, on the opposite end of that—what is your least favorite part?

00:13:06
Jackson:
My least favorite part is when—wow. My least favorite part. My least favorite part probably is when I fall short of doing my best. When I feel a family feels I’ve let them down, and you know it’s never good. I don’t have time to go back and it’s a one-time thing. If it’s not perfect for them—and it doesn’t happen often. As a matter of fact, I think it’s only happened twice in all the patients I’ve taken care of. But it’s devastating. It’s really bad when you can’t undue what they perceive as bad.

00:13:57
Mann:
Because it’s hospice do you often interact with patient’s families more than the patients?

00:14:01
Jackson:
Yes.

00:14:03
Mann:
Do you like that?

00:14:05
Jackson:
I love that. I love that. I love teaching and I love journeying with these folks through this process. Most people, no matter how many deaths they have encountered in their lives, each one is unique. Each one creates its own problems and concerns and emotional ties. If I can be of any help with that, I feel very blessed and very rewarded.

00:14:38
Mann:
As you’ve done hospice for a few years now, is there a question or is there something that you repeatedly hear from patient’s families or patients themselves more so than others? Like is there a common phrase that you hear a lot? Or question that you hear a lot?

00:14:55
Jackson:
Yes. “How much longer? When do you think that this will happen? [15:00] Will you promise me that I will not be in pain?” Those are probably the two most common. Can you tell me how long I have and will you promise that I will not have any pain at the time?

00:15:17
Mann:
And so when something like that happens, when somebody asks you a question like that, I can imagine that maybe tugs on your heartstrings a little bit. In terms of, this is an emotional profession I think. How do you cope with that all the time? How do you practice self-care so you don’t feel too much?

00:15:43
Jackson:
For me, my grounding factor in all of this is my faith, number one. My family, number two. I turn to the Lord a lot. I pray a lot. I have a great family. My husband is a saint. Truly. I have three grown children that provide me more joy than I should ever be entitled to. I have both of those things in my life. My self-help and my grounding is that. Second, I do a lot of exercise. Because I like to eat, I exercise a lot and I take downtime. I am a great vacationer. I could write a book on how to vacation well because I do it well.

00:16:39
Mann:
I’ll have to read that book!

00:16:42
Jackson:
I have to write it first, you know.

00:16:44
Mann:
So, maybe switching gears a little bit toward education. I know that you mentioned that you went to Germanna. Did you like nursing school?

00:16:51
Jackson:
I liked it. Yes and no. You know, I was never a great student. I’m more of a hands-on kind of person. So for me sitting reading textbooks all the time was not great. But, I will tell you it was the best foundation and I still rely on my textbooks now, especially when I have anatomy questions. My anatomy/physiology class was the biggest struggle in my life and I just could not wait to finish that class, but that is the class I go back to more often than not and that textbook and everything.

00:17:37
Mann:
Do you feel that nursing school prepared you well for a career in nursing?

00:17:45
Jackson:
It gave me some knowledge, but I don’t think it’s practical. You know, nursing is hands on. You can’t learn that in a textbook. [18:00] You can’t learn the emotional side of nursing in a textbook. You learn the knowledge. It prepared me for understanding that if someone has heart failure what those side effects of heart failure are and what can be done to help that, what I am looking at when I see someone struggling to breathe, why that’s happening, and what I can do to help that. But it doesn’t give you the emotional compassion that you need to nurse well.

00:18:32
Mann:
So would you say that’s the number one thing that you learned, not saying that you didn’t have it before, but learned on the job rather than in school is compassion?

00:18:43
Jackson:
Yes.

00:18:45
Mann:
Is there anything else that you feel like you learned on the job that you didn’t learn in school?

00:18:50
Jackson:
I think just being able to relate to people. You never learn that in school. I think you only learn that by living. School has a purpose and I think we need it, but I don’t think it makes for a great nurse. I’m not sure it makes for a great any profession because most times you have to be with people to really experience and live the job in which you’re working.

00:19:23
Mann:
And just a clarification question, what is your degree?

00:19:30
Jackson:
I’m an associates RN. I have an associate’s degree.

00:19:32
Mann:
And do you think at this hospital or previous places that you’ve worked at, do you think nurses with different degrees interact with one another differently? Or is that not something that’s on the radar?

00:19:42
Jackson:
Let me rephrase your question a bit. I feel that for me, what I’ve done with my associate’s degree is where I want to be, which is at the bedside. If I wanted to get into management or if I wanted to become more than a bedside nurse, then I would’ve pursued additional education because I do think you need to have business savvy. The bottom line in the hospital is it’s a business. We do great patient care here, but it’s a business. You need that if you’re going to be in management. You need to have management skills in order to supervise people. That’s not of interest to me. My interest is at the bedside. I will always be a bedside nurse.

00:20:40
Mann:
Do you think patient care is the most important part of a hospital?

00:20:44
Jackson:
Yes.

00:20:45
Mann:
Do you find that there are people in the administration who don’t feel the same way?

00:20:52
Jackson:
Yes. I don’t know. Let me back up a bit. I don’t think they necessarily think that it is. [21:00] I think they think of two things. They think of patient care and they think of the bottom line. I don’t worry about the bottom line. I really don’t. I’m a good user of all of my—I watch the supplies I use. I do those kinds of things, but I don’t look at the big picture of is this hospital making a profit or not? I don’t really care because when I put the head on the pillow at night, that’s not of any interest of me. What is of interest to me is that I take care of that person the way they deserve to be taken care of. It’s a different philosophy. It’s a different way of life for me than a lot of people.

00:21:43
Mann:
And when you talk about taking care of patients, I think to some people that could mean a multitude of things. So if you wouldn’t mind, would you be able to go into specifics about what it is you physically do for and with patients?

00:22:07
My role as a hospice nurse is different here in the hospital than it was when I did home care or when I did floor nursing.

00:22:20
Mann:
You can explain one or two or all three? Whatever you would like.

00:22:23
Jackson:
Okay. Floor nursing is very much hands on. It is head to toe assessment. It is rolling patients back and forth to assess skin, it is emptying Foleys, it is cleaning up stool, and it is cleaning up vomit. It is physically a challenging job. There are other folks that do a lot of that care, such as your nursing aides and those kinds of things. But ultimately the floor nurse is the responsible party for that patient laying in that bed and for all of those things needing to be done. Physically it can be challenging because of what you need to do. You also are in charge of medication administration—so any medicines that the doctor has ordered you must give to that individual and you must always question is this the right dose? Is this the correct patient? Is this something they should be taking? Oftentimes with blood pressure medicine, the question becomes, is the blood pressure where it should be in order for this to be beneficial or does it become more a burden for the patient? You’re always critically thinking as a bedside nurse. I rely, now in hospice, on the bedside nurse. I still do my own head to toe assessment. I still make sure that symptoms are being managed appropriately and that skin breakdown is prevented and those kinds of things but I don’t take care of emptying Foleys anymore, things like that. [24:00] If I see that the Foley is really full and problematic to that individual, I will empty that but it’s not really part of my day and day out responsibility. I do make sure that medications for this individual are appropriate and that symptoms are being managed. And if not, I will be the one to get a hold of the doctor and say we need to increase this pain medicine. My role is a little different. I work really side-by-side now with the bedside nurse. When I was a bedside nurse I was really in charge of the overall care of the individual. It’s a little bit different as far as that. When I go to someone’s home I am the medical person for that family. For that family, my role is even more expansive than it is here in the hospital because I am in charge of making sure that everything for that patient is appropriate and put in place, whether it’s equipment or medications and that the family understands what is happening. That’s a huge part of what our home care nurses do. It’s making them understand and feel confident that they can care for this person because we’re not in the home twenty-four hours a day. They are and they have to feel comfortable in what they’re doing. That’s my role at the home. Each role is very unique and very different. But I think the biggest change I have seen in nursing is that there’s so much collaboration with other disciplines that it’s just a joy to be part of that team. Whatever area or environment you’re working in, it’s really very collaborative, which is great. It was not that way when I started and that’s what I think has been the biggest change and the best change. We are working as a team, where before I felt very much on my own and sort of out there and just waiting for that branch to fall and for me to go tumbling down. It wasn’t a good place for me to be, but now I feel very different. I feel things have changed considerably.

00:26:16
Mann:
So you mention working as a collaborative team, so who’s in that team?

00:26:20
Jackson:
For hospice, I’ll start there. For hospice, it is the nurse who is generally the case manager. There are other support nurses also. We have an aide assigned to each patient. We have a medical social worker assigned to each patient. We offer chaplain and we offer volunteers. We have massage therapy, music therapy, and art therapy. We have physical therapy and occupational therapy. The families get to choose what services they feel would be best to make the quality of that individual’s life the best for whatever time they have left. [27:00] So it’s great because we offer a whole lot of services and it’s sort of a la carte: you pick and choose what’s going to work best for that individual. It’s nice. I should include the physician at home. I don’t mean to exclude. There is always a physician assigned to every patient. They are not necessarily day in and day out part of the plan of care, but if anything needs to be changed they are the key for that nurse to go to that doctor and contact them for a change. Here in the hospital we are now doing walking rounds, which is just phenomenal. I mean it’s like a teaching hospital here, which is just great. Part of the walking rounds occurs every day on every floor. It’s a doctor, it’s a nurse, it is the case manager, it is the discharge planner, it is the aide if they’re involved, and any other disciplines like a chaplain, if a chaplain has been involved in the plan of care. If it’s a hospice patient, we weigh in. If it’s a palliative care patient, they weigh in. It’s great cause every day every member of the team is aware of exactly what’s going on with that individual.

00:28:15
Mann:
And when you said walking rounds—

00:28:19
Jackson:
In every patient’s room. This group of individuals goes into the room and introduces themselves. We find out first if the patient has any concerns or questions about their plan of care and it’s open dialogue. It is great. It is just great how different it is now than it was.

00:28:35
Mann:
And so has this sort of team effort, has that permeated into the relationships between nurses and physicians? Has that relationship changed?

00:28:43
Jackson:
I think the relationship with physicians and nurses changed several years ago. Prior to even walking rounds, I think when this hospital went from primary care doctors to hospitalists—I don’t know if you’re familiar with any of that. We now have a group of doctors that are called hospitalists and they are dedicated to this hospital and the patients in this hospital. If a primary care physician out in the community sends an individual to the hospital, the patient’s care in the hospital is done by the hospitalist and no longer by the primary care physician. It’s great because we have physicians now here in the building if we need something they act much quicker. It was a tough road as a nurse, I have to say, trying to get hold of doctors when we needed them for a patient here in the hospital. One, they either took a really a long time to respond back, or when they did, oftentimes they made you feel like you were an imposition. “Why are you calling me about that?” It was never a good dynamic and now it’s really a good dynamic. [30:00] I think nurses are definitely becoming much more respected and much more an integral part—probably the primary part—of patient well being here in the hospital, which is great. It’s good to see and good to have because who sees that patient more often while they are here than the nurse? They are in that room every hour. It’s really good. It’s very good.

00:30:31
Mann:
And also, in your personal experience—in our class we’ve been doing a lot of research on the history of nursing and what continually comes up is the idea that nursing is women’s work in terms of gender roles and that only women are nurses. Have you had any experiences where, I don’t know, somebody said something sexist towards you about what you do or anything of that nature? Have you experienced any of the gender role stuff that goes into what you do? So has anybody ever said anything to you?

00:31:08
Jackson:
I personally have not encountered that, but nursing has been primarily a female occupation. I think we’re seeing more and more males going into it. I will say this as a female nurse: I love having male nurses. They bring a new dynamic to it. There are four male nurses on 4-North, which is where I primarily have our patients because it being an oncology floor. There are four—one, two, three, four—male nurses and I think it’s great. I wish we could get more doing that. The reason I think there are not more going into nursing is mainly because it’s hard for a male to be cleaning up a female and doing things to females in a nursing role. It makes it a little hard—it’s hard for the female patient to even have that happen. That’s going to be a barrier. But slowly but surely that is breaking down considerably. As the nursing pay scales increase, I think you’ll see more males going. At one time, you know, nurses didn’t make a lot of money. Don’t get me wrong: we’re not making a ton of money now, but it’s a better, financially stable environment now then I think it’s ever been. Medicine is more stable than most occupations at this point in time. [33:00] You’re pretty much guaranteed a job at some level in nursing because we need nurses. People feel a security with nursing more than a lot of professions at this time. Economically, nursing is going to be around for a long, long, long, long, long time.

00:33:36
Mann:
And then, in terms of your patient care, and I’m sure you’ve seen a lot of people, in particular with hospice because this isn’t a profession that you kind of have the same people for a long period of time. Like you said there’s turnover. Have you ever gotten very, very close to any particular patients or their families? Has anybody really impacted you or do you have any stories you would want to share about that? If you wanted to. And I can understand why you wouldn’t want to so that’s fine too.

00:34:05
Jackson:
Yes, the children for sure. They are the most difficult. I still am in touch with the parents of a child I took care of and it’s one of the more valuable friendships that I have. Children are the most challenging. I have several of my dearest friends—they’ve lost their husbands and I have remained good friends with them. I am one that doesn’t often—I try to hold my emotions in check, but it’s hard for me. It’s hard in this type of work to do that. Although I do try to honor boundaries, there are some that just there is no way. You can’t just suffer with them and journey with them. That compassion just over flows.

00:35:26
Mann:
Does it stick with you? Do you hold onto those experiences, you don’t forget your patients?

00:35:35
Jackson:
I journal. I journal a lot. I take away something from every patient I encounter—in a small way, something, either a touch or a word. I still see people in the community. Family members, I run into them at the grocery store. And I’ll be honest with you, some of them I don’t remember [36:00]. It’s always such a treasure when they say, “Nancy, I’ll never forget how great you were.” I honestly can’t remember them and I feel badly. My world is very blessed. I really have very little negative things to say about anything that I do. I really love what I do.

00:36:29
Mann:
And with those patients who you did have relationships with and when they passed when you’re with them, I can imagine that’s hard. I know that’s hard. But do you ever talk to anybody about it? Like I said, we’ve been doing a lot of reading and another thing that’s come up is the fact that nurses keep these things to themselves. Do you find that that’s something you struggle with in your career?

00:36:57
Jackson:
There’s always the confidentiality. You have to protect that at all costs so I cannot run home and say to my husband you just won’t believe how endearing this person is or anything like that. You can’t really do that to protect the confidentiality of what you are witnessing. So no, I don’t really talk to anyone in particular about this. Again, so much of what I do is faith-based and so much of what I do is focused on God and my vision of what God is. I go to him a lot and talk with him a lot. Good and bad. I do have an Irish temper. So when I get really upset, he hears it! I can’t really talk a lot of people.

00:38:08
Mann:
And when it comes to hospice, do you think there are any misconceptions about what end of life care is?

00:38:15
Jackson:
Yes.

00:38:16
Mann:
Would you like to expand on that? (Laughs)

00:38:18
Jackson:
Sure! (Laughs) Yes, I think that once someone hears the word hospice they immediately think that death is imminent. It’s so far from where we need to be in this society. Hospice is such a great support. We can’t reverse the disease process. We don’t even consider or attempt to do that. The sooner we can get it, to build trust and a relationship with that individual and that family, the best care takes place. The worst cases are the one where you get the referral, you get there, you meet them, and they die the next day. [39:00] You’ve had no time. None. For a lot of people, that’s what they think hospice is. They think hospice is, “I’m going to die. And if I don’t die soon enough you’re going to give me morphine and make me die.” There is the whole concern people have with morphine and the misconceptions about morphine and the fact that we hasten death. It’s just unfortunate. Slowly but surely doctors are getting better at referring earlier and I think we are doing remarkable work. I don’t just mean Mary Washington Hospice, I mean hospice nationwide. There needs to be much more open discussion about the dying process because every single one of us is going to do it. We should all be aware of what our loved ones want. The worst ones are with children your age who have to make decisions about mom who’s in the ICU unexpectedly and now on a ventilator. Now you have to make that decision and you’ve never had the discussion. It’s hard. Those are the cases where I go home and I sob about it because no one your age should ever have to be put in that position—or any age. No child should ever have to make a decision like that. Society as a whole feels uncomfortable talking about dying and death and putting in order now when you’re healthy what you’re wishes are. There’s a lot of good documentation out there that helps you and that walks you right through the process. There’s a great project going on right now that our hospice is very involved in called “The Conversation Project.” It’s exactly that: how do we start these conversations with our loved ones? I think hospice has got a very negative connotation most of the time, unfortunately. We’re slowly but surely breaking the ice and getting to where people understand dying can happen to any of us at any time. It’s part of life and we should be talking about it much more openly then we are.

00:41:30
Mann:
Have you made a point to talk to your own children?

00:41:32
Jackson:
Oh yeah. They don’t like hearing it, but you know what? They need to know. My husband and I have done the five wishes. We have put in place everything we want, from the songs we want at our funeral and everything else that we don’t want to have. It’s important that they know all of that because I don’t want to end up in a car accident and be here in the ICU and then they have to come together and tell the doctors when to take me off life support. I don’t want that for them. I’ve watched that. [42:00] It’s awful. It’s a horrible place to be.

00:42:05
Mann:
Obviously not all that you do is medical and medicine care. When something like that happens, where there is someone who just doesn’t know what to do, do you often find yourself assisting that person or do you just stay out of it?

00:42:20
Jackson:
No, we are right there in the thick of that. We are. We are there as a support. We are there to present options: this is one thing you can do and if you don’t like this you can do this. Informed decision-making needs to be our role when there is nothing in place. We have to present that. That is really a responsibility of the medical community to present to those grieving families what the options are, let them make informed choices, be there to answer questions, and be there for support. We offer a lot of family support in the ICU, in the ER when needed, and on the floors throughout the hospital. 4-North has the majority of our patients because many of them are cancer patients. Heart failure is huge—huge death and mortality. We have a lot of heart failure patients. We have a lot of Alzheimer’s or dementia patients. They’re all over the hospital. Education, support, and informed decisions: this is how this is going to look, this is what we can do to help, and hospice can be whatever you need us to be. It’s not a place. It’s a service. We will go wherever you want your loved one to die.

00:43:50
Mann:
This is another broad question, but what has been the biggest thing that you’ve learned so far in your career in terms of working in hospice? What has affected you the most?

00:44:04
Jackson:
I will say hospice work has changed my life. It has changed it so much for the better because I value life so much more. I know how quickly it can go. I’ll get very personal here. Three years ago my husband was diagnosed with cancer. My husband—as much as I love him, and I truly do—he was not one to go to doctors. I have been married thirty-eight years and I think it was year thirty-four that he went to the doctor for the first time. [45:00] It was because he had a growth on the back of his neck and his hair was getting longer. I said, “Honey you’re hair is getting long why aren’t you getting it cut?” He said, “I can’t.” I thought, “Are we broke? What do you mean you can’t?” He said, “No. I have this thing on the back of my beck and it hurts.” I said, “Let me see.” I looked at it and said, “You probably need to have somebody take a look at that.” We called our primary care doctor and the office said, “We’re sorry, Mr. Jackson. He’s not taking new patients.” My husband said, “I’m not really a new patient. My wife and my three children have gone to him for twenty-some years. I just haven’t been.” He went in and our doctor—who is fabulous—said, “Why don’t we do a complete physical.” He did and he found an enlarged prostate. He sent him to an urologist and the urologist said, “Yes. Here are your choices. It acts and looks like cancer from the lab work and everything. You can have it removed, you can get it seated with radiation, we can try some chemotherapy, or you can just ignore it.” We talked about it. But I will tell you when the doctor said, “Cancer.” My world went upside down. Wayne went ashen. I said, “Breathe. Don’t do this.” I know what that’s like to get a cancer diagnosis: it’s scary and it’s horrible. I have a great deal of empathy and compassion for those that are looking death head on. We are not. He has been clean for three years. Praise the Lord. But other people aren’t so fortunate. I know what that’s like to have your world turned upside down—to come in with a cough and find out it is lung cancer. It happens. It’s not easy. It’s hard. And so what it has done probably for me is softened me and made me much more aware of the frailty of life and how incredible people really are. They really are. People are just amazing things. They really are. We don’t treasure them enough, sick or healthy. We live in a great nation. You think of people in Africa with Ebola—I mean that’s a tough thing. We don’t have those kinds of horrible things here. Nursing has done a world of good for me.

00:48:00
Rigelhaupt:
To transition, I want to ask about how you see hospice being supported by the organization, by Mary Washington Healthcare because traditionally hospitals are acute care centers and focus on cures. It’s a different focus that you are describing and I am wondering how you have felt in the decade plus—and maybe you could break it into time—your first few years in hospice and if it’s changed, the level of support from Mary Washington Healthcare?

00:48:39
Jackson:
I don’t think the level of support has ever changed. I think we have been supported from the moment we opened our doors to today. We are well respected, truly. We are truly loved by this organization because of what we do in the community. Our presence in the community is as great, if not greater, than a lot of other ancillary departments here at Mary Washington Healthcare. We get accolades all the time. We do an amazing job and I think this health care system is aware of that. We have great patient satisfaction scores. We have great associate engagement and great associate scores. Support has never been, at all, in my opinion and from what I have seen, a problem for us or for the organization. I think they respect everything we do. As a matter of fact, probably in all honesty, when I came here to the hospital we only had one nurse here at one time doing what now three nurses are doing. We’ve expanded our coverage to seven days a week, twelve-hour days. At one time it was five days a week for forty hours a week. It’s been so beneficial to so many people in the hospital that now we’re here for seven days a week and twelve hour days. It has worked out to be even more than what anybody expected it to be. It has really worked out very well.

00:50:29
Rigelhaupt:
One of the things I have heard a lot about in these interviews is a sense of mission, a sense of values, in the organization. What do you remember from your first few months, or even first shift, or even orientation, hearing about the values and the mission of Mary Washington Healthcare?

00:50:51
Jackson:
I remember nothing about that from the beginning. [51:00] I feel like in the past probably five, six, seven years it’s really come to the foreground: value being put on the mission of the hospital. That is not to say that it wasn’t there, but I just wasn’t focused on it when I first came here. I just knew what I wanted when I came here and I didn’t really focus on what the organization was doing. I feel that there is much more on values. The “ICARE” values, which we now incorporate, are just magical. They are just a great way to do business and I think we’ve done a really good job of patient care and it goes beyond patient care. It goes to other associates here and the respect that we show each other. Those are certainly things that have been much more valued and much more talked about in the organization in the last five, six, seven years. More than ever before.

00:52:04
Rigelhaupt:
Correct me if I’m wrong, but I hear a sense of improvement. I mean in the past five, six, seven years, an emphasis on values and the mission. How does that happen? How do you learn about it? Where does it come from?

00:52:19
Jackson:
I think it comes from the top, with management embracing the change that is needed. They were seeing less engagement. They realized that associates at that time may not have been as engaged or as happy with where they were working. They started really analyzing that and looking at that. We weren’t doing well as far as our associate’s opinion surveys. They got a full sense of that and started listening to what associates were saying they needed. I remember very distinctly being a floor nurse and somebody asking me about somebody in management. I was like, “I don’t even know who that person is!” I didn’t know our vice-presidents. That was all brought up at an associate forum. We are talking about these people and we don’t even know who they are. They all started coming and doing rounds with us. They would all come and shadow us on the floor and they would be part of our world and we had them one on one to talk to. I remember Fred Rankin being side by side with me—he came out with scrubs on one day—and he was partnering with me as a floor nurse. It was great. He saw what I did. I think it starts at the top and it filters down. I feel there’s been a tremendous improvement in the value of what associates feel and think and say here. Management takes it to heart and they work on it. [54:00]

00:54:07
Rigelhaupt:
In the years that you’ve been here so probably fifteen—

00:54:14
Jackson:
Fifteen with the organization, yes, in a full time capacity. I did some part time.

00:54:24
Rigelhaupt:
But even thinking about it as part time, even earlier, what are some of the other areas of critical lines, what are some of the other areas of practice that the organization has expanded that you really think has benefited the community and the organization as a whole?

00:54:40
Jackson:
The outpatient services have been a tremendous increase. We now have outpatient clinics. We have the freestanding ER, the whole Lee’s Hill complex. The value of having something at that end of the town, as well as here, and the other hospital up in Stafford. All of those things benefit this community. They have done a remarkable job of serving the needs of this community and being present for what people need and want. I don’t know numbers and I don’t know financially whether it’s been successful, but as far as visibility and access to health care, I think they’ve done a remarkably good job having the freestanding ER as well as having the other clinics here in the area.

00:55:43
Rigelhaupt:
You mentioned earlier not necessarily thinking a lot about the business side of health care. I’m going to ask a follow up even though you may have already answered the question. Because you mentioned the question of access, but certainly over the past decade the cost of health care has been front and center in the news and I certainly think it was something that was talked about for decades before that, though not necessarily with the same kind of press. What do you see in the ways in which the business of health care has been talked about within the organization? Does it come down to floor nurses and nurses in hospice?

00:56:36
Jackson:
Yes, it does. Yes, I know that financially we are working at a deficit at this point. I don’t know the exact numbers of what that deficit is, but I also know we have had a reduction in staff as a result of that. I think it’s the first time in the history of the health care system that we actually had to do some laying off of individuals—more than a couple of them taking early retirements and things like that. [57:00] Health care nationwide is hurting and financially there is a real difficulty that we are all facing. I think reimbursements from insurance companies are getting to be less and less and costs are getting greater and greater. Without getting into a whole political discussion about it, I do think that there are certain forces driving that, and I think pharmaceuticals is one. Health care is across the board suffering. What we’re going to find is that the larger health care businesses are going to ultimately take over the smaller ones. As we see health care today, I’m not sure it’s going to be the same in five years from now.

00:58:10
Rigelhaupt:
So thinking about the economic and political climate that we live in—that’s what is. But what you described earlier about hospice care in terms of a large team that makes rounds. These are many people, highly skilled people every day going from room to room and being focused on patient care. Are there questions of reimbursement in how that practice takes place and how you have seen hospice practices be a part of what you do as a nurse?

00:58:54
Jackson:
What hospice is always looking at—and I can’t imagine that it isn’t across all of the ancillary departments as well as all of the nursing staff here at the hospital—are ways to cut costs. We’re looking at our pharmaceutical companies. Is there a company we can get our medications from that is less costly? We look at our equipment costs. Is there a company that can provide equipment that is less costly, but still allowing for patient satisfaction? We’re always looking at our resources and trying to come up with better ways in which to spread the almighty dollar without compromising patient care. The bottom line is we will never compromise patient care. We will do almost anything we have to before we compromise patient care. I mean, I feel this organization feels that strongly and certainly hospice does. [01:00:00]

01:00:07
Rigelhaupt:
As we’ve done research on nursing, we can see the history of nursing is one that is patient-centered and very committed to the patient. Have you seen that commitment come through the dynamics with physicians, administrators and even with the board if that has been something that is talked about or that you have heard about?

01:00:38
Jackson:
I think patient-focused care is bantered around more often than it is applied. I believe that doctors are focused on patients. I’m going to say honestly, I really believe that the only group of individuals in the health care system that are genuinely, truly, one hundred percent of the time patient focused are nurses. The rest of them, I don’t believe are. I believe that they run a business and I think they are always juggling the business side with the patient care side. I’m not sure patient care wins out all the time. I don’t know if that answers your question, but that’s just my opinion. That’s why I think nursing is. That’s’ why I think we will always be here, because I think the public and the community will always value nurses over and above anyone else.

01:02:01
Rigelhaupt:
What are some of the reasons you would point to that nurses have sustained that focus on patients and patient-centered care, even when as we’ve just talked about, the questions of economics and politics—

01:02:17
Jackson:
Because I think people go into nursing for that reason. I think that’s the only reason that drives them into it. I don’t think all doctors go into the practice of medicine to do patient care. I think oftentimes it’s the glamour of money or the power. I don’t think nurses do that. Nurses go into nursing for the compassion and being able to take care of people. That’s their motivator. We don’t make a lot of money, but there’s got to be reason that we go into this and I believe it is truly the love of the human person and the compassion to take care of that individual. [01:03:00] I can’t say that truly about other professions. I mean it certainly wasn’t true on Capitol Hill. It certainly isn’t true in law. It is certainly not true in medicine, I don’t think, other than in nursing. I think nurses just do that. We don’t start our own businesses. You never hear of nursing as a business. We work for the patient, with other people, but for the patient. That really is our goal.

01:03:36
Rigelhaupt:
Are there other things that you can think of? You know, dynamics? You mentioned hospitalists now as a change in practice. Other things that the administration has done that have supported that core focus of nursing on patient-centered care?

01:03:57
Jackson:
Probably the biggest is that we’ve gone from manually recording everything to computers. Everything now is computer focused and that is all definitely patient focused. Medication administration is all done by computer. We are scanning bracelets so that we have the right patient, at the right time, in the right room, the right medicine, and we are protecting those five rights. The fact that everything is documented by computer means we can all look at that record if it applies to us and we can also read and understand what’s going on with that individual. Before, I would say the majority of our time was spent trying to decipher what that individual wrote in that chart. I don’t know what half of this even means. I can’t even read it. Doctors in particular. For all my doctor friends out there: I’m sorry, because I do love you all! But I think the whole move towards computers and electronics in the health care field is patient centered and patient focused. That was a costly expense. It was much less expensive to stay on paper for sure, but it’s not good patient care to be doing that.

01:05:26
Rigelhaupt:
Are there other technological advances? Because that’s certainly what we hear a lot about medicine: this device to that device, this cure. But in your practice in hospice, has that been beneficial to the practice?

01:05:42
Jackson:
We don’t use a lot of technology in hospice work. We are no longer curing. We are really just allowing that individual to die naturally and comfortably. [01:06:00] I guess the patient controlled analgesia that we can use now in the homes has been really a wonderful thing. The patient can get a continuous infusion at home if they need it for pain and those kinds of things, but that’s really probably the most advanced that we are. We just don’t need the equipment that you need in an acute care setting, like a hospital. We just don’t need those kinds of things.

01:06:30
Rigelhaupt:
Do you continue to consult or do work with palliative care in terms of pain management?

01:06:35
Jackson:
Yes.

01:06:36
Rigelhaupt:
Are there technologies that have been beneficial in palliative care where it is not hospice, but very focused on pain and care for the patient in that sense?

01:06:49
Jackson:
In the acute care setting I would say that just about all technology has its palliative benefit to a patient. I don’t know if you need to necessarily have palliative care in place, but things like the whole brain radiation now. What they’ve come up with as far as treatment for cancer is just phenomenal. The gamma knife itself is technology at its finest and has truly, truly helped with brain cancer and shrinking that tumor, palliating pain, palliating nausea, and palliating breathing difficulties. Technology advances all levels of medicine. It’s just that we’re at a different place—hospice is just very different than those types of medicines are doing in the trajectory of health or life and death. I mean, we’re way at the other extreme so we’re not looking at technology. We’re more looking at hands-on symptom management where most of our liquid medicine and our patches are all very beneficial to us rather than high tech.

01:08:19
Rigelhaupt:
How do you keep up with advancements in the field? I know it may not necessarily be technology in terms of hospice care but what are the ways you continue to learn about best practices?

01:08:34
Jackson:
There’s a national organization called the National Hospice and Palliative Care Organization. We are always tapped into what is going on there. Most of us are members of the association. We get our monthly journal, which discusses new technology that occurs in the field. There are always seminars being held. There is an education budget for us to be able to go and attend those seminars. [01:09:00] We are really blessed with technology in so far as we can look up whatever we want whether it’s at home or at the office. We can look and see what best practices that are out there.

01:09:23
Rigelhaupt:
Are there instances you can think of that you or another nurse in hospice, or previously in oncology or palliative care, brought an idea that you learned at a seminar or education to a nurse manager or administrator and some of the things that you learned about were implemented in the organization?

01:09:44
Jackson:
I think primarily in our care of the child or the infant who has a terminal illness. We have been very fortunate in being able to now have mannequins at the office where we can actually do some treatment modalities on the mannequins that are beneficial to care of the child or the infant. Most of us were afraid to do that kind of care. It’s just not natural to have a baby or a child dying of cancer. We have made really great strides, I feel, to care for the child or the infant who has a terminal illness. One of our nurses is on the board for writing certifications for hospice and palliative care. We do a lot of smaller things in great ways and we help each other through learning what is best and what we’re doing is really the best way to be doing what we do.

01:11:06
Rigelhaupt:
You mention a nurse on the board. Who are some of the leaders who have been influential in the development of hospice and palliative care at the organization?

01:11:16
Jackson:
The board I was talking about wasn’t our board. Eileen Dohmann was our manager for five years before she was brought over here now as Vice President of Patient Quality and Safety. She’s always been a great advocate of hospice. She still comes every Christmas and provides a fully cooked meal that she has done herself. (Laughs) Eileen is definitely a supporter of hospice. Fred Rankin is a great supporter of ours. I’m feeling terrible because I cannot remember his name. [01:12:00] He is head of the foundation—thank you! Xavier Richardson. I took care of his mother. That was my first encounter with Xavier, when I took care of his mother at the hospital. He’s a great supporter of hospice. We are really well respected and well liked. I don’t know of anyone who hasn’t had some dealing with hospice through the years that hasn’t walked away saying this a great group.

01:12:46
Rigelhaupt:
I’m not sure how to phrase this question because part of what you’ve articulated is that hospice is a well-respected group within the organization. But what I’m trying to think about is the tension with that—and I don’t know if tension is the right word. But what makes hospitals hospitals is the acute care, the advances with radiologic treatment or high technology. When we even think about the marketing of hospitals, it is what we can provide and it is usually high tech care. It’s not often that bedside nursing is marketed. It’s open-heart surgery. It sounds like this organization has very much valued something like hospice and bedside nursing even when while making significant strides in terms of the level of care they can provide medically to the community. I’m not sure that was a question.

01:13:51
Jackson:
Well, I don’t know if that was a question. I’m not sure what that meant. Are you questioning why in an acute care setting hospice could possibly be valued? Is that what you’re saying? Because it is an acute care setting.

01:14:20
Rigelhaupt:
It’s just that it is a more recent phenomenon in an acute care hospital and to think about the growth and support for something that is not traditional come into the emergency room really sick, get treated, and go home, which is what acute care hospitals or advanced surgeries have traditionally done. The level of support for this—

01:14:46
Jackson:
Right, right, right. I will say this. Maybe this will help clarify some of that. Any time a patient walks through the ER or is transported to the ER the very first goal is to set up a discharge plan for that individual. [01:15:00] Hospice is valued because oftentimes after every bit of treatment has been exhausted, the next stop, if it is incurable, needs to be hospice. Though it doesn’t mean this patient is necessarily going to stay here and get hospice here at the hospital. It means we are consulted. We sit down with the family, and say, “These are your options.” You know we’re beyond cure at this point. We are looking at comfort and getting this individual to his home, to a nursing home, or to an assisted living with our support. Not knowing how long an individual has, because we don’t ever know that. We’re a good support to help you with that and get things in place so that if and when that individual develops symptoms due to the dying process we are part of that plan to help with that. It’s not necessarily that we do hospice care all the time in the hospital. There are some people that are imminent that we do admit as an inpatient under the hospice umbrella and the reason we can do that is because Medicare and all health insurance plans have a hospice benefit for inpatient hospice. We’re able to do that and the hospital is able to get reimbursed. Not at the same rate that they are reimbursed for someone like you or I who would get ongoing treatment, but there is a reimbursement for that. The fact that we do allow for hospice and this organization allows for patients to take advantage of that speaks very well for this organization. That isn’t true at all several of the other hospitals in this immediate Northern Virginia area. It works out very well for these individuals that they are able to do that. I don’t know if that answered your question, but I think in the ideal of what medicine is all about as far as curing—you’re right, we are not part of that. But again, as the population ages, we are seeing more and more people in need of hospice because imminently we are all going to die. We are able to help with that once they’re here in the hospital. I can’t begin to tell you how many people are sent here from nursing homes. There really is no more treatment available. What is the kindest thing to do with these folks? [01:18:00] That’s time in with hospice. We can go to the nursing rooms, we can take care of them there, and put in place at the nursing homes what is needed so that their quality is really good as they die. People in this day and age should never die suffering. There’s just no need for it. There’s too much out there. There’s too much good medicine to help so that people don’t die suffering. That is what hospice does and does it really well.

01:18:30
Rigelhaupt:
That did answer my question. It was part of the ways in which a not-for-profit community hospital can provide medical care that doesn’t fall under the traditional, curative emergency room entrance or high tech cancer care and that the organization thinks more broadly about providing medicine and health to the community.

01:18:56
Jackson:
I mean, you know this hospital-—we do a tremendous amount of indigent care as a not-for-profit. And again, I don’t know dollars and cents and everything else. It is remarkable that when they come to the floor, I really don’t know if they are indigent care and it really doesn’t matter because we are going to take care of that person as well as we are going to take care of the person who is going to reimburse us. Whatever that reimbursement rate is. That is what this hospital does so well: we don’t look at dollars and cents all the time. I mean I am sure there are people who do that. Nurses don’t do that. Nurses say patient A is as valuable to us as patient B is regardless of their ability to pay. Hospice is that way too. We will take anyone regardless of their ability to pay and we will make sure you have the best quality for whatever time is left.

01:19:56
Rigelhaupt:
Are their ways that extends out to other health care providers? I know the hospital has a relationship with the Moss Free Clinic and I know you mentioned what was it? Harbor View?

01:20:08
Jackson:
Harbor House.

01:20:10
Rigelhaupt:
Have you seen the organization support, even if it’s education, in terms of your expertise in hospice care going out into other health care providers, to teach about or provide care?

01:20:25
Jackson:
I think all the nursing homes. Our presence is in all the nursing homes. We’re present in all the assisted living facilities. We’re a part of all of those facilities. We have several adult homes that have three and four individuals there. We have been with patients with each and every one of those for end of life care. Again, our care is done wherever that individual chooses to die. I actually had a patient who was living at the back end of a gas station. [01:21:00] We go anywhere that is needed. We’ve had people who are homeless and we’ve supported putting them up in adult homes, in facilities, and worked with them. I’m trying to think of the ministry—Micah Ministry. We’re very big proponents of Micah Ministry. We’ve had several patients at their house and we work with them. We get them transported to the hospital if their symptoms aren’t being managed well. We reach out in all areas in this community.

01:21:46
Rigelhaupt:
Trying to think about your career as a nurse here and thinking about nursing in general, I mean obviously your connection is most close with hospice, and a little bit of oncology and a little bit of palliative care before. What are and how would you define the strengths of the nursing community at Mary Washington Hospital? Within the health care system?

01:22:13
Jackson:
I would say that we have some of the best nurses that I witnessed. Now, my daughter is a nurse down in MCV. As far as education and one-on-one training, I think we exceed what they’re doing down there. And they are a teaching hospital. It’s not to slam MCV. Don’t get me wrong. I’m not trying to do that. Our salaries are competitive and our benefits are very competitive. I think we are doing a good job at elevating our LPNs to RN status and our RN associates degrees to bachelor degrees. The importance of nurses in his environment is getting better every day.

01:23:15
Rigelhaupt:
One of the important milestones that I have heard about in interviews and seen noted was Magnet status in 2009. What did that mean to you as a nurse?

01:23:28
Jackson:
(Laughs) Magnet status really meant nothing for me truly as a nurse. I’m going to be honest about why I laughed: my heart is in this hospital regardless of what status they achieve or don’t achieve. Will it help draw better nurses? I think there are a lot of nurses who think of Magnet status as something and they will only work for hospitals that have Magnet status. [01:24:00] In the world of nursing, Magnet are premier hospitals. They are the cream of the crop. They do well with their associate nurses. They do well in education and support. For a lot of nurses, it means a great deal. Personally for me, I’m never probably going to leave this organization. I’m probably going to be the one that will die with this organization because I love it here. I am the one—maybe the few I don’t know—that really loves what they do. I mean there are days when I’m pulling my hair out, but overall this is a great organization. It’s been great to me and has always been good to me. I’ve never been without. If I needed something, I knew who to go to. I went and if they could give it, they gave it. I can’t complain. So for me Magnet status doesn’t have much bearing. I hope they get it again. We’re up for renewal this coming year. They have done a great job at getting us prepared and I think we will get it again. I hope they do because it does mean a lot to a lot of people.

01:25:21
Rigelhaupt:
So one of the things that I’ve heard you talk about is the importance of compassion, being with people at their most vulnerable time and dying. But nurses are highly skilled medical practitioners. What are some of the skills that you’ve been most proud to master or get better at over the course of your career in terms of providing medical care to your patients?

01:25:53
Jackson:
That’s a great question and you’re absolutely correct. The two things I think nurses at this hospital do well are skills and compassion. Skills for me personally—I think I am so much more knowledgeable in treatment of symptoms when it comes to the value of different types of pain medicine. What will work well? What won’t work well? What dose works well? What dose doesn’t work well? The whole idea of adjuvant therapy and the importance of that. For me, my knowledge base has really expanded in the past five years. It’s really been a wonderful experience to know how much I know. I really do feel I am one of the best nurses for hospice. For me, it really has been great as far as my knowledge. [01:27:00] I also think I am good at explaining to families what’s happening as the body shuts itself down. Even prior to it happening, what to look for and how to deal with that. Call us. We’re here to help support and do whatever we can do to help. Education. Educating families on the importance and the takeaway always is put your life in order now. Don’t let yourself as the spouse get to this point where you don’t know what he wants. Let your kids know now. Prepare now for the future. Get the business side done now so emotionally when it happens they don’t have to deal with anything but being your child. You have already made your wishes known. There is such relief in that when a family says, “Oh yeah. They already took care of that.” They don’t want to have a Peg tube or they don’t want to be intubated. They don’t want a funeral. They want to be cremated. If you have it ahead of time, it’s just great. The ability to talk to the public and help them with that has been fabulous, but as a clinician symptom management for me has been the best.

01:28:38
Rigelhaupt:
What would you want the public to know most about what a hospice nurse does?

01:28:46
Jackson:
I think the most important thing is that we are a support. We are compassionate and we will suffer right along with you for whatever time is left for that individual. We don’t try and play God. We certainly don’t prolong and we definitely don’t hasten. Whatever day-by-day encounters you have with this—and I think it is to empower other people. That they can do this, as hard as it is for them to be in the foreground of caring for someone they love as they’re facing death. We do understand it and that we can help you through that, but in turn you can help your loved one. That is probably the most important thing: that they have to be able to step back and know that they can give medicine with the proper instruction. They can support this individual who, as much as you love them, is facing an unknown that is scary and frightening and we are there to help them through that. [01:30:00]

01:30:13
Rigelhaupt:
So the way I like to end is with a last question, which is really two questions. But is there anything that I should have asked and I didn’t, or is there anything you would like to add?

1:30:28
Jackson:
Yes. I think there was a very important question you didn’t ask. Would I encourage people to become nurses? Yes. Yes. Yes. Yes. I think nursing is the most honorable profession you can go into. I have never looked back with one regret and I have helped a lot of people. When that judgment day comes, however you envision it to be, you’re going to be judged not on how much money you made or how good looking you were or how intelligent you were. You’re going to be judged on how well you took care of your neighbor and nursing is the best way in which to do it. I think anyone who has any inkling to be a nurse should do it.

01:31:32
Rigelhaupt:
Thank you.

01:31:34
Jackson:
Thank you.

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