For this issue of Journal of Hospice and Palliative Nursing (JHPN), I have invited 2 guests to share their perspectives with you in lieu of my usual editorial. This began when I was contacted by Jennifer Wilson, DNP, RN, CPN, who is a clinical professor and Director of the Nursing Honors program at Texas Woman's University. She shared with me that 2 of her students had learned that they were accepted into the nursing program and then, just days later, the COVID pandemic began. Dr Wilson wondered whether the students, Stephanie and Megan, would question their choice of a nursing major, and she then guided them in a process of observing nurses through the media to determine whether this was still the profession they hoped to enter. What follows here is a letter to you, the readers of JHPN, from these nursing students in which they share their decision. Their wisdom, insight, and conclusions are a gift to each of you as we end 2020, a year that has tested all of us. I am grateful to Dr Wilson, who clearly is a role model for all of us as a mentor for these students, and to Stephanie and Megan for this letter.
Betty Ferrell
Editor, JHPN
DEAR NURSES
Have you ever considered how sharing a nursing experience on social media influences the strangers who silently read your post? Could a simple post about being that nurse who refused to let a patient die alone shape the path of future nurses? As prenursing students who received our acceptance letters to nursing school within days of the country shutting down due to the COVID-19 pandemic, we found ourselves briefly pausing to give our career choice a second look. Like the rest of the country, we found ourselves surrounded by confusing news stories about heroic nurses on the front line of a largely unprepared health care system. The lack of preparedness and basic protection honestly frightened us, sparking a need to further examine this profession so we could make an informed decision to either change majors or stay with our intended career choice. We naturally addressed our dilemma by turning to the experts: nurses. We read nursing articles, interviewed nurses, and joined nursing social media groups to expose us to the raw and enlightening "insider's view" behind the superficial news stories. The posts spanned a broad spectrum of topics that illustrated the harsh reality of the profession we were contemplating joining. Like most students, the prospect of caring for a dying patient and catching a disease that puts our own lives at risk topped the list of genuine fears about nursing and nursing school. How ironic that reading social media posts about nurses' intimate accounts of death and end of life care were ultimately what confirmed our pivotal decision to stay.
The posts about death immediately drew us in and spoke to our souls more than any other posts. We were immediately hooked and learned more from scrolling through the nurses' raw accounts than we could ever glean from a textbook. The nurses' posts embodied nursing values at their core, unknowingly sparking heavy reflection and reinforcement of our own beliefs and knowledge about the nurses we strive to become. As we read and discussed these stories, our fears, although appropriate, were initially replaced largely with a sense of pride, followed by motivation to grow into the shoes of palliative care nurses. We found ourselves not only confirming our decision to stay but also considering a specialty that had never previously crossed our minds.
We applaud the nurses who exposed us to the power of end-of-life care, replacing our fear with hope and inspiration. As honors students, we strive to create a life defined not by "success" but by "significance." Without thanking you, the nurses who unknowingly inspired us, we waste a valuable opportunity. We hope to reciprocate by assuring you we see and hear you; we are watching you with awe, and we are cheering you on. We hope, by sharing the lessons we learned and themes we discovered, you will be empowered and inspired to continue leading by example.
Transparency
Transparency remains essential to the formation of future nurses. Instead of sugarcoating the reality of our profession, nurses earned our trust through candor and honesty about the severity of COVID-19, the ways the virus affected them personally and required them to change the way they delivered care. Nurses posted statistics about the overwhelming number of daily deaths compared with prepandemic. The evidence frightened us, as we have yet to witness even a single death. However, the gift of transparency prepares novice nurses for the reality of the profession that differs from the one portrayed on screen. We were surprised by the transparency and humility of nurses with years of nursing experience who suddenly found themselves providing end-of-life care for the first time because of the pandemic. Experienced hospice and palliative care nurses were eager to share their expertise, even as they were suddenly required to modify the "best practices" they knew. These nurses demonstrated an unwavering commitment to preserve human dignity, speaking to the bravery and calculated selflessness that shook us. When we learn about best practices in nursing school, our thoughts will immediately turn to those nurses. Many posts illustrated the emotional toll death brings, while clearly impressing upon us that exemplary care relies on an intentional commitment to fundamental values and work ethic.
Transparency translated to resilience. Although nurses could not save that COVID-19 patient, they could apply lessons learned to the next patient and educate other nurses in the process. By reading about your experiences, we are more aware and better equipped to apply them the first time we encounter our first death in clinicals. We were surprised by the nurses who bluntly admitted fears after witnessing a record-breaking number of deaths. We read about nurses who died at the hands of COVID-19. We watched some nurses leave the profession while others actively advocated and fought for solutions, which sparked heavy reflection about whether the fulfillment of pursuing one's passion outweighs the fear and danger associated with one's career. We dove deeper into our purpose, reinforcing and further motivating us to keep reading. One by one, the posts transformed our fear and inexperience with death into confidence and gratitude for getting to be that nurse for patients and incorporating the lessons we learned. We no longer fear our first dying patient but rather look forward to the privilege of being that nurse. And we know that we will be okay; we just need to embrace the human experience with intention.
Core Values: No One Should Die Alone
The intimate end-of-life encounters in an uncertain, stressful, and isolated environment provided deeper insight into nursing fundamental core values. The new normal required patients to battle the virus alone with 1 major exception: nurses serving as surrogates for the family. As the pandemic lingers, we wonder whether this new normal will be the only one we know. If so, we will follow the example of the nurses who provided comfort at the environmental, sociocultural, and psychospiritual levels however they could. Nurses sang, they played instruments, and they sacrificed their own comfort, showing pictures of themselves wearing an overwhelming amount of PPE and the skin breakdown that followed. When families were banned from visitation, nurses stepped up and became a family member, providing physical comfort and ensuring no one died alone. This lesson, perhaps the most important one, now remains cemented in each of us with a commitment to continue your legacy.
The Power of Touch
We suddenly found ourselves fascinated by the concept of touch, a repeating theme in the impactful stories, sending a strong message that this concept is important. Despite busy schedules and the risk of COVID-19 transmission, nurses devoted time to hold patients' hands. We learned the simple act of holding a patient's hand can have profound effects on both the nurse and the patient because touch is a reciprocal experience. In the process of providing comfort to a patient, human touch can brighten a nurse's mood in a dark shift of COVID-19 tragedies. Touch can also reaffirm our purpose and privilege of being the nurse caught in the right time and place. Nurses must find a way to convert self-risking situations to self-developing ones by adapting to a new set of rules and circumstances. Instead of thinking of the situation as one that would put them at risk for COVID-19, nurses are refusing to abandon the core value of touch. One post in particular details the last minutes between a hospice nurse and a patient dying from COVID-19. The nurse reflects on his experience guaranteeing the family that their loved one will not die alone. As the family was not permitted, the nurse stepped in to hold the patient's hand until the final breath. The nurse's commitment and simple example will stay with us for our entire careers. Sadly, he will never know it, because the post was removed, teaching us another valuable lesson to share empowering words before the opportunity flees.
We read posts about nurses who invested time and passion ensuring patients' comfort and peace with death. Other posts described a patient's positive turn, celebrating the joy when patients recovered, showing us the emotional investment of nursing on the roller coaster ride. These joyous moments demonstrate human dignity at the core; we now understand that, regardless of a patient's outcome, these experiences between patients and nurses during times of uncertainty are not 1-sided but rather shared, sacred, and reciprocal. We believe this dynamic is precisely what allows nurses to overcome their fear of death. Our window into the intimacy at the core of caring for someone in their final moments guides our professional development during this temporary pause in our education, enabling us to approach each experience less afraid and more aware, knowledgeable, thoughtful, confident, and empowered because of the nurses' examples.
Instead of associating nursing with vigorous schooling, memorization, and medications, we have created a new narrative about nursing and our professional identity. These stories remind us of the beauty of nursing and patient interaction. These shared stories instill a sense of belonging, assuring us we are in the right profession. We now look forward to being that last nurse for patients, regardless of our specialty or role. These nurses inspire us by demonstrating the values we will ingrain into our practice as nurse leaders. We are looking up to nurses as a virtual mentorship and cementing these illustrated values of comfort, compassion, and care for patients. These stories on social media illustrate that it is ok to go beyond the textbook to ensure quality care, just like the nurses who held their patients' hands and refused to let them die alone.
As novices, we are grateful for the nurses who stepped out of their comfort zone to share their experience on social media, unaware of their impact. Unknowingly, nurse novices are turning to nurses for insight, inspiration, and motivation. Instead of letting death scare us, these posts provided clarity on our purpose in nursing. We encourage nurses to remain aware of this platform, using it wisely. The community of nurses on social media has shown us that all nurses have the ability to influence others by sharing their raw emotions. The nurses' honesty, vulnerability, and willingness to share the reality of end-of-life care demonstrates the leadership to which we as nurse novices aspire. They have beautifully taught us that self-development is never ending by showing how to push through fear and challenges during a crisis, while preserving the core values essential to exemplary nursing. We applaud you and encourage you to continue sharing your transparent experiences, with assurance they are causing a ripple effect by shaping the next generation of nurse leaders. We will honor you by following your example and approaching our career with the same humility and commitment to excellence you demonstrated.
Megan Brieden
Stephanie Reynoso
The authors have no conflicts of interest to disclose