Pediatric home and palliative care nurse Greg Burns of HomeHealth Visiting Nurses of Southern Maine joins host Jamie Davis to talk about his experiences as a nurse and his choice of home health, palliative and hospice care as a focus for his nursing career. He is focused on pediatrics and parent education for infants who are able to leave the hospital, but deal with developmental obstacles.
Nursing Notes Live is an audio extension of the national award-winning monthly e-newsletter, Nursing Notes - which offers the latest industry news, trends and updates in nursing. You can subscribe to the e-newsletter at www.discovernursing.com. Each month’s Nursing Notes issue, hosted by nurse Jamie Davis, is accompanied by a select few episodes of Nursing Notes Live, which expands on the content and provides you greater insights into the topics presented in the e-newsletter. You can listen to previous episodes and subscribe to the podcast on iTunes!
Jamie Davis: Hi, Greg, welcome to Nursing Notes Live, it’s great to have you on the show here. I thought I’d ask you our traditional first question for our Get-To-Know Nurse of the month and that is, what is it about nursing that drew you to this profession?
Greg Burns: Well, thanks, Jamie. I actually wanted to be a nurse when I was a teenager, when I was about 16 actually. I did some work on as a junior firefighter and rescue personnel and got in EMT when I was quite young. I decided early on, at that point, that I really wanted to kind of get into nursing. I had a chief who I worked on there, who was a nurse at one of the local hospitals, and she was kind of my role model and that really - watching her work, watching how she dealt with people really intrigued me and made me want to come and follow into the profession.
Jamie: That’s interesting you said that. That’s actually partly my background. I was originally an EMT and a Paramedic and people kept saying you really treat patients like a nurse treats patients. You should continue and move forward and become a nurse. And that’s what drew me in the nursing school was that passion to continue building on my healthcare education and continue going that direction. It’s interesting. You’re actually the first person I’ve interviewed that said that though, that had a similar career path, so that’s interesting. What was your educational path like that drew you into eventually going into the career path of HomeHealth Care?
Greg: Yes. Out of high school I started pre”-nursing”, what it was called at that point in time, through USM, University of Southern Maine, Portland and Gorham. There are two campuses actually. The pre-nursing track was kind of all the sciences and all that kind of stuff. To actually get into the nursing school, you have to then reapply. I had to kind of do that. Before I did that, I did three years actually of pre-nursing because I did a kind of music/theater minor as well. I actually took a year off in the middle of that, kind of just to re-evaluate and make sure I was making the right decisions, make sure that is what I wanted to do. I went back in earnest after that year off, having reapplied to the School of Nursing and being accepted. I was the only guy out of 43 students at that point in time. It’s really interesting. I feel like I had a little bit of a tough time in nursing school because of being a guy, which was really interesting because a lot of guys that I talked to, they talk about it being not having kind of hard time. I think I felt almost like I was having to break into a sorority as it were, do you know what I mean, in a way. And so that was a really interesting piece for me. I graduated cum laude from University of Southern Maine and, prior to graduation, I had gotten a job on an Ortho unit at Maine Medical Center. I did that through school and then after school.
Jamie: So what drew you from working in a hospital setting to moving into Home Health Care because that is quite a shift and I’m curious what moved you in that direction?
Greg: Yes, so interestingly, not to go on and on here, but I started as a MedSurg nurse and then after three years, moved to Pediatrics. I worked on pediatrics at Maine Medical Center for a good six years after that. At that time, as well, I was working at Maine Children’s Cancer Program. So that was my clinic experience. I worked as a clinic nurse there. Kind of did those two simultaneously – worked in the hospital and then worked also in the clinic. So I got to see a little bit of patients coming in from their homes and that kind of thing. And when I left both of those jobs, I had a friend who was a hospice supervisor at a local Home Health agency and really kind of heavily recruited me to do both pediatrics and adults. And in those times, I was a little wary of it, but I decided to go ahead and give it a shot, because I liked the idea of being out of the four walls of the hospital and the clinic and actually wanted to see what that was all about, to go into somebody’s home. Actually, I did three years with Community Health Services. I really never looked back. After that, I started a program called the Jason Program, which is a palliative care and hospice program for children, and that was a home-based program as well. We travelled to people’s homes to kind of offer the care and the health community to care for kids living with critical illness out in the communities of Maine. After that, I got this job at HomeHealth Visiting Nurses and have been on their Maternal-Child Health staff now for six years and it’s been great. I’m helping to create a palliative care program at this hospital system right now as well.
Jamie: That must be incredibly difficult to - we think of home health care, and I think a lot of people think, of taking care of sick elderly people. And if you’re thinking about hospice, you’re thinking about critically ill, terminally ill elderly people but there are children that are in these situations as well and we need home care for those specific patients too.
Greg: Yes, absolutely. It’s an underserved population actually. It’s one of those things. That’s the question that I’m mostly asked, right, about doing pediatric palliative care. How do you do that? I struggled with that question for a long, long time, like, coming up with an answer for that. I’ve worked hard to understand as much as I possibly can about pediatric palliative care and pain management, symptom management, kind of all of that kind of stuff. So I have this set of skills now. So my answer to the question now is “How do I not do that?” Like if I have these set of skills that I can offer these things to families, then it’s almost like imperative that I do that.
Jamie: And I’ve always found with pediatric patients that you really are managing an entire family of people that need some assistance and care. It’s not just living like with an adult patient where you just have the adult to deal with, but you also have the entire family of caregivers - perhaps siblings, perhaps parents, perhaps even aunts, uncles and others. So how do you approach that particular situation?
Greg: So one of the key tenets of a good palliative care hospice program is that you do this work with a team. There is always a team that’s available and you approach the family together. In other words, this nurse, doc, social worker, we’ve kind of always try to have the clergy member involved. And you approach the family as an interdisciplinary team and you provide whatever is needed at whatever given time. And that is, you’re right, Jamie, for the whole family. I’m involved - the doctor, myself, are working perhaps on good symptom management while the social worker is actually working with the siblings of the child or the parents of the child and perhaps also grandparents. You never know kind of like what the make-up of that family is going to be and who has what role. This type of work, pediatric palliative care, you’re really delving into that family structure and you are caring for the whole family when you are providing that kind of care.
Jamie: So what does it take to be a good nurse in that situation? If someone’s listening to this and they say, “You know what, I think I can provide care for that people in that environment,” what skills should a nurse or even a nursing student tries to foster in their education and their career process in order to facilitate them to move into that type of position?
Greg: So the clinical skills, right, you have to have a good working knowledge. Not just the working knowledge, but an excellent knowledge of good pain control and good symptoms management. Critically ill kids can have so many different problems that you kind of have to know about. Every situation, you have to be able to approach. I think pliability is one of the things that you need to have. You need to be able to approach every situation and try to understand that and be able to - when you have knowledge gap, go and find that information. So that’s one of the first things – so good working knowledge, pain and symptoms management, and ability to be able to be pliable and to kind of figure things out as you go along. Also there’s another kind of pliability. I think it has to do with when are going into these situations with these families. You really have to kind of put your agenda to the back and really find out what the needs of these kids and families are and address those, as well as, what you have on your agenda. Do you know what I mean?
Jamie: Yes, I do. I’m curious because when you do that, when you take some of your own self out of the picture, that’s good patient care, but you also, at some point, have to address how you manage your own feelings about what you’re doing, like you said, people have asked you the question. But I am curious what have you had to change or what have you adapted in yourself to manage the stress of dealing with these critical situations?
Greg: Right. So that’s the other piece, right? You kind of just hit right on the head. The other piece is good self-care. In order to do the work, one has to then rely on that team to be able to do the debriefing that’s necessary. To be able to really kind of lay out your own feelings about situations. Certainly, one could walk into any one of these situations with anyone of these children and become a puddle on the floor because there are - I dealt with situations and deal with situations that are completely tragic. But the thing to remember as a nurse, as a provider, is that you don’t want to then also become another person that the family will have to take care of, right? So you really need to keep yourself in check and rely on that interdisciplinary team. Also rely on the things that you do for yourself, to kind of fill yourself up. I play music a lot and I listen to a lot of music. Those two things give me a great deal of thought. I meditate a lot. That’s another piece that kind of give me that ability to kind of clear my mind and really tap into my heart. But then there’s also things like – I fish. I play with my grandkids. I do all kinds of different stuff to celebrate life.
Jamie: Yes, that’s important. When you build a program like this, do you try to build some aspects of self-care for the nurses and the other team members in the program as part of it or is that something you leave up to their own professionalism that they’re going to manage that themselves?
Greg: Yes, I think that’s one of the areas, Jamie, where we need to maybe do a better job of checking each other on. I have been involved in a state level with the Maine Hospice Council here in the state of Maine. One of the things we used to do on a regular basis, on a yearly basis, was we had a self-care retreat, that as many as 100 people used to attend. That retreat was geared towards all of the things that we all kind of traditionally think of as good self-care. So there were workshops. There were massages available. There were all kinds of different healing arts types of things available at these retreats to kind of help people remember that, that this is a part of the work. That if we don’t keep ourselves fulfilled in this way and check in this way then we run the risk of becoming burnt out. I do think that it is important and incumbent upon us really to take care of one another. The people that are doing this work in whatever way we can. The interdisciplinary team is a really important piece in there and being able to, like I said, kind of debrief and really be able to lay yourself out on the table if you need to, to really talk through things is important. But there is an element within each of us that we have to do as professionals, like you’re saying, there’s a little bit of both of them.
Jamie: I think, from my experience, just as birth is an incredibly important and almost a gift to be present during that part of someone’s life, for myself, I tend to look at those opportunities when I’ve had to share the final moments of someone’s life with them in some small way and help ease them through that process and their family as well. I look at that as a very special time too.
Greg: Absolutely. The other piece of this is that there is incredible inspiration that comes from this. That to watch families and to watch children deal with these types of life changes and transitions is incredible. It’s amazing. One of the things that keep me doing this work I think is that I can make it a point to learn the lesson from every patient that I see. There’s something new I can gather from every patient and family that I come into contact with and I’m always trying to open myself up for that as well.
Jamie: Just shifting gears here a little bit, we always get a couple of questions in and often from student nurses asking for some piece of advice that you might be willing to share. I guess my question that I would select from that pile of emails that we get is what is that piece of advice that you received from another nurse or a mentor or maybe an educator at some point in your nursing career that you’ve found is really something you carry with you day to day in your nursing practice?
Greg: There’s a woman named Virginia Fry. She’s written a lot of books and I actually saw her speak one time back about almost 20 years ago now. Her talk still kind of resonates for me and the thing that she said, the one thing that she said that resonates for me and I – it’s almost like I kind of like try to say it to myself at least once a day and that is when you enter somebody’s home, and really when you enter somebody’s life, you really need to do that on your knees. There’s humility here. That’s part of that kind of selflessness. That’s part of that kind of taking your stuff out of the equation and really figuring out what it is that you can give the people. The medicine piece, it’s just one small part of it.
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Make sure you check out the entire February 2015 issue of Nursing Notes where we look at what it’s like to be a home healthcare nurse. You can read the entire issue www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I had a discussion with Elaine D. Stephens, Executive Vice President of the National Association for Home Care & Hospice, she’s also Former Chair of the Home Healthcare Nurses Association. Also joining us on the home healthcare nursing panel is Barbara Burgess, chief executive officer of Pathways Home Health, Hospice & Private Duty. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.