February 22, 2022
Intelligence empowers us to learn new concepts and apply that knowledge to solve problems.
Emotional intelligence is the ability to learn about yourself and apply that wisdom to the world around you.
“IQ” – Intelligence Quotient (first test 1904) – and “EQ” – Emotional Intelligence Quotient (first assessment 1990) are ways to assess these intelligences.
What kind of intelligence, then – in addition to having heaps of IQ and EQ – do best-of-breed Hospice Triage Nurses have?
Best-of-breed Hospice Triage Nurses have a “High TQ” (2022) or “Triage Quotient.”
A triage nurse, especially a virtual triage nurse, expertly assesses patient and caregiver situations, prioritizes treatments, and initiates/coordinates medical care.
Having been a Hospice Triage Nurse and a Clinical Director for a hospice, here are my top-10 characteristics of a “High-TQ Hospice Triage Nurse.”
Triage is an in-the-moment, up-to-the-minute skill and discipline. Best-of-breed Hospice Triage Nurses must actively, consistently, expertly (ACE) listen for, observe, and even anticipate. Telenursing Triage Nurses swiftly apply this information to elevate the patient experience, the caregiver experience, and their clinical team experience.
Being “nice” is often not nice, especially in the world of hospice and hospice nursing. Compassionate, confident, compact directness is required in communicating with patients and family members. “Death” is one of many words to not shy away from. “Hospice” does indeed mean your loved one is in the process of dying. Our comfort as an after-hours nurse on call breeds others’ comfort with what will come.
Hospice is the journey to the end. We meet the patient on their journey, ever-learning and becoming increasingly aware of their wants/needs, cultural/religious implications, and any other essential insights. Such awareness and commitment ensure we meet them where they are and support them and their loved ones through to the end. We do not always know what is going on, and sometimes the patient’s emotional place can be very out of line with their physical decline. For example, even when it is clear they are dying, patients commonly think they can get better, (Kübler-Ross’s “Denial.”) Sometimes a nurse needs to not ‘correct” or educate but support the patient and let them go through the emotions or the “stages” to accept where they are. Denial is more evidenced by family members. It is common for near-end-of-life patients to be force fed by well-intentioned family. Force-feeding puts patients at risk of choking or aspirating. Sometimes you must work with the family to educate them and then let them make the choices they feel are best, even when it is not the choice you would make.
Far from “cold,” we are level. Clarity-afforded science and insight guide us, as do full hearts and emotion at the closing of one’s life verse and other compassion points during the continuum of care. A “High-TQ” Hospice Triage Nurse answers the call of the science and art of nursing, within the pulse of life’s dance and graceful bow.
Best-of-breed Triage Nurses are voracious learners – about everything from Palliative Care to patients’ cultural and social nuances. We embrace our role as educators. This means being educators of patients, of caregivers, and sometimes, of our colleagues. But mostly, as educators of ourselves. We sign up for extra learning opportunities. We thirstily drink in each moment of work and life experience, using that as a reservoir to inform future decisions and actions. We recognize that sometimes we have thoughts and prejudices and accept these as places to further question ourselves and, in so doing, improve our care. We recognize options in terms of curative and comfort treatments and carefully, respectfully, dutifully communicate these options to patients and caregivers.
Hospice is the intersection of life and death. It is emotionally charged for all involved. It is not our journey, but it is our calling to aid the journeys of others. Sometimes we will take abuse – especially if we are physically remote (e.g. telephone triage nurse assisting over the phone). We understand this is an aspect of hospice and indeed humanity. Resilient, we move onward and upward.
As nurses, we believe in people. As Triage Nurses and as Hospice Triage Nurses, we must optimistically believe in people’s abilities to learn, grow, and change. Once-timid, tentative caregivers can improve and rise to challenges – with our support, respect, and belief. Long-held assumptions about life and death can change, amid the realities end-of-life bring. We need to remain convinced of human capabilities and our mutual goal to elevate patient care. An “aha moment” in nursing came to me when highly religious children of a cancer patient set aside their religious distaste for Dronabinol (man-made cannabis or marijuana used to relieve extreme nausea), to allow their mother significantly increased peace on her death journey.
These lines from a vintage Police song remain with me: “When you find your servant is your master.” As a Hospice Triage Nurse, many roles interchange as we are informed by patients, caregivers, and colleagues, and, in turn, so inform them. The key here is elegantly gliding from being coach to being coachable. Both yin-yang traits are essential. As nurses we need to be humble enough to set aside what we may consider “superior” education and experience and be willing to learn from caregivers who have had more time with this patient in front of us. Science and education should not trump caregiver/family intuition but co-exist. A family member may tell you something that is not “textbook” but provides spot-on insights about what their loved one thinks, feels, or needs. In this instance a nurse who goes in arrogantly dictating what needs to happen is, of course, very ineffective. A nurse who can go in and work with the family to guide them and help them navigate the care in a situation like pain medication is far more effective. For example, consider the situation of a hospice patient’s enduring a lot of pain and refusing pain medications. Then the family shares the patient’s fear that meds will render him unable to further communicate with his family. This helps the nurse to know how to address the real issue of confronting the ensuing reality of death with support of family together, rather than commanding the pushing of pain meds.
Ancient Greek playwright Euripides said it best: “Silence is true wisdom’s best reply.” In dealing with death and death’s journey, High-TQ Hospice Triage Nurses know when silence is okay, or even best. The moment of death, family member’s loud or silent grieving, Kübler-Ross’s denial and anger stages of grief squarely directed at you — These are times to breathe deep and find your friends’ silence and compassionate touch. The same is true if we are ever asked anything we do not know the answer to. “I don’t know” is raw truth. Finding, then sharing the answer is bountiful truth.
The trait of being balanced is essential. Many of these other traits on this short-list of “High-TQ” Hospice Triage Nurse characteristics allude to this fact.
Being a Triage Nurse is tough. But it is part of why we love and answer the calling, and why others love us for it – even if they are never able to show it.