Bedpan Banter

Part 1 with Hospice Nurse Julie: What Nurses And Families Should Know About A Good Death

• SimpleNursing • Season 1 • Episode 6

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What if the thing we fear most—dying—is often gentler than we think? We sit down with Hospice Nurse Julie to unpack the stark differences between ICU deaths shaped by machines and a natural decline supported by hospice, where bodies often lead the way with less hunger, more sleep, and a surprising absence of pain. Julie shares the moment she learned to raise her hand in rounds and ask for family meetings, and how clear, direct language can transform care plans from “survival at all costs” to comfort with dignity.

We dig into practical, bedside communication that any nurse or loved one can use right away. Julie offers real phrases that reduce confusion, outlines the typical signs seen in the last months of life, and explains why “keep them comfortable, safe, and clean” is a powerful daily compass for caregivers. For complex pain, she walks through the advanced options agencies should be ready to deploy—subcutaneous pumps, port access, and coordinated protocols—so families know what to demand before a crisis hits. She also clarifies palliative care versus hospice, how Medicare standardizes hospice benefits, and why timelines matter when it comes to preserving meaningful time at home.

Burnout and boundaries get the honest treatment too. Julie names compassion fatigue for what it is—detachment born from unsafe expectations—and shows how to say no with professional courage, using the language of safety to protect licenses, patients, and team culture. For nurses eyeing hospice, she separates myth from reality: hospice requires strong assessment skills and autonomy, and an inpatient hospice start can build confidence before moving into home care. Along the way, we talk about Julie’s book and journal that teach therapeutic communication step by step, and how social media made these conversations more accessible for families everywhere.

If you value candid, compassionate care and want real tools for the hardest conversations, this one’s for you. Listen, share with a colleague or caregiver, and tell us: what honest phrase will you try first? Subscribe, rate, and leave a review to help more people find thoughtful, practical conversations like this.

To submit your stories & comments, visit: https://simplenursing.com/podcast/

SPEAKER_02:

We got a code brown. Welcome to Bedpan Banter. With me, Nurse Mike, the Dead of Nursing. Can I get a Bedpan over here? Welcome back to Bedpan Banter, the official podcast of Simple Nursing, where we talk about the human side of healthcare. I'm your host, Nurse Mike, and today we have a very special guest, Julie McFadden. You may know her as Hospice Nurse Julie with over 4 million followers across your bloodworm. And I think it's the first time we're ever interviewing a New York Times bestseller for books.

SPEAKER_00:

Thanks for having me.

SPEAKER_02:

So you've been a nurse for over 17 years?

SPEAKER_00:

Yeah.

SPEAKER_02:

Wow. And you have most of your experience as an ICU nurse?

SPEAKER_00:

It's like half and half now. So yeah, ICU and then switch to hospice.

SPEAKER_02:

How long have you been in hospice now?

SPEAKER_00:

Oh my gosh. I really need to figure it out. Probably eight, probably eight or nine years. Okay. Yeah.

SPEAKER_02:

All right. So let's talk about your start in the ICU. Did you always know you wanted to do ICU? Or was it?

SPEAKER_00:

No. I mean, I was young. I don't know about what your experience was. Like I was young and full of ego, and I was like really excited about being a nurse and couldn't believe when I finally passed my NCLEX and all the things, right? And I remember Googling like number one hospital in the country.

SPEAKER_01:

Whoa.

SPEAKER_00:

Which was Johns Hopkins at the time.

SPEAKER_01:

Yeah.

SPEAKER_00:

And then I thought being an ICU nurse or an ER nurse were like the baddest, like the best thing to do. So I applied for ICU first and I got that job at that hospital.

SPEAKER_02:

The first out-of-the-gate job.

SPEAKER_00:

Yeah. Yeah. I mean, I feel like back then, I don't know. It seemed like it was easy to like nurses. I I think nurses are always needed. I don't know.

SPEAKER_02:

Well, yeah, they're always needed, but I think there's there's certain time gaps.

SPEAKER_00:

Yeah. I mean, 17 years ago, it felt like easy to get a job. None of us were like, oh, I don't know if we'll get a job. We all were like, and then like all this stuff. Yeah. Uh-huh. Yeah. So that was a long-winded. I didn't know what I wanted. I just wanted to be like the best.

SPEAKER_02:

Yeah. Was it C V ICU or just ICU in general?

SPEAKER_00:

It was surgical ICU at first. And then eventually I went into like surgical trauma ICU at that same hospital. Oh my God. Yeah. So it was soul crushing. Really? Yeah, it was. No, I mean, I had a whole plan, right? After two years, I was gonna go back to school for anesthesia.

SPEAKER_02:

Oh, C RNA, yeah. Yeah.

SPEAKER_00:

And uh, and then after two years, I was like, I don't know what I'm doing. This is so I'm still feel scared. I still feel new. And then even more longer after that, I was like, I don't know if I like this.

SPEAKER_02:

What, like nursing in general?

SPEAKER_00:

Yeah, nursing in general.

SPEAKER_02:

What made you like really think it was it just your patient acuity? Was it patients that weren't getting better necessarily?

SPEAKER_00:

Yeah, I think I mean, like my transition to hospice, because I think initially I was always afraid of like quote unquote like losing my skills, right? Like I didn't want to lose my skill, that's what I thought.

SPEAKER_01:

Yeah.

SPEAKER_00:

Uh but I in the ICU, I just wasn't there were so many amazing things happening. So don't get me wrong. Like the ICU is a beautiful place, it saves many people's lives. It's wonderful. But to me, it always felt like I had to like hurry up, like hurry up, get a bunch of tasks done. Many of them are amazing. A lot of them felt like these like tasky, little punch. Yeah, yeah, yeah, yeah. And it was always like we need you to care a lot. Yeah. But but hurry up.

SPEAKER_02:

Yeah, hurry up, get the stuff going.

SPEAKER_00:

Hurry up and do it, but and hurry up and care. And it was like, oh, I just felt so awful all the time. And then a lot of people were dying too. And then as I was doing this for a long period of time, I could tell that there were certain people that were really sick, but we knew they probably would get better, right? We could they'd get out of the ICU, they would live, they would, we would help them survive. Then there were some that I felt like we kept alive and we all knew we shouldn't be doing this. They're going to die, they're not going to get out of here, but we still did it, and we just weren't talking to the families about like the truth, the reality of what was happening.

SPEAKER_01:

Wow.

SPEAKER_00:

I don't think anyone was like purposely doing it. I think we all just had blinders on. It was like survival at all costs.

SPEAKER_02:

Yeah, just keep them alive.

SPEAKER_00:

Yeah, all the drips, and like on all the drips, all the tubes, all the machines. And I think everyone was kind of like, someone else will make that decision on when when enough is enough. Right? Like it was like passing the buck. Like it, like the pulmonologist won't say it, the the cardiologist won't say it, the like the intensivist, maybe they'll say it. Like maybe someone will eventually say to the family, like, enough is enough.

SPEAKER_02:

Yeah. Have a hard talk.

SPEAKER_00:

Yeah, have that hard talk.

SPEAKER_02:

As a as a nurse, like, does that all fall on you? Because you have to see the families a lot.

SPEAKER_00:

Um, I didn't know who it was gonna fall on. That's what I and I don't know, I'm sure it's not always like this, right? And it might be even different now. And there were times when people would say the hard things, but most of the time they weren't. And that after years of doing that, I was like, someone has to. And and I eventually got confident enough to be the person who would raise my hand during rounds and say, What are we doing? What are we doing? Yeah. I mean, I would say, like, can we get a family meeting together? Right. And of course, everyone kind of knew what that meant. And what I saw was they listened, right? And we would have these family meetings, and then we would talk about what was happening. And then the patient would die. We'd take them off the machines, we'd take them off medications because once the family heard the truth, yeah, they were like, My loved one wouldn't want to live like this. And and so that those experiences in the ICU was what made me start thinking, like, okay, I'm not really happy here, but where else would I be happy? Like, if and in hospice was something I thought about because I was like, we're all gonna die. Yeah, and that's the truth. And if we are, like, there has to be a better way to do it than like what what I'm providing here.

SPEAKER_02:

Yeah, that should be like the best practice on the exit. Because there's best practices on the entrance, right? We have all the Afghar scores and yada yada for the babies, but we and yeah, you're right. There's not a really a cohesive developed plan that's evidence-based. That's like and thank you for you're heading the way on this.

SPEAKER_00:

Yeah, and that's so that's how I transitioned to a hospice nurse. And it still took me a bunch of years, even after that realization, because I was afraid to leave the pos you know, I was used to being an ICU nurse, so I was afraid to leave. So it's still, even after that realization, it took me a long time. But I eventually just took the plunge and became a hospice nurse.

SPEAKER_02:

You were already a hospice nurse, kind of, in a sense, right? Yeah, yeah, yeah. Like a good portion of your job as an ICU nurse, you had those patient populations that were gonna die anyways. So would you say like the big difference in those scenarios is communication and educating people? Because sometimes they don't want to hear it, right?

SPEAKER_00:

I guess or yeah, I mean, I think communication there is a huge difference with dying in the ICU and dying on hospice. Oh, okay. Huge difference. Very, very, very, very, very different. Oh, yeah. So in the ICU, uh, it's usually like they've already been kept alive for quite a long time. So there's a lot of issues there. They're on a bunch of machines and medications. So by the time you take them off of those things, they're dying usually very quickly.

SPEAKER_01:

Oh man. Right?

SPEAKER_00:

So it's like which is like fun, which is okay. I mean, they look different because they've already been pumped full of fluid, they've already been in a hospital bed for six months, they've already have necrotic toes and necrotic fingers and uh necrotic noses sometimes. Oh my god. You know, and they're like so they just look really different. They die quickly and comfortably, but it is quick. And the biggest thing I noticed becoming a I uh a hospice nurse, which was mind-blowing, hence why I said all this stuff, is that that's not how it happens when you die naturally. It takes a while, usually, if you don't come on hospice too late, and your body is built to die, and it helps dehydrate you, it helps put you to sleep. There are so many patients that I've never had to give, and I'm not anti-medication, of course, yeah. Um, but there are so many patients that I didn't have to give any medication to because their body just like naturally dies.

unknown:

Wow.

SPEAKER_00:

And not in pain. Like people always think dying is painful, but diseases you die from can cause pain, which is a symptom, right, of the disease. But dying itself, particularly if you're dying what I would call a natural death, which is like you're dying from something, but you're allowing the body to naturally shut up the system, shut up itself, is not painful. Wow. I know exactly. Like I didn't, even as an ICU nurse, I did not know this. So to see it was like that that first year of hospice nursing, my mind was blown over and over and over again by like the difference. And and to me, it's it was so comforting to know, like, wow, our bodies help us do this. Our bodies are literally built to die.

SPEAKER_02:

Yeah.

SPEAKER_00:

And uh if you allow it to happen, it can be like a very natural, like dare I say, beautiful process.

SPEAKER_02:

Yeah, so that kind of segues or transitions into a lot of the summary that you put in your book between dying in the intensive carina, which sounds intense, right? The entire body looks different, versus dying a natural death and a dignified death or yes. I mean you said a perfect to summarize this, I think it's all about therapy and communications, what you're saying, and collaborative approach, because in the ICU, we want to keep people alive at all costs. And it's up to the advocacy of nurses to stand up and just like you did, bring all the providers and doctors and healthcare practitioners together. What do you think the best way to communicate that for nurses who are maybe might be intimidated in the ICU?

SPEAKER_00:

Well, so what I found was I was speaking the elephant in the room. Like I thought I would speak up and people would go, don't say stuff like that. You know, we're supposed to keep people alive at all costs. And like I, but that's not what anyone said. Everyone was like happy that someone brought it up, right? And I think, again, I don't think anyone, I know no one is purposely not bringing it up, right? I think we all just have blinders on. And like you and I both know, you know, in nursing school, I'm sure, I'm sure there was a part of nursing school about death and dying and how to talk to patients, but I don't remember it because it was very small.

SPEAKER_02:

I did do a five-minute video on it, that's all I'll say. Yeah.

SPEAKER_00:

So, like, and same with medical school. I think, and then you get into the hospitals, we're not talking about it either. We're talking about like what do you do when someone's blood pressure is low? Right. What do you do when someone is in respiratory distress? It's always about like the decision to keep them alive, right? So our brains don't go there. I never was chastised or like told not to do it when I brought it up in the ICU. And after a while, you can tell, you can see, like, oof, this isn't looking good. You know, you know. And everyone's thinking that. And no one just knows who's supposed to say it. So all I all I'm saying is I'm wanting to encourage people, whoever's watching, whether you're a doctor or nurse, or um, you can be the one. You can be the one to speak up for your patients. And it feels weird to advocate for your patient's dying death, right? And that first time I did it, and the first time, the first time I ever did it, and this is actually in my book. Yeah. Um, so the first time I ever like brought it up, the patient died before the end of my shift.

SPEAKER_01:

Wow.

SPEAKER_00:

And I remember going to my car and crying because I remember thinking, like, because of me, it felt like because of me, this patient died.

SPEAKER_01:

Uh, it felt like your fault, yeah.

SPEAKER_00:

And of course, like I knew logically it's not my fault and it was the right thing to do. But it's just that first time you do it, it's a little bit like, oh, wow, wow, I really had the power, is what it felt like. I had the power to speak up, have this meeting. They heard the information, and the family said, We're done.

SPEAKER_01:

Wow.

SPEAKER_00:

And so it was sad, but it also was like, oh, that's what advocating for your patience is. Because to me, death is not the worst possible outcome. Like suffering is far worse. And a lot of times we create a lot of suffering.

SPEAKER_02:

Very true. Working from in the ER, and a lot of our viewers are nursing students and aspire and go to the ERICU or new grad nurses or new nurses. And I think the most practical thing that you've explained in your book, and I even bunny eared it here. Don't mind our little placeholder.

SPEAKER_01:

Yeah.

SPEAKER_02:

But I love this. It's so practical. It shows you the difference between what you're tempted to say, your internal thoughts, and what you should say for therapeutic communication. This is very practical. It's amazing.

SPEAKER_00:

That's what so that is exactly why I so I wrote the book first, and then I would say like six months later, we started with the journal. And I was more excited about the journal because I'm a I'm a big practical girl, right? Like, I want, like, okay, we're supposed to be talking about it. Tell me exactly how.

SPEAKER_01:

Yeah.

SPEAKER_00:

Or tell me what to say, tell me what to do. So the journal was developed to help people like know where to start and know how to do it. And I think what I have found, nine times out of ten, maybe even nine point five times out of ten, people are relieved that someone's willing to say the hard thing.

SPEAKER_01:

Oh wow.

SPEAKER_00:

People are not like, don't say that. People are like, finally, someone's willing and not afraid to say death, dying, dead. Here's how long we think your loved one has. The more, the more, you know, you can deliver it with kindness and compassion. But the the more um direct I am, the more relief I see on people's faces. Because people want, even if it is still an illusion, but like control. And they have more control when they know what the heck, can we swear?

SPEAKER_02:

Yeah, no, but yeah, what the hell's going on?

SPEAKER_00:

Yeah, what the hell's going on, right? What the hell's going on? And you'll learn over time. You'll learn over time. I wasn't, and you're gonna mess up, right? You're going to mess up. You're going to get people who get mad at you sometimes. But it's like when you know what you're trying to do, when you know the the the reality of the situation, um, you'll get better and better at it as time goes on. So you just gotta practice, you gotta do it.

SPEAKER_02:

It's just like any skill, I guess. And yeah, and I think that's that's the hardest part about uh being a nurse is just knowing that you're not dumb, you're just new. Yeah, you know, that's your first time doing stuff, and that's okay. There's always first timers, like even if you've been a nurse for a decade. So before we get into the book, uh let's talk about the journal. Who is the journal? Who is it written for? Was it written for the family, for the practitioner, for the nurses?

SPEAKER_00:

I think, I mean, of course, I'm saying of course I'm saying this right. I want to say it's for everyone, right? But it to me, it is for everyone. The book and the journal are for everyone because we are all dying. So it is not just for nurses or doctors or people dying, which is all of us, but it really is meant for anyone who wants to get comfortable through education about what dying is like to an ext-ish, right? I mean, uh, I really don't talk about like what dying is like from a car accident, right? It's more about like uh if you have some kind of terminal illness, learning about that kind of death. And same with the journal. So it's really for anyone who wants to increase their knowledge. So if you were, if it's mostly nurses who listen, I would say any nurse who is curious about what where they want to start working, or if they want to switch into hospice, or if you're an ICU nurse and you want to know more about death and dying. I mean, to me, this would have been invaluable when I when I was an ICU nurse. It would have blown my mind.

SPEAKER_02:

Yeah.

SPEAKER_00:

Because it blew my mind becoming a hospice nurse. I was like, what is this?

SPEAKER_02:

And I think it blows my mind because like no one talks about this. No, there's no educational workshops, there's not a lot of YouTube videos, not even a textbook.

SPEAKER_00:

Uh my YouTube videos, hey.

SPEAKER_02:

Hey, there you go. Right?

SPEAKER_00:

I mean, I know. I mean, yeah, that's that's the thing, is that's why I started becoming so so passionate about it because I was like, how have I been a nurse for almost a decade and I didn't know this stuff, right? So in and dying, I I hate to keep saying dying is beautiful because I get the sadness around it.

SPEAKER_02:

I understand, yes. But I mean life is sad in general, and you know, you have to enjoy the good times and the bad.

SPEAKER_00:

Yes. And the fact that like our body is literally physically built to do it was just so fascinating to me.

SPEAKER_02:

But I think that that's a beautiful part. Once I mean I'm very spiritual on one side where I'm just like, you know what, you came to Earth to do a mission, and once you've done the mission, you know, you it's been a good run. And when it's your time, it's your time, you know.

SPEAKER_00:

To me, I feel like knowing the truth of your quote unquote fate, right? Let's say you have some terminal unless and is in you're at the end of this, right? Whether no matter what you do, you know, that's at the end. Wouldn't you want to know that? So you if you have six months or left to live, wouldn't you want to know so you could live out the rest of your life actually and do what you want to do?

SPEAKER_02:

Um, it's almost like if an oncologist, doctor, or provider would be like, Hey, you have cancer, and they didn't tell you how long you had to live. I would want to know, like, hey, you have six months. I'm like, okay, I'm gonna reorganize my life.

SPEAKER_00:

And this idea of people going and providers, again, I never want to sound like I'm like calling people out, but here's what I'll say.

SPEAKER_02:

But it's the truth.

SPEAKER_00:

Here's what I'll say. People who say, We never really know. Yeah, I want to go. You kind of freaking do. If you are an oncologist who's been dealing with this type of cancer for 25 years and you know the treatment, you know where they're at, you kind of do.

SPEAKER_02:

You know the stats.

SPEAKER_00:

You know the stats. And yes, I do think if there is a standard treatment, you should do it, right? If there's a particular surgery plus chemo plus radiation, it's going to extend your life seven years, yes, do it. But when the when when the time keeps coming where you know as a provider, because you've seen this over and over and over again, hey, they are looking like they've got about six months left to live. Yeah, I think we need to be a little more blunt about that because all people hear when you say you have about six months left to live, but we could try this one treatment maybe they hear that we can try that one treatment, maybe.

SPEAKER_01:

Yeah.

SPEAKER_00:

And I and I don't blame you for saying that. I don't blame them for wanting that. But I think I just see so many people missing out on those last few months of life because no one's willing to really give it to them like that.

SPEAKER_01:

Yeah.

SPEAKER_00:

Like and like that is you have probably six months left to live, no matter what we do. How do you want to live your life? And I think most people would say at home with my family.

SPEAKER_02:

Yeah, that's it. Reminds me a lot of my grandma. She had pancreatic cancer, which is one of the worst cancers to have in terms of um the duration of life. And I think they only gave her like less than a year. Uh she lasted a little bit longer, but it was a lot easier transition. Uh I think she was at home for the majority of that time. Yeah. And my uncle's a doctor, obviously I'm a nurse. And it was a lot easier for us. But can you explain, just in uh layman terms, what does a good death, like a good death, look like from a hospice perspective?

SPEAKER_00:

Okay, from a hospice perspective, yeah. So because what I was going to say was a good death is like whatever you as the person dying would want it to be. I don't want to say like if you don't want a death at home surrounded by loved ones, then that wouldn't be a good death to you, right? So it so it is like whatever the person wants. But I think um a good death for me as a hospice nurse is someone who is dying as they want to, right? So let's say they want to be home with loved ones. They have spoken honestly about how they feel about this, where they're at with the fact that they're dying, even if the truth is I'm angry and I don't want to die, that it that will give you a better death. There is something about speaking the truth. So anyone who's willing to speak the truth of what's happening, just get off your chest.

SPEAKER_02:

What's good, bad, or ugly. Yes. Would you say that that's what people fear the most about dying, or is it just being honest with themselves, honest with their family?

SPEAKER_00:

Or what do people fear the most if in your I think they just fear the c uh the unknown. I mean, death is like the ultimate unknown, right? So most people fear that, you know, they fear fear itself.

SPEAKER_02:

Yeah.

SPEAKER_00:

Fear, fear, fear dying, because they don't know what it's going to be like. And hence why, as a hospice nurse, and again, it's a little easier for me because they know why I'm there.

SPEAKER_01:

Yeah, right.

SPEAKER_00:

So there's already this like preload of yeah, yeah, I'm not the one breaking the news, right? I would be though, I would. That's so just so everyone knows. Like if I had to, I would.

SPEAKER_02:

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SPEAKER_00:

What I found was when I'd go speak to patients, right? And and I would openly start talking to them about like, here's what you can expect at the end of life. Here, here's what you can expect with your end of life journey, with your specific disease you have.

SPEAKER_02:

Is there like a um step-by-step protocol that's generalized?

SPEAKER_00:

Yeah, that's generalized, yes. And and not, and I um I love talking about it, oddly enough. So, so I'm like a nurse who's like coming in there and being like, listen, I'm gonna tell you all the things because I know I would want to know all the things, right? And even with specific diseases, people people generally die the same. Yeah, but specific diseases you can kind of tell, you can expect this, you can expect this, you can expect this. And my point to saying all that is is that helps alleviate some of the fear because it takes out some of the unknown. Yes, some of the unknown.

SPEAKER_02:

So just explain. So if we were to put it down on our bullet point list, explaining the disease process, what's happening to the body. Yep. What's next? Is it like making what would you say, communication with their loved ones? Yes, and that's maybe people doing like, I don't know, getting their house in order.

SPEAKER_00:

Yes. So it's I never hit them with that stuff. Okay. The first visit where first it's about the disease process. Well, let's explain your disease process and what death and dying and how your body's going to help you die. Right.

unknown:

Wow.

SPEAKER_00:

Which is crazy to think. In the in the last six months of life, you're likely going to be less social.

SPEAKER_02:

Right.

SPEAKER_00:

You're gonna kind of like concun. Like your body is going to make you be like, I'm gonna be uh a little less active. Right. I'm not gonna be as hungry or thirsty. I'm gonna probably sleep a little more. I might be a little less social.

SPEAKER_02:

It's like Maslow's, you're focused on physiology.

SPEAKER_00:

Yes. So then, and then your body will slowly just keep doing that more and more. Eating and drinking less. You do not feel hungry, sleeping a lot more, getting a little harder to do the everyday things, right? So you do lose independence. There is difficulty there, right? Because you're you're used to being able to do whatever you want to do and you won't be able to do that anymore, which is hard. But that is the main things you're going to see. And I always tell people to focus on like if they're caring for their loved one who's dying, they should focus on am I are they clean, are they safe, and are they comfortable? And if they are, what what are we gonna do the rest of the day, right? Like that that's it. Yeah, and then the person dying just focuses on how they feel and doing what they want. And if they're comfortable, like okay. If they want to sleep, sleep. If they don't want to sleep, don't sleep. Whatever they want to do that day is what they should do.

SPEAKER_02:

Do you think that's this is the reason why people watch you a lot uh on social media? Is it is it family, is it nurses, is it both? Oh my gosh, vacation.

SPEAKER_00:

Right. The social media thing. First off, I was so surprised that it blew up. And it really did blow up like overnight. I had no um, I didn't think about it, I didn't plan. You should see some of my first videos.

SPEAKER_02:

This came out of the oh yeah.

SPEAKER_00:

My first videos are so bad. It's like in the barely almost like in the middle of the night in my room, being like, hey guys, me in my phone. And how it happened was after a few years of being a hospice nurse, again, I was super into it. A couple of my very good friends, their um their parents got sick and were dying. And I was sort of rattling off all the things I knew about death and dying to them. And they were like, How have we known you for so many years? And like, we didn't know that you knew this stuff. And it's because, like at dinner parties, you say you're a hospice nurse, people in real life are like, oh, or like I know we don't want to talk about this. This is uncomfortable. So I just never assumed people would want to talk about it, right? But these two friends of mine were like, You gotta do something with this, you need to like start talking about this, people need to know about this. And then I saw my nieces who were tweens and they were on TikTok, and I got on TikTok just to watch them do their dances, literally. Like, that's the only thing I was that's the reason you joined TikTok. Yes, I that's the reason I joined TikTok. And then once I started watching TikTok, I saw people like my age. I'm I was almost 40 at the time, like talking about like space and gardening and stuff. I was like, oh my gosh, there's like people my age on here. So I recorded like three or four videos again in my bedroom, just being like bada bada bada bada about death and dying. And the fourth one in like went viral. I had like 10,000 followers overnight, a hundred thousand followers in a month, a million in a year.

SPEAKER_02:

Oh my gardens. Right?

SPEAKER_00:

And then it went to Instagram, YouTube, Facebook, Facebook, you know, and then the book deal. So my whole point to saying all that is I think people do want to know. We always say we don't want to know, or people don't want to talk about it, but I feel like my social media is evidence that this is something people want to talk about and learn about. And maybe because it's not real life, like on like a screen that they're watching, yeah, right, and maybe a little easier to take in.

SPEAKER_02:

Yeah, maybe more palatable. Yeah, yeah. We're gonna make you into a cartoon, which would be real easy. Okay. How would they add? Yeah. No, but I think that uh the climate and the culture that we're in, we have such curiosity about everything. So it's natural, right? That we would naturally be curious about death. All right, let's move into some QA's here from your followers. What do you do in the final days when the patient's pain is more difficult to manage?

SPEAKER_00:

Okay, so two things there. When someone's in their quote unquote final days, it doesn't necessarily mean they're going to be in more pain. So that's a big big myth that like dying equals pain. The closer they are to death, they're they're gonna need more meds because they're more in pain, right? So one, know that that not everyone dying is going to be in pain, and not everyone getting closer to death will have pain increase.

SPEAKER_02:

Wow, because I always thought that pain increase as death was imminent. Yeah. Interesting.

SPEAKER_00:

It can. I mean, it can depending on the disease, but usually it's like if they've had pain all along the way and it's been getting worse and worse and worse and worse and worse, then maybe yes. But if it's if it hasn't been, then it's not going to suddenly become a problem. The second, let's just say it is though. Okay, let's say it is. That's when the hospice company needs to step it up. And really, families and patients need to ask their hospice company prior to coming on to hospice, how do you manage difficult cases? Not everyone's gonna need a couple drops of morphine. Some people were already gonna come on to service with, you know, um, fentanyl and diluted and a bunch of things to manage pain, right? And if you're already coming on to hospice knowing you have a lot of pain, that hospice company needs to say to you, we can do, we can do cad pumps, which is basically like sub Q needles.

SPEAKER_02:

Okay.

SPEAKER_00:

Um we can you we can access your central line or your port. We can um, they just need to have like a plan on what to do. If they if you already know, hey, I already have pain, that's pretty complicated. What are you guys gonna do when things get out of hand? And if they can't really answer, they give you a typical answer like, well, we have morphine. It's like, no, that's not that's not we need they need to be um and some hospices are better than others, obviously. Some are equipped with all the stuff and some aren't. So that's stuff you have to ask ahead of time.

SPEAKER_02:

I see. And who do you advocate to? Is it the provider?

SPEAKER_00:

Is that the hospice company itself, or is it it's uh the yeah, as if you're the person advocating or you're the nurse advocating, you need to talk to the doctor and you need to talk to the administrators. Got it. And sometimes there's nothing you can do, but sometimes you can be the very, very squeaky wheel. I definitely, this is in my book. There's there's times when I have like had just had it, you know, and I just, I mean, don't yell, don't scream and yell at work. But every once in a while, I'm sure nurses understand where it's like you've hit your max and you're like, no one's listening to me. Yeah, I'm the person here, I'm the person watching this person suffer.

SPEAKER_02:

Yeah.

SPEAKER_00:

This is what they need.

SPEAKER_02:

This is my patient. I need to stand up for them.

SPEAKER_00:

Yes, yes. And and most of the time, hospice companies will will eventually do it, but sometimes they're just not equipped to, right? So that's the stuff you have to kind of know if you're a patient or a family member, what the hospice company will and won't provide. Um, as a hospice nurse, you want to work for a hospice company that is like an elevated one that can do steps if pain's not controlled.

SPEAKER_02:

All right. So last and final question, but a big question here, especially for a lot of our newer nurses, um, or soon to be. How do you cope with compassion fatigue? And what the heck is compassion fatigue?

SPEAKER_00:

All right, yes. I definitely have dealt with compassion fatigue where I feel detached, you know, from my job. I don't feel um, I I don't know if I wouldn't say I didn't feel compassion for my patients and like who I was working with.

SPEAKER_02:

Lack of empathy, maybe?

SPEAKER_00:

But lack of empathy and like detached. Yeah, it was a little like robot ish, right? And or like I used to always say, like, oh, I'm dead inside.

SPEAKER_02:

What do you think are the steps that lit led up to that?

SPEAKER_00:

Not listening to myself. In terms of burnout, or yeah, like like not working in a place that was conducive to my mental health. I mean, some hospitals are better than others. I it was really hard to take PTO. It was really looked down upon to like take a mental health day. I mean, never would you ever, right? Like if you were asked to stay over, you stayed over, you know. There was No, there was no like, yeah, there was no no, I can't tonight. Never. So, and that was because of where I worked, and because I was a new nurse, and that was the culture of the unit, right? And once I got older and wiser, right, and switched to hospice, there was still when I was full-time, there was still that like you take you take the extra patient because if you don't, the patient will suffer. If you don't, this nurse has to do it, you know. So it's that's the culture of nursing, I feel like, at times, right?

SPEAKER_01:

Yeah.

SPEAKER_00:

And what I've learned over the years is to be confident enough to say no and to work for companies and places where you can say no. One, that's why I'm a big union girl. Because when you're unionized, you can say no and they can't do anything about it. Um, and I will say, you know, I have been the one I have been the one to kind of like spearhead the the culture in the unit. I would say no. And the people would come back and go, Well, if you don't, then so-and-so has to do it. And then I'll say, which okay, this is gonna sound bad, but I will go, okay. Yeah, then they can do it.

SPEAKER_02:

That's that's the number one rule of um what is it called? Emergency medicine, working on the ambulance as a feramed. They said, your number one thing is personal protection and personal safety. Yes. Because you don't want to have two patients. All right. You and now the patient.

SPEAKER_00:

Yes.

SPEAKER_02:

Because if you overload yourself, and then it looks right.

SPEAKER_00:

So then it creates this culture of like, well, what the heck? Julie didn't do it, so now I have to do it. But then they learn.

SPEAKER_02:

Yeah.

SPEAKER_00:

Then I say no. And guess whose problem it is? The administrator's problem. And then people go, but then the patient, right?

SPEAKER_02:

Well, we need more funding. But we need to more staff.

SPEAKER_00:

This is not, this doesn't need to fall on the back of me. Yeah, exactly. And this doesn't need to fall on the back of nurses. It is unfair, I agree. And and patients should shouldn't suffer. I agree. But we are just as important, and I have learned that I am just as important as anybody else, including the patient. And in order for me to be a good nurse and to not have compassion fatigue and not have resentment for the person that I'm going to see that I didn't really want to go see because I didn't have the the time or the space to do it.

SPEAKER_02:

Or the resources, yeah.

SPEAKER_00:

Or the resources, that person's suffering now too, because now they're getting a nurse who's burnt out and has compassion fatigue, right? So it stops at us, and there's easier places to do it than you know, like it's easier for me now because I'm old, I'm older, I'm wiser, I've been doing it for long enough, and I'm a unionized nurse in California, period.

SPEAKER_02:

Yeah, yeah.

SPEAKER_00:

Um, right.

SPEAKER_02:

But like I mean, to that point, it's like you're only one person.

SPEAKER_00:

Yes. Yes.

SPEAKER_02:

There's always gonna be the next patient. Yes. You can't do a hundred, and if you do a hundred, you can't do 200. Right. If you do 200, you can't do 500. Yes. I worked in nine different emergency rooms, some bigger than others. And think about it. If we had 10 beds, we had 10 beds.

SPEAKER_00:

Yep.

SPEAKER_02:

We can make maybe three, but you can't make a hundred.

SPEAKER_00:

No, and you're allowed to you are uh, and it's gonna feel like you can't say no. It is, it's gonna feel like you need to say no. There's always there's always something else. And there probably are certain cultures where like you actually have you can't actually say no, right?

SPEAKER_01:

Yeah, but you really can't place, yeah.

SPEAKER_00:

Right. Um, but generally speaking, that's what I implore everyone to do is to get confident enough to go, I can't, you know, no, I can't. And guess what they'll listen to? It it's unsafe. This is unsafe.

SPEAKER_02:

That's the number one rule on the Netflix.

SPEAKER_00:

This is unsafe. I don't feel comfortable with this. This is unsafe.

SPEAKER_02:

Protect your license, yes, yeah, and protect your patients and protect yourself.

SPEAKER_00:

Yes, yes, yes, yes. And that's the biggest thing I've learned, and I'm so grateful I learned it. And I'll preach it if you couldn't tell till high heaven.

SPEAKER_02:

I love it. I love it. What's one myth about hospice nursing that you wish every nurse or really the general public understood?

SPEAKER_00:

Oh man.

SPEAKER_02:

There's a lot.

SPEAKER_00:

There's so many. Um, one myth about hospice nursing. I think if you're a nurse watching this, one myth is that like you'll lose all your skills, and it's like what you should do when you're about to retire. It's definitely a different skill set, but that's not the reality. You should be an experienced nurse. Yeah. To be an hospice nurse. Yes, because you're alone. You go to people's homes, so you're in your you're working out of your car, you have to make decisions on your own. Of course, you call the doctor and get the orders, right? But like you are the person that has to know what the heck is going on. So for me, like the ICU background was so good because I kind of knew what we would do if they weren't on hospice, right? Or if like they weren't dying, I would know. So I knew that side of it. So then I could be, I feel like it made me a really good hospice nurse. So you do have I think you should have experience before you go into hospice.

SPEAKER_02:

Oh, for sure. It sounds like it. Yeah. Um, so what's the big difference between palliative care and hospice?

SPEAKER_00:

Palliative care is a symptom management program. Okay. Generally speaking. Okay, I'm being very general here, but only because only because it would take a long time to actually explain the both, right? Explain both of them. But basically, palliative care is a symptom management program. I think anyone with like a life-limiting illness should be on palliative care.

SPEAKER_02:

What's an example?

SPEAKER_00:

Uh, like if you got diagnosed with cancer and you are receiving um chemo radiation and you had a surgery, right? I think palliative care would be a great factor in there because they would help with the symptoms of the disease or the symptoms of the treatment for the disease, right? So someone who's like in a lot of pain or has a lot of nausea or vomiting, they could be on palliative care and they would kind of look at them as a whole and help manage those symptoms so they don't spend a million hours in the ER. Right.

SPEAKER_02:

Oh, that would be the worst. Like we see, I see it a lot.

SPEAKER_00:

You see it all the time. And where hospice is truly end of life. You have to have a doctor say, um, you have less than six months to live.

SPEAKER_02:

Is it the six-month window or more?

SPEAKER_00:

It's six-month window.

SPEAKER_02:

Okay.

SPEAKER_00:

Now you can live longer than six months. People often do, and you can stay on hospice. But uh technically you have to prove that you have less than six months to live. And the other big thing is that hospice is always funded by Medicare.

SPEAKER_01:

Really?

SPEAKER_00:

Yes. Unless it's a hospice that somehow like collects donations and like they don't work off Medicare, but very few and far between do that. Most of them are all Medicare driven, which means Medicare is our boss, which also means all hospices should be operating the same.

SPEAKER_02:

Got it. Like standard of care.

SPEAKER_00:

Whereas palliative is a little different. It can depends on what hospital you're at or who's who uh is doing the palliative care.

SPEAKER_02:

So big question here. Would you recommend that a new grad right out the gate go into hospice immediately?

SPEAKER_00:

Here's what I'll say. I never want, I never want to say no because I get if you have a real passion for it, I want people to do what they're passionate about. If you are a new grad and you're thinking about starting off right into hospice, I would always, with like 100% certainty, you have to do this. Do an inpatient hospice care. So there are inpatient hospices where like it's like a hospice home where there's 10 patients at a time and they're all hospice patients. Okay. So you're still working at a place with other hospice nurses, doctors there, so you can hear them talking about things, you can see what they're all doing. Um, so you can learn on the job that way. Because I think when you're a new nurse and new grad, learning on the job. I know for me, the first six months of being an ICU nurse, I dreamt every single night of like beeping and like things going on. And I had a preceptor who followed me around for six months, right? And you really, really need that. And as a new hospice nurse, if you were going in people's homes, you're alone all the time. You're alone all the time. And you would really only get like a couple a couple months, maybe with a preceptor.

SPEAKER_01:

With a preceptor.

SPEAKER_00:

So you really need to know your stuff to do it. So if you're gonna do that, I think you I think it's doable, but I would do an inpatient hospice.

SPEAKER_02:

That makes a lot of sense. I think that humans learn the best by modeling behavior. Yes. I can see with my brother's little kids, the toddlers, that everything you say is like like little parrots. But I think that's the same way as learning anything new, like a new grad.

SPEAKER_00:

So and you'd have to be comfortable with seeing someone die, right? Like and if you're not used to that, you could be a little bit like, is this right? Is this okay? Right? But and so you'd have to that's why I think it's important to have experience. Now, if you already have a couple years' experience and you're like, I'm sick of this. Nurses, are you guys listening to me? Listen up, learn from me. Like you are a nurse, you are needed everywhere. Don't be afraid to make changes. Like, I was so afraid to leave the ICU, even though it was like literally killing me. It felt like it was like killing my soul. I hated it so much. I still stayed for like years. Really?

SPEAKER_02:

It sounds like a bad relationship.

SPEAKER_00:

I know, right? So don't do what I did. Move around. Like you can do it, move around. So if you have been a nurse in med surge or ICU or the ER for a couple of years, and you're thinking maybe I want to transition, hospice is a beautiful place to go. And definitely a couple years of experience somewhere else is definitely enough. And you just gotta take that plunge. That's all I did. I literally applied for a job that said, must have hospice nurse experience. I did not. I did not, and I applied, and I basically, like, in the interview, like begged them. I was like, I know I don't have experience, but I really want to do this, blah, blah, blah, blah. And they gave it to me, you know.

SPEAKER_02:

I mean, new grad nurses, listen up, apply for everything, even if they say you have that need experience.

SPEAKER_00:

Yeah, and I always recommend nurses doing like agency nurses, nursing, travel nursing. I mean, there's just ways to nurse. Like, I always say, like, work, work smarter, not harder. I mean, I put in a bunch of like hard work in those first couple years. And then, like, after that, I was like, How can I how can I help people but also make money, but also have good work-life balance? And you can make nursing work for you. You can find your niche to to have the life you want and the job you want. I mean, I truly am like the happiest I've ever been. And the whole hospice nurse hospice nurse Julie thing has been amazing and like uh icing on the cake. But even before that, becoming a per diem nurse where I could like make my own hours, do what I want, but still, but still nurse, still have a good life. It's been so beautiful. And like any nurse could have that. You know, you just gotta figure out what you want.

SPEAKER_02:

And then it's the beauty of nursing. You can do almost anything with any department. I was supposed to be a physician assistant before or PA. And sometimes you're just specialized into one area and you can't move around as much. So nursing is amazing in terms of adaptability. All right, guys, that wraps up our podcast for today. With Nurse Julie here. Her book, Nothing to Fear, you guys can get on Amazon. You also can get it on Barnes Nobles, Walmart, but I think Amazon's probably the easiest.

SPEAKER_00:

Probably the easiest.

SPEAKER_02:

Are you gonna come out with a side note? Are you gonna come out with an audiobook?

SPEAKER_00:

It's already out, and I and I recorded it. It's my voice. I love audiobooks.

SPEAKER_02:

If you can see it from my face. Where can our viewers, listeners find you on social media?

SPEAKER_00:

You can find me anywhere you get social media at Hospice Nurse Julie.

unknown:

I love it.

SPEAKER_02:

Well, thanks so much for coming on the show. I can't wait till the next episode. Um hopefully we're doing this again, and your next book. So, again, thanks so much for watching and listening to Bedpan Banter. And as always, don't let the Bedpan spike.

unknown:

Woo!