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The Toronto Sun CareerConnection


The toughest nursing job

By Susan Poizner
Special to The Toronto Sun

Nursing is a tough job. Consider the pressure on the RN working in intensive care or a trauma unit. And then there's the palliative care nurse, surely the toughest job of all and, until recently, one for which there was little training.

In fact, it's only been three years since Humber College introduced its palliative care program for nurses, one of only a few available anywhere.

Sylvia Segal, co-ordinator in the Continuing Education program for nurses at Humber, says the course has been taught exclusively online for the last two years. Before that nurses had to arrange their schedules around classroom lectures.

This year there are 10 to 12 nurses signed up, and Segal expects that to double in 2005.

"There's a definite need for educating palliative care nurses," she says. But it seems there'll never be enough of them because emotional exhaustion forces many out of the field.

"There's a high burnout rate," says Segal. "You lose some of yourself when each one of them (the patient) dies."

The program takes about two years on average to finish, and tends to attract nurses who have already gained practical experience in other areas such as intensive care and geriatrics where death is not a constant but never far away.

As well as the course itself, students also have to complete an unpaid 120-hour practicum in a setting of their choice. Segal says Casey House, the AIDS hospice in Toronto, is one place where many of her nurses work to meet that requirement.
Sylvia Segal
Humber College

Subjects covered in the program are the philosophy, history and practice of palliative care; pain control and symptom management; and death, dying and bereavement.

Tuition is about $3,100, although the Registered Nurses Association of Ontario offers some financial help.

Earning the Humber certificate doesn't mean more pay. Palliative care nurses receive the same or similar salaries to those working in maternity or orthopedics or anywhere else.

One of Segal's students, Maria Rugg, has been a nurse for 15 years and works as a palliative care nurse-practitioner at Toronto's Hospital for Sick Children. She says the loss of a "pseudo-grandparent" when she was an adolescent was one reason she was drawn to palliative care nursing; another was a desire to help families cope with watching a child die.

"The dying process needs to be more like the living process," Rugg says, explaining how she thinks

palliative care nurses can bring about change and improvement for their charges.


Rugg concedes that for the untrained observer pediatric palliative care is "unfathomable." And, further, that her job can be heartbreaking.

"I have hard days. I have days when I don't want to do this anymore. It's too sad," she says. Still, on balance, there are more good days than bad, says Rugg, who suggests that nurses contemplating a move into palliative care should show "a willingness to be comfortable with the uncomfortable."

One of Rugg's colleagues is Josie Barbieri-Tacoma, a palliative care nurse at Toronto East General Hospital.

She says she knew within the first five years of her nursing career -- she's worked at the Don Jail, the Wellesley Hospital, in mental health and as a community nurse -- that she was interested in palliative care.

Part of that was personal. Although no one close to her died when she was growing up, thanks to her Italian background death was discussed frankly, something that's not common to all cultures, she points out.

Barbieri-Tacoma enrolled in the Humber program because those she worked with frequently asked her questions about palliative care -- as if she knew, she says.

Now she does. They, and her patients -- and Rugg's -- must be grateful.

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