Hospice nurse Cheryl Showard reflects on her profession and promotion

There’s no question that Delaware Hospice’s new care manager for Sussex County, Cheryl Showard, has been fortunate to have chosen a profession that suits her perfectly - hospice nursing.

Before moving to Delaware Hospice, Showard served in many nursing roles, including medical surgical, critical care, hospital units and private practice.  She said, “Looking back, it seems to me that regular nursing was always more technical.  You spent more time following orders, seeing that IVs were running, checking blood sugar levels and following a strictly regimented schedule.  When someone had a problem, there was never enough time to stop, listen thoughtfully and find a remedy for the situation.”

Hospice care is multidisciplinary in its approach, which Showard finds particularly important.  “I have found hospice nursing to be truly holistic in every sense.  We address every part of the person and the family with enough time to really listen.  We serve on a great team, freely calling the medical director, social worker, chaplain or nursing aide whenever appropriate.  Everyone is very responsive, and it’s quite satisfying.”

Since joining Delaware Hospice in 2004, Showard has traveled to every area of Sussex County.  “I think I’ve been on every back road there is.  I’ve learned that when you turn on a remote, dirt road, it doesn’t always mean it’s a driveway,” she said.

Originally hired as a case manager visiting homes, Showard moved in 2007 to team leader for the Delaware Hospice Center to help prepare for its 2008 opening.  During that interim period, she was instrumental in hiring staff, developing inpatient policies and putting them into place and overseeing the intense education needed by the medical professionals for that high level of hospice care.   Then, in September 2009, when she needed a more flexible schedule for personal reasons, Showard went back on the road visiting patients’ homes.

Asked how she handles an initial visit to a home, Showard answered, “You knock on the door and listen for barking. Seriously, when you meet someone for the first time, you need to find out where they are in their journey.  You can’t make any assumptions that people understand their disease or that they understand where they are in their disease progression.

“As we talk, I ask them to tell me about what’s happening with them. I’ve discovered, sadly, that people find it unusual for a healthcare professional to ask something like that. It really shouldn’t be near the end of a disease that someone’s found the time to sit back and listen to the patients and families.   I ask about their symptoms, how they feel about their situation or how they’ve gotten here.

“From there, I try to find out what’s most important to them.  It might not be the symptoms. It might be the ability to enjoy family meals. Perhaps they don’t want their pain controlled to the point that they’re too lethargic to enjoy the company of others.”

She added, “Sometimes a patient’s goal might be for us to help the caregiver let go. I’ve heard: ‘She wants me to get up every day and eat a full meal. She believes that if I exercise, I’ll get stronger.’ In private, that person will look at me and say, ‘You know that’s not going to happen. I’m OK with that, but I’m worried about her.’ With the knowledge shared in these private conversations, we might call in a social worker or chaplain, or maybe early bereavement for that family member and try to bring them around to what’s going on. Ideally, the family member and the patient will then be able to have some open dialogue, and the patient can find the peace of knowing that the family member is going to be OK.”

Showard opted to take the exam for professional certification in hospice and palliative nursing.  “This is an all-encompassing, very in-depth clinically, difficult exam. In addition to clinical areas, there are Medicare-based questions, billing questions and questions on admission criteria. It was quite tough. The benefits are that you gain knowledge and confidence, and you gain credibility with other medical professionals. If you are looking for a physician, you prefer a board-certified physician in that field. The Certification in Hospice and Palliative Nursing indicates a similar level of expertise.”

Showard was promoted to be Delaware Hospice’s care manager for Sussex County this month. She said, “I’ve worked in many positions over the years, but hospice is clearly my passion. I love bedside nursing, but I also love the opportunity to mentor and teach other nurses.  My new care manager role seems to be custom-made for me, combining a leadership role with a continued presence in patients’ homes."

Showard discussed her passion for mentoring other nurses.  “Nursing in general is a difficult, challenging job.  We go into the nursing profession with an idealistic view of wanting to help people. Few enter this profession for the money or the glory.  We go into it in a helping mind-set. However, once established in a professional role, nurses are so often overworked, understaffed, buried in bureaucracy, unable from a nursing level to effect change or be an effective patient advocate.  Burnout rates are high, and people leave this honorable profession to seek other careers.”

As a hospice nurse mentor, Showard strives to show nurses ways to effect change and to be positive influences on patients and families as well as to achieve personal satisfaction. She said, “For example, I tell them not to miss the little things that are so meaningful, or to find coping mechanisms for the high stress level that goes with the job.  Being able to have a balanced life and leave work behind is so important, and nurses struggle with that. We are not shuffling papers; we are dealing with real people and families. It’s not easy to go home and not worry about the person you saw at 1 that afternoon. I try to teach that important skill of setting boundaries. I remind them that at Delaware Hospice we are a team, and we have as good a quality of care on the night shift as we do on the day shift.”

The greatest payback for Cheryl is the sense of satisfaction.  “I will never, ever be able to give as much as I get from this work - achieving comfort for someone who’s been dealing with pain for a year; allowing the patient the opportunity to openly and honestly discuss their situation.  Before we come in, there is hopelessness.  Delaware Hospice’s care team brings hope.  Hope for a good day. Hope for another good memory. Hope for a peaceful future for their loved ones.”

For more information about Delaware Hospice’s programs and services, upcoming events, or employment opportunities, call 800-838-9800 or go to  www.delawarehospice.org.