|Author: Esther Martin|
|A Love for Teaching & Nursing|
|"I love nursing and teaching nursing," says Kathy Hager, ARNP, CDE, CHPN, a professor of nursing at Jefferson Community College in Louisville, KY. "I love the questions the students ask. Their questions make us find answers we would not otherwise have thought to [seek]. Without students, the rest of us would soon grow stale."
Hager realized how much she loved teaching in the 1970s, when she became a faculty member at Norton School of Nursing in Louisville after working for just one year as a staff nurse at the University of Kentucky Medical Center. She also sensed something else, however: "I realized as I taught that I did not know enough." Hager wanted to supplement her clinical knowledge. "When Norton closed its doors along with all the other diploma schools in Kentucky, I decided to continue both my education and experience in the field before returning to teaching again."
After earning her master's degree in nursing, Hager worked as a home healthcare nurse and later as a nurse educator at Jewish Hospital in Shelbyville, KY. As nurse educator, Hager worked with diabetic, heart and lung patients as well as other patients with long-term illnesses, giving them their discharge instructions and making sure they understood their follow-up care plans. She also told patients what they could expect to experience when they went home. Hager then returned to teaching, assuming her present position at Jefferson Community College.
"When I first taught as a young nurse at Norton, I did not have the confidence I have now," she says. "Although I feel I can never know enough and I am always ready to learn more, there are several areas in which I now feel confident. These areas are diabetic care and end-of-life issues. In these areas, I feel I have something really worthwhile to pass on to aspiring nurses. It is a very pleasurable feeling to be able to pass along the knowledge I have acquired and I truly love my work.
"The community college has a wide range of student ages, from recent high-school graduates to returning adults," explains Hager. "We recently had a 55-year-old nun who came to us to learn about end-of-life issues so that she could help care for her sisters as they aged. There is great diversity among our student body. Some students come to us having completed their GEDs, and some are students for whom English is a second language. Community colleges are set up in such a way as to make continuing education possible for people who may otherwise not have that opportunity. This is one of the aspects of the work that I find most rewarding. Even with the challenges they may have in their lives, our students so often surpass any goal we may set for them. It is inspiring to witness what the students accomplish through their dedication and determination.
"The community college attitude is that our job is to help our students succeed. Not everyone is equally qualified for success, but a faculty member can make a difference in a person's ability to succeed and we all try our best to make that difference for our students." As professor of nursing, Hager's responsibilities include teaching Fundamentals in Nursing and Advanced Medical-Surgical Nursing. In addition, she advises students and is involved with continuing education, community service, professional development and instructional services. She is the administrator for the Jefferson Community College Continuing Education Providership with the Kentucky Board of Nursing, and served as chair of the Kentucky Nurses Association Nurse Practice Cabinet/Education. Hager is currently serving on the Governmental Affairs Cabinet for the Kentucky Nurses Association.
"A typical week involves Mondays as lecture days and Tuesdays and Wednesdays as clinical days," explains Hager. "I am responsible for eight students who are doing their clinical work at Jewish Hospital in Shelbyville, Kentucky. Although we concentrate on topics we are currently covering in class, during their clinical work time the students are giving total care to the patients. Shifts are flexible. However, I like to advise my students to work 12-hour shifts if possible for two reasons. The first reason is that more and more nurses are working 12-hour shifts, so this will give the students a more realistic experience of what their job will be like. The second reason is because a 12-hour shift gives a nurse more familiarity with their patients, and subtle changes in the patient's condition will be more readily noticed. It can be of critical importance for the patient to have the nurse notice these subtle changes. I have been a nurse for 30 years. I have seen nursing change from a much slower pace with less-ill patients to faster pace with more acutely ill patients. This has to do with the way healthcare is managed, with patients returning to their homes far sooner than they used to. For this reason, there is much more emphasis placed on the nurse to identify significant changes. It is for this reason that I am in favor of 12-hour shifts."
In order to keep up with current nursing practice, Hager puts in four to six hours a week as a nurse practitioner for Alan D. Honaker, M.D., and serves as a staff nurse for Hospice and Palliative Care of Louisville, taking call one night weekly. Dr. Honaker runs a family practice in Shelbyville, and is also the medical director for the rural team at Hospice and Palliative Care of Louisville. Hager met him through her church and her children: he mentored her throughout her nurse practitioner studies and the requisite clinical work. When Kentucky did not grant nurse practitioners prescriptive authority for controlled substances, it became clear that Hager would not be able to work independently as a nurse practitioner in the hospice field. Since she admired Dr. Honaker's caring manner with his patients, accepting an offer of employment at his clinic seemed like a logical choice. Today, she has no regrets.
"Dr. Honaker has 30 years of experience in the field," explains Hager. "Not only is he kind and compassionate with his patients, but he is also highly intelligent. I love being able to go to him with questions because I know I will get a good answer. The two of us share a deep interest in end-of-life issues and it is good to have such a wise colleague to consult."
Besides teaching, hospice care is Hager's passion in nursing. "I love being able to see people get relief from their pain," she says. "Some people think that working with dying patients must be depressing. I do not find that to be the case. When a nurse works in a hospital setting, most of the time s/he sees patients for a short duration, and then may never see them again. In hospice care, a nurse cares for a patient on a continuing basis. The nurse really gets to know the patient and the patient's family. It is very rewarding to be able to take part in making the quality of a dying person's life improve. It is amazing what can be accomplished in a short amount of time. Our role as hospice workers is to do just that: to improve the quality of life for our patients.
"I work as an on-call nurse one night a week during the school year. My role usually involves symptom control, such as help with controlling nausea or constipation or questions clarifying the use of their medication. Patients need to have someone they can contact all night long. The process of dying can be scary for the patient, and it is reassuring to know they can count on having someone to help them during the night as well as during the day. This falls in line with the whole concept of hospice care.
"The underlying principle behind hospice care is to follow the wishes of the person who is dying in order to make the dying process as pain-free and peaceful as possible," continues Hager. "No decision is ever considered permanent. The patients always have the right to change their minds. As a hospice worker, I can inform and educate, but it is my job to respect every decision that my patients make. For example, if a patient agrees to try a catheter, I will explain the pros and cons and then say, 'If you will let me put this catheter in, you can let me know at any time that you want it out and I will remove it.' Hospice philosophy is to bring peace and symptom control for the patients and peace for their family members. It is never about making decisions about what would be best for the patient. It is always about educating and enabling the patients and their families to make the decisions that are right for themselves."
According to Hager, this approach holds true whether a hospice patient is at home -- as most are -- in a nursing home or even in a hospital. Wherever end-of-life care takes place, it addresses the patient's spiritual and social needs in addition to medical issues. "Hospice care is a team concept. Besides nurses and physicians, there are social workers, nurse's aides and chaplains all working together to give patients and their families the support that they need.
"I am on what is known as the 'rural team' that covers rural areas in four counties in Kentucky," she explains. "Besides myself, my team consists of four full-time nurses, two nurse's aides, two chaplains and two social workers, one of whom is also the team director. All of us recognize that if the dying person is at home, the person doing most of the work is the family member or friend who has chosen to be the main caregiver. We come in and out to alleviate symptoms and consult with problems, but we recognize the vital importance of the main caregiver and always show respect for that person. That is what hospice care is all about: it is about giving respect."
Apparently, the respect between Hager and her patients, colleagues and students has been mutual throughout her career: she has been honored for her dedication to nursing with numerous awards. She was one of two national winners to become a Roxanne Scholar in 2000, an award that included all-expenses-paid weeklong attendance at a nationally recognized center for pain control. In 1996, she received Mayor Armstrong's Excellence in Nursing Award for Excellence in Faculty Education and Research from Jefferson County, KY. She won awards for Outstanding Student Support from Jefferson Community College graduates and was named Nurse of the Year at United Medical Center during the time she worked there.
Kathy Hager, ARNP, CDE, CHPN, graduated from the University of Kentucky in Lexington with her Bachelor of Science in Nursing in 1972. She received her Master of Science in Nursing from the University of Kentucky in 1976. She attended the University of Kentucky's program for Primary Care Nurse Practitioner Post Clinical Scholars component in the graduate nursing program with 29 hours past the Master's, and is currently pursuing her Doctorate of Nursing Practice at the same institution. Hager is certified as a Diabetes Nurse Educator (2000), a Hospice and Palliative Care Nurse (1999) and became certified as a Nurse Practitioner in 1996.
Esther Martin is a freelance writer from the Philadelphia area. She is on the editorial staff of NEWS-Line for Nurse Practitioners.