2017 Leader of Tomorrow: Kayla Bruce, LPN

Kayla Bruce, LPN, knew from the eighth grade she wanted to be a nurse, but at first she thought her patients would be much younger. She’d planned on being a neonatal nurse, but one night during her clinical rounds she was assigned to an elderly hospice patient who had been placed in one of the hospital’s rehab beds. “She was struggling, and we couldn’t figure out what she was hanging on to,” she remembers.

Bruce gathered her team and spoke with the family members, who said the one thing their loved one enjoyed was having a good bath and having her hair and makeup done. “So we bathed her, got her all dressed up, and moments later, she took her last breath.”

From then on, she realized improving quality of life during a person’s last moments would be her passion. “In hospice care, everybody knows what the end result will be. It’s about what you do in the meantime, how you improve their lives in the meantime.”

Kayla Bruce, LPN Louisiana Hospice and Palliative Care Hammond, Louisiana

It often takes decades for caregivers to develop the empathy and understanding that Bruce has achieved in just 4 years as a licensed practical nurse. Her insights into patient behaviors and her understanding of the potentials and values of hospice care are the tools she uses to inspire others toward person-centered end-of-life care.

In the past, hospice care tended to be provider-centric and clincially focused—nurses managed the pain and daily care and doctors made all the decisions. Today, quality hospice care means getting to know the patient while they are still verbal and cognizant, in order to provide person-centered care later, she notes.

“I learn as much as I can about them, like whether they’re modest and what calms them. Many of them feel like they’re a burden, so I try to remind them every day that they’re not. And that it’s okay to ask for things. Then, when they no longer can vocalize, I know what they would want. I know their boundaries.”

Bruce’s care site, Louisiana Hospice and Palliative Care (LHC) of Hammond, uses the consistent staffing method to care for its 35 to 50 hospice patients per month. “I can’t imagine it being any other way in hospice just because it’s such a personal time,” she says. “You need to be able to compare subtle shifts day to day, to be able to tell that on Tuesday they were in high spirits and on Thursday they were down in the dumps.”

Being an excellent observer of clinical conditions is just as important in hospice care as in nursing home care. Just because a patient is eventually going to die doesn’t mean nurses should let a pressure ulcer slide or take the easy way out by overusing enemas. “There are times where a patient may be in a situation where they’re not being neglected but better care could definitely be delivered,” she says. “Sometimes it’s a matter of teaching the families better ways to clean them or move them or how to communicate with them better.”

Hospice nurses tend to play major roles in engaging with families, much more than in nursing homes, Bruce adds. Although her facility has the services of a social worker “to help when things get deep,” much of the time Bruce finds herself reassuring families about their deep-seated fears, insecurities, guilt and even emotional outbursts, especially when families are dealing with a loved one who has dementia.

“Sometimes patients will lash out when they’re confused,” she explains. “Many times I find myself saying to a family member, ‘Your Mama doesn’t know she’s doing that. She really does appreciate you. She’s still the same person she was before she got sick. She’s just confused now and you have to work through it.’ It’s just reassuring them they’re doing the best that they can do and that their Mom or Dad would definitely appreciate everything that they’re doing for them.”

She’s learned a lot about managing the stresses and care fatigue that go along with caring for the dying, including when to stay strong and when to share emotions with a patient. “I cry with them,” she says. “The first time I cried in front of a patient, I was apologetic, saying ‘I’m so sorry.’ But she said to me, “Don’t be sorry! Now I know you really care.”

She credits the administrative team at LHC for providing the unique support hospice nurses need, including giving them time off to attend the funeral of a patient or allowing an afternoon off after an especially difficult night. “It’s not about census numbers, it’s not about money, it’s not about any of that,” Bruce explains. “It’s about the patient. It’s about changing their lives and doing everything that we can for them. And in return, it gives us something. It gives us something to push forward for, to work hard for, to be proud of. And that’s how we get through it.”

Now, at 27, Bruce says more education might be in her future, including in healthcare management. She learned about managing people—and inspiring them to manage themselves  better—while helping with her mother’s retail business. One of the key lessons followed her to her current career: Teach by example.

“I wish there were more people with more compassion, but if you get out there and do things with them, they’re more apt to do better themselves,” she says. “For example, no one likes to disimpact a patient. It’s just one of the worst things you have to do as a nurse. I gag and cry all at the same time. But if you’re talking with the patient, you’re focused on them and not on the task. You never want things to become so routine that you’re just going through the motions to be done by 4:30 p.m. so you can leave.”

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.