How a surprise hospice placement changed my perspective on death and team resilience
When I found out I was being placed at Hospice Tairāwhiti in Gisborne for my final-year nursing placement, I will admit I was filled with apprehension. As a nursing student from EIT Napier taking part in the Tairāwhiti Interprofessional Education (TIPE) programme, this was not my original destination. I was supposed to go elsewhere in Gisborne, but due to staffing shortages, the universe redirected me here.
Before walking through the doors, I held a common misconception: I thought hospice care was exclusively for people actively dying within days, and honestly, I thought it might be slow and a bit boring. On top of that, I considered myself emotionally vulnerable. The idea of being surrounded by death felt like it was going to make this five-week journey incredibly difficult for me.
I could not have been more wrong.
A Very Welcoming Team
From my very first day, the stigma I carried dissolved. I was welcomed so warmly that every single member of the hospice team already knew my name and was expecting me. A lovely nurse walked me through the building, which was clean, fresh, well-organized, and beautiful.
Starting out is always hard; the clinical systems were new, and I did not know the patients yet. However, the hospice team empowered me in a way I had never experienced in previous placements. On day one, I was handed a tablet with my own login details to look up care plans, and by the second day, the Boss of the Hospice Team provided me with my own laptop for the duration of my rotation. Having my own dedicated technology made learning seamless and allowed me to study patient details without having to fight for a spare computer rather than being a hurdle I had frequently faced in the past.
Facing Workforce Realities with Shared Equity
Like many areas in New Zealand healthcare, the team frequently faced understaffing and shortages. Yet, what I witnessed was a masterclass in nursing resilience. The team always stepped up to fill the gaps. Even when the nurses were visibly struggling under the pressure, they shared the patient load equally and worked cohesively to ensure every single person received their care on time.
What made this care so seamless was their behind-the-scenes organization. The hospice manages its own limited stock of patient equipment, servicing and replacing items diligently so patients always have what they need at home. They also run a lean but highly effective after-hours service, where on-call nurses are always available to answer late-night questions or rush out to emergencies.
Beyond the clinical realm, I discovered beautiful holistic initiatives like the patient biography service. Through this program, volunteers sit with patients to write down their entire life journeys, turning their memories into a book. It was a powerful reminder that our patients had vibrant, full lives before they became ill.
Learning the Art of Hard Conversations
One of my greatest learning curves was discovering how to communicate what hospice actually means. End-of-life is a confronting topic, and many patients and families are simply not ready to hear it. I learned how vital it is to ask open questions and give clear explanations. We had to gently help them understand that the hospice team is not there to accelerate death or give up on them; rather, the team provide comfort care so they can live well, whether their remaining time is measured in years, months, or days.
This placement also introduced me to the realities of the Support and Consultation for End of Life in New Zealand (SCENZ) group regarding assisted dying. Learning about this pathway was initially overwhelming. However, I came to realize that when a patient has no further options, is experiencing unmanageable pain, and is truly ready, it is a profound legal and compassionate choice.
No matter what a patient’s choices or cultural beliefs were, I saw absolutely zero fault in how the staff respected their autonomy. Every single clinician tried to go far beyond limitations to honor the patient’s wishes and deliver the best possible care.
Clinical Growth and Emotional Breakdowns
The nurses did not hold me back; they pushed me to grow. Day by day, my confidence soared. I went from doing basic observation checks on day one to making professional clinical phone calls, admitting patients, preparing hospice packs, and actively participating in staff multidisciplinary meetings. The nurses also had me write progress notes independently, taking the time to review them with me to polish my documentation skills.
I also witnessed the powerhouse of allied health supporting the nurses. The approachable social worker provided vital financial and emotional lifelines to families. The passionate clinical educator helped me immensely with my education sessions, and her impact on my learning was profound. Even when the hospital-liaison nurse fell sick, I pivoted and shadowed the rest home hospice nurse, learning how to bring a vibrant, positive approach to patients in aged residential care and hospitals.
Of course, there were emotional breakthroughs. It broke my heart to watch patients cry and ask, “How long do I have left?” I saw the stark contrast of human relationships: some patients were surrounded by beautiful whānau who made them feel entirely cherished, while others had family present but were entirely neglected and lonely.
The Ultimate Lesson: You are the Boss of Your Life
Seeing patients reach the stage where they could no longer speak or move, only able to see and hear us, taught me the absolute sanctity of end-of-life care.
The hospice team taught me a lesson that extends far beyond clinical nursing: You are the boss of your life, and you make the decisions. It taught me that supporters who takes care of you at the end stages of your life should be chosen wisely, and that we must have courageous conversations early.
Death used to be a topic of fear for me. Now, I see it clearly as a natural life process. When an Advance Care Plan is ready, it takes the guesswork away from healthcare professionals and allows us to deliver the exact comfort, dignity, and peace a person wants. The hospice team may be small, but the magnitude of relief they provide to save patients from pain and misery is massive. What else could make a person’s final transition more comfortable than that?
Ka nui te mihi,
Amanda Grace Shantu
