Hospice workers in the area share dedication to both their profession and their patients

Published 11:32 am Monday, March 7, 2022

Growing up, some people aren’t sure what they want to do. For others, their dream job turns out to be something completely different than what they went to school for.

For Andrea Madrigal, her career path was inspired by her mother, Patty, who herself is a nurse. 

Madrigal started nursing in 2015 as a personal care assistant. She then worked up to a licensed practical nurse and finally to her current job at Embrace Home Care LLC as a registered nurse.

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“I love helping people,” she said. “I actually went to school to become an occupational therapist, and when my mom started this company I started out as a PCA and I found that I loved working with the clients.”

Being a health care nurse isn’t just drawing blood and administering shots either.

“Every day is different,” she said. “For the most part we try to help out with things needing to be done with patients such as paperwork, phone calls, schedules, handling employees,” she said.

During one of her nursing shifts, she may have to take an evening shift from 3 to 10 p.m., though on occasion she’s worked 14-hour days with nothing more than a 30-minute or hour break. One shift constitutes seven hours with one client, and she’s currently alternating between three clients.

Because Embrace is an in-home service, she also has to travel to patients’ homes. All of her patients are ventilator dependent, and some require gastrointestinal tubes.

“Most of the time we are just caring for them, getting their hygiene cares done, their oral cares done,” she said. “Any patient appointments that they need to go to, we are there with them at the hospitals.”

She also administers medications and treatments.

Patients may also have diseases.

“We take little ones out of St. Marys,” Patty Madrigal said. “We’re in the process of taking one now where we have a baby that was born with a disease or they were born prematurely, and we take them and we put them in the home and then we staff them with nurses.”  

Another challenge is staffing, and if they’re short-staffed or other agencies are, that means someone in the community in need of care won’t have it.

And like everything else, COVID-19 made Andrea Madrigal alter the way she works, whether it was being more mindful of things happening around her or washing her hands more frequently. She’s also wearing masks in patients’ homes at all times.

“We’re just mindful of them and being more cautious,” she said.

Embrace currently has around 60 clients and 10 employees covering seven counties, with most of their base in Steele, Freeborn and Mower counties.

Madrigal is working on her master’s degree as a family nurse practitioner, and she also serves as a case manager at Embrace.

‘Every patient is different’

One circumstance can alter a person’s life trajectory forever. This was the case for Erin Brandenburg, a BSN/RN at Mayo Hospice.

“My dad had multiple sclerosis for many years,” she said. “He was diagnosed a year before I was born.”

That meant she helped care for him at home while in school, and her work drew her to the field.

“When I worked in [a] rural hospital in Emmetsburg, we had a hospice room at the end of the hall and nobody wanted to take the hospice patients,” she said. “I kind of volunteered and enjoyed it and liked it, so then I kind of became the hospice nurse who would take the hospice patients when they were at the hospital.”

So when she moved to Lake Mills and saw a hospice position open, she applied and was hired. 

As a hospice case manager, she and her team deal with six to eight patients.

“I schedule visits throughout the week,” she said. “The thing with hospice patients is every patient is different. Some might be seen several times a week, some may be seen once a week, some maybe three to four times a week or daily depending on their needs and how they’re doing overall.”

Typically, Brandenburg tries to see four patients daily within the 45-minute hospital radius.

“I go into the patient’s home, the nursing home or wherever the patient resides, and I’m assessing the patient’s symptoms,” she said.

That can mean figuring out what’s bothering the patient, as well as prescribing treatment. She’ll also educate the family or facility staff depending on who is caring for the patient.

She also tries to save one day for admissions.

”If there’s a new patient to take on, I like to have room for that,” she said. “Admission to hospice can pretty much take up your whole day.”

Originally, unless absolutely necessary, COVID-19 put a pause on patient visits and made her adapt.

“We would do Zoom visits, video visits of any way, telehealth, all of that — phone visits sometimes if they didn’t have the technology for telehealth,” she said. “We were doing a lot of that when the pandemic started.”

She’s also wearing personal protective equipment and goggles.

“Facemasks obviously are a must, but it kind of hinders being able to see your patients and them being able to see you and … you miss that kind of connection you had with your patients prior to the pandemic.”

Another challenge she has faced is not knowing how many staff she’ll have.

“You may have to take on extra because somebody is sick or somebody is out or you pick up extra work because you just don’t know what the day’s going to bring or if you need it you might pick up an extra day here or there just to help out and get through.” 

During the pandemic, Brandenburg has learned the value of teamwork.

“Having people there to support you as well as you supporting the patients, and just being able to work together to get through,” she said. “You just never know.

“Some days you’re working fine, everybody’s working. Next day somebody is out because we all have families outside of this.”

She’s also spending less time at the physical hospital because she starts and ends her day at home.

“I have my laptop, and so I just go from my patients to home to patient’s houses to back home,” she said. “Most of our meetings here in the office are all via Zoom now, so we don’t have to physically see each other in person very much.”  

And that’s something she was very appreciative about: easier access to patients.

Brandenburg grew up in Buffalo Center, Iowa, and received her two-year nursing degree through Iowa Lakes Community College, and earned her Bachelor of Science in nursing through the University of Iowa. She has been a nurse since 2001 and has been with Mayo Hospice since 2008.

Supporting patients and families in new ways

Knowing what you want can make life easier. That was the case with Jacqueline Carstens, a medical social worker with Mayo Hospice.

“I started at [Naeve Hospital] as a discharge planner where I helped people get placed into facilities or health services at home,” Carstens said. “Then they started the Hospice program around 1985 and they were looking for social workers. So I was able to help with that when it started.”

Besides that, she went to the nursing home that Naeve owned in Wells, so being in health care was always in her plans.

“It’s a philosophy of caring for people at the end of life, and working as a team and just having that support to help people when a lot of times people are not wanting to be with people at the end of life,” she said. “I just thought it was a very rewarding experience, and I’ve stayed with it ever since.”

As the social worker on her team, she tries to help people with social and emotional concerns.

“A lot of times the nurse is focusing more on the symptom management of the patient,” she said. “A lot of what I do is try to help with the family.”

That could mean making a phone call or taking a home visit, where she wants to support the family with information on what to expect as their loved one progresses through a disease.

“We work not only with the patient’s physical needs, it’s the social/emotional,” she said. “And then we have a chaplain on our team that helps with the spiritual. So we really work as a team of professionals.”

Because of changes made during the pandemic, Carstens is able to work from home.

“We all have laptops with all of the patient information in, and so we kind of look at what I’m going to be doing for the day, setting up my scheduling,” she said. “I usually try to see people at least once a month, but it may be every two weeks.”

After organizing her data, she’ll make her visits or phone calls to some of her 23 patients.

She said the pandemic hasn’t stopped their visits, but at the beginning it did change how she operated.

“Some of the facilities where we had our patients reside in, the families weren’t always allowed to be there with them,” she said. “And so I remember being outside a window of a facility because they could only look at their loved one through a window. 

“So supporting them that way, that was a big change.”

The emergence of telehealth has also interfered with any personal touches to one-on-one support.

That’s not to say everything has been harder.

“Sometimes things can be more efficient if you’re able to do things by telehealth,” she said. “We do a lot of Zoom meetings and connections.” 

But the current crisis has also taught her to not be afraid. Instead, she tries to do the best she can while still being careful.

“Life is precious,” she said.

She also admires her colleagues on the front lines of the crisis who aren’t afraid to go in with their personal protective equipment.

“It is a tough time but we still have to be there to take care of the people that need us,” she said. “I think that made us stronger as a team, too.”    

Visits typically include assessing how patients are coping and answering any questions

But make no mistake, not every day is the same.

Carstens grew up in Blue Earth and graduated from St. Benedict’s with a major in social work and has worked in hospice for 26 years.