As National Nurses Week comes to a close, we give thanks to all great nurses for the many ways you care and comfort patients and families. At Empath Health, our nurses are passionate about improving quality of life for those in our community facing serious or advanced illnesses.
Mary Lynn Guarino, ARNP-BC, ACHPN has served a longtime mission of care in nursing with Suncoast Hospice and Empath Health. Guarino now works as an ARNP (advanced registered nurse practitioner) in palliative care with our Empath Health physicians services. In this Q&A, Guarino talks about her background; her role providing consultations to patients and families and education to hospital physicians and staff; and her joy supporting those in her care so they find better understanding and comfort.
1. What’s your background?
My first professions were veterinarian care and preschool teaching. Then I went to the University of South Florida (USF) for nursing with specialties of geriatric, palliative and hospice care. I began my nursing career in infectious disease caring for people with HIV in Pinellas County. I didn’t have a team and was everything to the patients. When I was in my master’s program at USF, I met Becky McDonald and Kathy Brandt, both employed at Suncoast Hospice at that time. I attended some of Suncoast’s educational presentations on pain management and more. Kathy encouraged me to apply to the organization and I did. Everything fell into place.
When I joined Suncoast in 2000, it was great because it was a whole team helping our patients. As a nurse practitioner, they wanted me to learn every job in hospice that was covered by physicians or nurses. For 10 years I did supportive care (or palliative care), including admissions, visits and recommendations for patients in their homes, nursing homes and hospitals. Then I worked with our continuous care, admissions, home, care center and flex teams. A few years ago, I moved to our physicians services doing visits and now palliative care.
2. What’s palliative care?
Palliative care provides an added layer of support during a serious illness. Our team can help patients and their family members medically, spiritually and emotionally. Palliative care is a specialty across the country and Florida and Empath Health is at the forefront of establishing it in hospitals. Doctors must be board certified to do palliative care. Our palliative care medical director Kevin Ache, DO and many of our other physicians are board certified in hospice and palliative medicine. My fellow ARNP Lori Burkhardt and I are board certified in hospice and palliative nursing.
3. What does your ARNP job entail?
Empath Health offers palliative care and consultations in many settings, including in patients’ homes, nursing homes, assisted living facilities and hospitals and we’re continuing to expand our services in other areas. Part of my role is facilitating palliative care presentations with physicians, ICU nurses, hospitalists and other staff in hospitals to help them understand the services we provide and when and how to make referrals. It has been fun and a real learning experience. My other hat is doing consultations with patients and families to assess their needs and goals of care and help them make informed decisions. It’s rewarding supporting them.
4. How do you support your patients and families?
I must have a connection with my patients and families so I can build trust. The number one thing is to walk in that door and some way, somehow make that connection.
One recent family member in a hospital said, “That’s my dad in that bed,” and I replied, “That’s my dad in that bed, too, because I’m treating him. I’m going to see that we do everything we can to make him comfortable and he gets everything he needs.” When I can go in and talk with families and they hug me, that’s what palliative care is. That’s my job. They feel so happy, thankful, comforted and supported. It makes it worth it.
5. What are the most important responsibilities of an ARNP?
Being efficient, flexible and great at documentation and working with patients and families. I’ve trained doctors on documentation and that’s a great honor. I try to have fun and a good outlook.
ARNPs are often there to handle the tough cases. I’ve had families who are angry because they feel that not everything has been done for their loved ones. My job is to listen, answer their questions and make sure they understand the whole picture and have their decisions documented. I’m there for them. And I’m there to support the entire team. I’m a liaison and advocate explaining all the options and helping families make their own informed choices.
In our care, we must be sensitive to our patients’ and families’ backgrounds and styles of conversations. To be good, we must be chameleons. For me, I adapt to whatever that family is. I do whatever they like to help them feel more comfortable. Sometimes, I’ll even sing to them. I remember working in one of our care centers and a Hispanic family, some of my team members and I sang a beloved song in Spanish that soothed the family’s loved one nearing the end of her life. Everyone was in tears. That was an amazing connection and the family was so grateful.
6. What has it been like working with the hospital staff and your colleagues?
It has been great. I collaborate with physicians, nurses and other care staff. I can help support the nurses because I’ve done their job and know how difficult it can be. We can work together. I’ve loved working with our staff at Suncoast Hospice and Empath Health over the years. Our physicians, nurses and leadership are so great. We have worked as a team and had a really good time. Our patients and families have always been our center. It’s rewarding seeing everybody we help and working with my colleagues. Having a work family makes it wonderful.
7. What’s your advice for new nurses?
Make a connection with your patients and families by listening to their needs and meeting them where they are. If you’ve done that and earned their trust, they will share with you, see you as a resource and call on you when they need you. You’ll learn the most from them because they’re going to tell you how they feel. Put yourself in their shoes, touch them, avoid judging them and speak to them in positives. The one thing I hear from patients and families more than anything else is, “Why hasn’t anyone told us about this (palliative care) sooner?” We’re there to help.
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