April Trahan

Read the inspiring story of April Trahan and follow her journey from registered nurse to Director of Clinical Services at Elysian Hospice, where she fulfills her purpose in life as a provider of compassionate end-of-life care.

Overview

April Trahan’s life story has all the makings of a modern-day fairytale – the type of biography one might expect to find on the Hallmark Channel or in a Lifetime movie. The distinguishing aspects of her story are made even more impressive when you consider that April resists the depiction of herself as the protagonist in her own personal history. Continue reading to learn more about her inspiring path to become a nurse, as she discusses the decisions she made and explains how she overcame each and every challenge she faced along the way.

Awards & Achievements

Bachelor of Science, University of Texas at Arlington

Associate of Science, Brookhaven Community College

RN Case Manager, New Century Hospice

RN Clinical Manager & Alternate Director of Nursing, Hospice Plus Dallas

Director of Nursing, Dignity Team Health

Director of Clinical Services, Elysian Hospice




Interview - Question & Answer

What happened after you learned of your son's birth defect and his need for surgery?

For the next nine months, I scoured the internet and books for anything I could find on the defect and surgery. I found quickly that the more I knew about my son’s condition, the better I felt of the expected journey. I watched many videos of surgeries, joined several support groups, and filled my days with research.

A routine 24-hours of observation in Neuro ICU was required prior to my son’s surgery. As I visited him in his bed, I couldn’t help but notice an infant in the enclosed room across from him. She had no family, and no one came to see her except the nurse assigned to her. I found out that she was there for Shaken Baby and CPS. It was then that I knew I wanted to help infants with no connection with anyone. At that time, however, I was not sure how to fulfill this new urge I was feeling.

My son recovered beautifully, but that little girl was still in my heart. We were not in the position to adopt or foster children at this time. I threw myself into my oldest son’s school and sports, volunteering to help other working parents while providing the children with the best memories.

What changed? What led you into the field of nursing?

In late 2006, after my husband was laid off for the second time, we were recommended by the Texas Workforce Commission to take a career compatibility test. Given the circumstances, I could no longer stay at home nor did I feel it was right at the time. The results of the compatibility test were Teacher, Social Worker and Nurse.

On to the practice test for the GED; and I was told I did not need to go through any remedial classes. I was more than ready to conquer this challenge since that was always holding me back from feeling worthy of a career. I was in my young 30s and often felt insecure because I quit high school despite my justifications at the time.  

I received my GED on my first try and attended the graduation ceremony with both my sons extremely proud of me. I was the example to them to finish school and continue to college, so I entered the local community college to inquire about courses. After completing the FAFSA we were eligible for the Pell Grant. Studying full-time and mentally ready to obtain a degree, I had to make the choice of degree to pursue. Although all the positions appealed to me at the time; I wanted a career where I could fulfill my purpose. Somehow that one child who was in the hospital years ago was still resonating with me.

How did you decide?

I call it the “snowball effect”: I couldn’t talk to an advisor until I enrolled in the school. So I did. Still couldn’t talk to an advisor until I completed the college placement test. So I did. Although I needed to complete developmental classes in English and Math I am thankful now that I had repeated those classes.  Once I started, I was determined to continue until I had a degree in nursing or at least enough credit to transfer to a four-year university. For the next two years I completed all prerequisites for entry into the nursing program with a GPA of 3.5 which was needed to qualify for the extremely competitive nursing program.

Where were you going to school?

I attended Brookhaven College School of Nursing (part of Dallas County Community College) and earned my Associates Degree of Nursing. I am now almost finished with my Bachelor of Science in Nursing at the University of Texas, Arlington; I have 3 non-nursing classes left to finish.

Describe your experience in nursing school…

I was accepted into the nursing program and the dream was truly becoming a reality in four semesters. Since Pediatrics and Children’s was my first choice of nursing, I was excited about the experience. I found out quickly that it was difficult to leave judgment and my heart at the door. I could see myself attaching to each troubled child that arrived on my floor. One Cerebral Palsy foster child stole my heart while a 12-year victim of assault preparing for jaw surgery broke my heart and activated the tears. I knew then that I had to move this field further down in my choices or I would come home each night emotionally exhausted.

Psychology was always one of my interests while growing up, so I was just as excited for the Psych rotation. It was also the subject where I got my highest grades in school. I chose the well-known Terrell State Hospital over local behavior hospitals in the area that mainly focused on drug addiction. My professor was well aware of my desire to work in Pediatrics, so I was assigned to the children’s unit and was given a six-year old who witnessed a suicide and retracted to infancy. Although this intrigued me, it opened my eyes to the selfishness of the world. I would come home mentally fatigued.

My last rotation consisted of shifts with our preceptor for their entire shift. Out of 40 nursing students, 10% were chosen for the emergency department. Despite being exhausted after each 3rd shift, I excelled at it and enjoyed showing up. My preceptor was assigned to the trauma rooms and I was able to participate in many traumas that arrived, jumping in to assist with what I was currently checked off for. This was my top choice of fields.    

What would you say was the hardest part about going back to school?

Leaving high school early. I always had the feeling of regret and shame that I did not finish, despite it being the choice I had made back then. I envied people I met who attended college right after high school. But then, going back to school as an adult gave me the determination to complete it with intensity and to be the best I could be at it.

What was the hardest part of being in school?

I am most competitive with myself and pushed myself to get all work completed the same day  of the assignment and to the best of my ability. (It may be a bit of pride versus competitiveness although they are both my attributes.) And since I was older than most of the students, I always strived to be at the top of the class and gave my professors the utmost respect. This, I feel, allowed me to be heard when I requested certain clinicals.

Did you have support from your family or friends through all of this?

My family has been a great support system and are the best cheerleaders. My husband and two sons have been my rock throughout my studies and my career. My youngest son was often my subject in helping with assessment check-offs, and at 17 he is interested in nursing as a career.

My mother-in-law was a graduate of Baylor with a degree in nursing. A grandmother is also a retired RN, and an uncle who is a LVN in the Lubbock, Texas area works in the home health field. Uncle Dave gave me my first stethoscope which I still have today and intend to pass on. Along my journey, I had many friends that were nurses who encouraged me and gave me guidance. I am forever thankful and stay in touch with them to this day. They continue to provide encouragement and inspiration.

It's amazing you began your career wanting to work with newborns and yet ended up excelling with those preparing for the end of their lives. Did something happen in college that inspired you? A class or a teacher?

End-of-Life was a prerequisite class in college and despite my competitive nature to excel back then, I felt it was a waste of my time. Volunteering was a requirement each semester and my choice was to volunteer at a hospice house at the back of a local nursing home. I found myself dreading the job where I visited an elderly woman who was unresponsive with erratic breathing. She had no visitors; there were no pictures in her room; there was only a Bible to read. So that is what I did for the next hour and found, to my astonishment, that her breathing changed when I read or sang to her.

We had to complete a major project with a speech to sum up our papers and, teaming up with another classmate, we drew Signs and Symptoms of Death. Only God knew that these events would lead me to hospice because I sure didn’t think I would ever use it again.

I originally went into nursing to be in Pediatrics because of children who had no one. Then it was emergency room because of the fast pace and the excitement of figuring out complexities. Ultimately, I found there were parallels with hospice patients. Sometimes they do not have anyone around because of families being so mobile.

What happened after graduation?

Once I graduated and the ceremony barely over, I turned my focus on getting a job in the local emergency rooms. There were several group-style interviews along with other graduating classmates. Many of the younger graduates were obtaining positions in the ED while I and another graduate nurse who was also in her mid-30s experienced difficulties obtaining positions despite being among the top of our class.

A home health nurse who I met through the medical struggles of my husband offered me a position as case manager with extensive training in the home health field. I would be caring for patients from orthopedic surgery requiring monitoring for physical therapy or wound vacs, and immune system disorders requiring infusions. Starting frequent IVs in the emergency department gave me the competence to excel during my stint with the home health company. I would frequently be assigned these types of patients.

What happened next?

A classmate called to see if I would be interested in case managing hospice patients. I had always said I would not work exclusively with the elderly, but I was quickly being burned out driving across the sprawling Dallas-Fort Worth metroplex every day to care for my growing caseload. At its busiest I was now working seven days a week.

7 days a week? That is a lot of work!

After several weeks I began to decrease my caseload to part-time to allow orientation with a hospice company. After completing orientation, I began observing my fellow nurses with families and assessing patients that were terminally ill. I recalled the woman in the hospice house to whom I read Psalms over and over, and her breathing would change. I would go home invigorated and inspired by the patients and their families.

It’s funny how the purpose that I was looking for actually found me. Caring for those loved ones at the end of life vs the beginning of life was always there the whole time. Looking back at my capability test years ago, the results had said Teacher, Social Work or Nursing. In hospice, I could do all three.

That is amazing! Can you go into more detail?

The autonomy of the nurse allows me to teach the patient and family on the disease process. The observation and assessment of the family dynamics allows a touch of social work and of course the main attribute of nursing ties them together. I couldn’t do that and did not see that at the time of my rotations.

Would you say, at that point in your life you were committed to hospice?

Over the next few months I was a sponge to hospice, obtaining the respect of my peers and management. The popular saying is that nurses either get hospice or they don’t. Within a year, I was offered a management position with the hospice I was working for. I declined the offer though, wanting to continue to case manage while learning more about the field with a larger hospice in the area.

That was a risk! How did your future unfold?

In three and a half years with one of the largest privately owned hospices in Texas, I again won the respect of my peers and physicians. From working as a case manager, I began to operate the telephonic triage for more than 1,000 patients across the state along with continuing to do PRN visits during the week. After a year of triage, I was promoted to clinical manager and within nine months became the Alternate Supervisor of Nursing (ADON).

Recently I accepted a position as Hospice Director of Nursing with Dignity Team Health. The vision of the company, I feel is unique. It is rare these days that a company focuses on patient care and the staff involved. Corporations are attempting to provide this but are falling short when the focus is ultimately on profit and not caring for the patient. At Dignity we know there is only one chance to make this time in someone’s life a rewarding and fulfilling process.

Families of those who are dying are vulnerable. How do you help?

The families are losing their loved one and their focus should be on the memories being made. The remaining time should not be spent making sure Mom is receiving the best care possible, or that the right equipment is in place, or that symptom control is being practiced. These families depend on hospice to get what they need: Compassionate and dedicated staff providing the best care with the best equipment, while controlling the symptoms in order that the patient experiences the quality of life that they deserve. This is Dignity’s responsibility to the patient and family.

Can you list the pros and cons of your specialty?

The pros have been:

  • Fulfilling my purpose in life
  • Case management allowed time management around my children’s school events
  • Allowing me to teach and guide families in denial to transition to acceptance of the inevitable, and being able to watch them transform
  • Helping patients find peace and listening to memories of the patient
  • Learning about the histories of families and what made them what they are today
  • Teaching new nurses or training nurses in the field of hospice
  • Closure for me as a nurse and a human

The cons have been:

  • Attachment sometimes to patients and crying for the heartbreak that is to come
  • Burnout/stress is high if not managed well, therefore taking care of oneself is important
  • Documentation can be tedious. But what field isn’t?
  • The demands of patients’ families can be daunting but remember this is their loved one. They have a right to be selfish at this time.
What qualities would you say a nurse needs to have to excel in hospice?
  • Compassion to guide families and patients through the journey of a disease’s progress.
  • Understanding that the families may not accept the final stage of life, and that they deserve the respect of your time.
  • Patience to give the family your undivided attention and to listen to their concerns and fears. They will only hear 30% of what you say, and you will need to repeat what you teach, possibly each time you visit.
  • A calming presence. When you are with a family at the bedside of a deceased patient you will need to have a calming presence and voice at that moment of finalization.
What do you love about your job?

The patients and their families expect hospice to be there when they need it, and I have the occasional twinge of guilt if I attempt to be selfish. Many times when I’ve worked all day and receive a call that could and probably would have been handled over the phone with any other nurse, the families’ fear of being alone in this journey would tug at me and before I could think again, I would be in my car on the way to their home to provide them face-to-face education on why their loved one is agitated, hallucinating, or in pain. Most of those times, I am thankful to have gone to their home.

The patient depends on the case manager to be honest with them and many home patients need the nurse to give them some peace. The fear of the unknown can be what leads majority of us to call 9-1-1. I have had many patients prior to hospice call EMS because of a strange or new symptom, only to find out that it is a symptom of the disease. A simple intervention can reduce the symptom. When hospice is involved, it generally allows the families to remain in the home where they are most comfortable.

Please share an experience when you faced adversity. How did you react to the situation?

I had worked in hospice for a couple of years before being promoted to telephonic triage for over 1,000 patients. The calls were coming in as fast as I could enter the information into our system. I was so overwhelmed with the stress of missing calls or delaying call backs. After my shift was over, I sat on my bed and cried that I wasn’t cut out for this position. My husband encouraged me to talk with my management and let them know I didn’t want to take on this position. This wasn’t a new position; I was replacing a previous nurse that moved out of state, so I kept telling myself if she can do it so can I.

I eventually found a time management groove that allowed me to conquer my inner thinking. By the end of my employment with the company, I continued to work the weekends which were the busiest due to fear of service failures and heavy call volume.

What would you say are the most important changes that have happened in your field in the past few years?
  1. Regulations of Electronic Medical Records have shifted the field into real-time interventions for patients, reducing medication errors and delayed relief
  2. Administration and financial responsibility to prevent abuse and fraud of the Medicare/Medicaid system
  3. Companies providing a multitude of levels of care from private care, home health, assisted living facilities to skilled nursing facilities and hospice (EX: Dignity Team Health, Brookdale, VNA)
  4. Increase in number of group home/residential home patients
If you could change anything in your field, what would it be?

There would be a balance of financial responsibility with patient care to allow nurses to focus on hands-on engagement with the patient. Secondly, many times documenting EMR in front of families makes it difficult for the elderly to understand we are providing care even while typing on a “computer.”

What goals do you hope to accomplish by the end of your career?

I would like to see greater public-awareness of hospice and its benefits to each person. There is a stigma about hospice and I would like it to be known that patients are admitted to hospice because they have a terminal illness with a prognosis of 6 months or less IF they continue on the route they are on.

When a patient has an exacerbation of their illness, leading them to go to the hospital repeatedly – many times once the person is admitted, they are no longer focusing on the treatment. I think the focus should be on the quality of life they have remaining.

Patients have medications that they struggle to swallow because of the other 20 pills they are taking. I’d like to see this reduced with education with family and the patient because many have become ineffective.

What would you say to an individual or nurse who is considering hospice as a career choice?

I would hope that all nurses would have a hospice rotation or volunteer in a hospice house or with several patients in their home as they experience various stages of the disease process. While studying for my bachelors, we were required to research a community health organization on the administration side. This did not relate to the clinical assessment and participation of nursing.

For non-nurses I would tell them to volunteer with hospice either with an active dying patient and reading the Bible or another book, singing songs and/or with an oncology patient to allow them reflection of their life.

Any final things you would like to say to our readers?

All throughout the nursing program we had a motto: “Be flexible and have humor.” It is truly needed in hospice. To be flexible throughout the day, you will set a schedule and by Monday morning it will change because of the changing needs of the patient. Humor is needed to keep burnout to a minimum. Find your hobby or a way to wind down, making sure to laugh at and be grateful for the good things in life.

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