Member Q&A: Laureen Borden, RN
Laureen Borden is Registered Nurse and NUHW leader at Sutter Care at Home: San Mateo Hospice.
How long have you been a nurse?
I am originally from the Philippines and graduated from nursing school there in 2002. For six years, I worked in a variety of settings including the operating room before moving to the US in 2008. I then worked in home health settings in San Francisco and, ten years ago, I started working as a hospice nurse for Sutter.
As a hospice nurse you largely care for patients in their homes. What is it like to work in this setting?
Working in the home exposes you to aspects of a patient’s life and some of the family/caregiver dynamics that you don’t get to see in healthcare facilities. For example, I have the chance to observe what resources and support may or may not be available to a patient. Some patients have lots of economic resources and family support or privately paid caregivers while others are on limited income and/or living alone. We see patients from all walks of life, which makes each visit different—not just in terms of the patient’s condition but in terms of the environment they are living in.
Nursing “in the field” also involves independence, autonomy, flexibility, and critical thinking. While I am very lucky to collaborate with a great interprofessional team including a social worker, hospice aides, a chaplain, and a physician, we are rarely all in the patient’s home together. So when I visit a patient and they have an unanticipated immediate need (for a medication adjustment, for new symptom management, for toileting etc.) I must address it without the type of in-person team support available in an inpatient setting. This type of independent problem solving makes hospice work both challenging and rewarding.
Working in the home also involves a lot of interaction with and education of patients’ family members and caregivers. The plan of care for the patient is also the plan of care for the whole family. I must therapeutically assist the family in understanding what to expect, navigating the patient’s needs, and, at some point, confronting the loss of their loved one.
All nursing work involves grappling with death and dying, but hospice is specifically situated in the end-of-life phase. What do you find most fulfilling about working with patients and families during this final stage?
Hospice patients have a wide variety of conditions and can be undergoing many different therapeutic modalities from tube feedings to colostomy care to medications via PICC lines or ports. But the one commonality is that the goal of care is palliative–not diagnostic or curative.
Achieving this guiding goal of making patients more comfortable and improving quality of life in their final days is very fulfilling. Everyday I observe tangible improvements in my patients’ pain management, sleep, and ability to enjoy time with family and friends or some of their favorite food. Both patients and families are really appreciative of our services. Hospice is more often than not a welcome respite and relief.
You and your fellow Sutter hospice healthcare workers voted to join NUHW in 2022. Why did you decide to unionize?
We decided to organize a union because our employer’s policies have been making our work more difficult and stressful while also compromising patient care. Management frequently changes expectations, demands increased productivity and larger caseloads, and introduces new required tasks–all without any input from the frontline staff that know what changes would actually improve patient care. Understaffing is also a chronic issue and Sutter has not been providing competitive pay and benefits.
You are currently on the bargaining committee in negotiations for a first contract. What are the main things you and your coworkers are fighting for?
We are fighting for improved pay, benefits, staffing, and a voice in the policies and procedures that impact our ability to provide high-quality care to our patients. Winning these things will increase recruitment, retention, and the time we have to spend with patients and families.
What made you want to serve on the bargaining committee and what has that experience been like?
I wanted to serve on the bargaining committee because I believe that if you want something to change you have to get involved. I am learning a lot in bargaining and I appreciate the opportunity for my coworkers and I to speak directly with management.
It feels powerful and strong to be able to confront management together with the reality of our working conditions.
Additionally, we have done our most recent bargaining sessions in-person. I really like these face-to-face sessions because you can really see all the non-verbal communication, and they require a deeper level of focus and engagement than bargaining over Zoom.
What’s your advice to other nurses who might be interested in getting involved in bargaining?
There will never be a perfect workplace but, no matter how much you complain to your coworkers, if you don’t take action and participate, things will never change. You have to actually work together with your coworkers to improve your workplace and win a contract that protects your rights.
It takes guts, commitment, and time. But if you really know what you’re fighting for and you really want something to change, then you just have to go for it!
At last fall’s NUHW Leadership Conference you co-instructed a continuing education course for nursing service staff. What was that experience like?
It was so much fun! I co-instructed with an awesome nurse from Fountain Valley Regional Medical Center in Southern California. It was great to connect with nurses from across the union and the state. I was able to share insights from my nursing speciality and also learn from other nurses and workers in different roles like CNAs. And it was a good way to overcome a fear of public speaking!