Beginning a Career in End-of-Life Care

Jessica Mauleon, BSN, RN, CHPN, born and raised in Chicago, jumped at the opportunity to stay in her hometown to pursue a doctoral degree at the Rush University College of Nursing. The inspiration and work ethic that propelled her life journey, though, originated many miles away.

Mauleon’s parents emigrated to the U.S. from western Mexico, becoming U.S. citizens a year before she was born. They also brought to the U.S. their own parents, who received compassionate end-of-life health care that left a lasting impression on Mauleon.

Now Mauleon is a hospice nurse set to graduate with a doctor of nursing practice degree from the College of Nursing’s Adult-Gerontology Primary Care Nurse Practitioner program, which is ranked No. 1 in the nation by U.S. News & World Report. She recently talked to us about her upbringing and how it shaped her career goals.

Tell us a little bit about your background and what led you to nursing.

I received a bachelor’s of science in nursing from Northern Illinois University in 2010. Prior to that, my interest in health care really solidified when I was 16 years old and started working at a community hospital as a dietary aid. I was really struck by the level of compassion and competence the nurses possessed.

One of the first classes I took after high school was a certified nursing assistant course, and I worked as a certified nursing assistant as an undergrad. That helped me gain direct patient care experience and learn what it’s like to work with a health care team. That only affirmed my decision to pursue a nursing career.

Also, my parents are from Mexico, and they weren’t able to pursue an education past high school, so they really instilled in my siblings and me the importance of hard work and the benefits of education. Because they were unfamiliar with that college-bound process, my siblings and I were really hard-pressed to navigate the education system. With those barriers I faced as a first-generation student — social, cultural and academic — I drew the parallel early on to the importance of caring for underserved patients and families, and helping to meet their health care needs in a system that’s sometimes fragmented.

How else has your family background shaped who you are?

Both of my parents were able to become U.S. citizens because the Immigration Reform and Control Act of 1986 passed. That was the year before I was born. If they had come after the act was passed, they wouldn’t have been able to become U.S. citizens.

We were so lucky and blessed. It meant that my family could all stay together, because a lot of my extended family had come around the same time as well, and they were all able to become U.S. citizens. That meant I was able to spend time with my grandparents.

On my dad’s side, my grandma had Parkinson’s disease and my grandpa ended up passing away from lymphoma, and both of them required end-of-life care. That really helped me understand the significance of the palliative care team that worked with them and were experts in managing the symptoms my grandparents were facing. That experience solidified hospice as something that I would want to do.

And now you work in hospice on an end-of-life care team?

Yes, I work closely with a home health care team that is affiliated with several local hospitals. My role as a hospice nurse is to evaluate if a patient’s case is appropriate for hospice services, and I also offer hospice education and support to patients.

I’m working closely with the primary care provider, whether that’s a nurse practitioner or a physician, and we make sure the patient is comfortable and they have dignity and quality of life near the end of their life. A big misconception is that hospice care is very limited in what it can do, but there’s so much knowledge and so much expertise in keeping someone comfortable until the end of their days.

What led you to Rush?

When I graduated from nursing school I knew at some point I wanted to go back. I knew that the doctor of nursing practice program at Rush would be perfect, because not only are you providing direct patient care, but you’re also influencing entire populations by conducting quality improvement projects.

Rush also has a nationally renowned medical center, and it didn’t hurt that it’s close to home.

Tell us about your experience at Rush and the Adult-Gerontology Primary Care Nurse Practitioner program.

The DNP faculty actively practice as nurse practitioners. In the classroom they offer real-world experience and really help you and push you to that next level. That’s been a big thing for me: having that level of support from the staff, knowing that they’ve achieved great things and knowing that they’re pushing for you to do the same.

What is the focus of your doctoral project?

A passion of mine is to improve advance care planning and increase advance directive rates in primary care. At my current job, I’ve been able to look at the evidence, and it demonstrates that there’s a strong correlation between higher hospital readmissions and a lack of advance directives. Unfortunately, right now, most health care professionals still lack the skill to discuss end-of-life care planning.

So in my doctoral project, I’m using what’s called a Respecting Choices model, a communication approach that is proven to increase advance directive rates. I’ve been able to use this framework to create policies and educate our interdisciplinary health care team of nurses, social workers, physical therapists and occupational therapists.

So far there have been positive results, and there are more patients who are having these conversations and getting advance directives completed.

What are your plans for after you graduate?

I look forward to being a patient’s primary care provider and being able to follow their health for a long period of time. I also hope I can merge my interest in geriatrics and palliative care.

Another goal I have is to lobby for the coordination of health care programs for patients nearing end of life. Right now the quality of health care, specifically for end of life, varies greatly in the U.S., so I hope I can help reduce the disparity, especially for patients who are minorities.

Do you have any advice for any students interested in pursuing your path?

Get involved, join national nursing organizations and seek leadership opportunities. You need to be able to demonstrate that you want to advance the nursing profession, and you also have to offer clear examples of how you’re striving for excellence.