James Mara, Hospice RN Case Manager at Anchor Hospice & Palliative Care, has been named to the Frontline Honors Awards Class of 2025 by Hospice News.
To become a Frontline honoree, an individual is nominated by their peers. The candidate must be:
- A dedicated, high-performing frontline worker who delivers exceptional experiences and outcomes
- A passionate worker who knows how to put their vision into for the good of their respective industry, the patients and residents they serve, and their families
- An advocate for their industry and their fellow colleagues
Hospice News recently caught up with Mara to discuss his time in the hospice & palliative care industry.
HSPN: What drew you to this industry?
Mara: My grandmother was the biggest inspiration and driving force behind my hospice career. During the COVID-19 pandemic, she became terminally ill. Looking back at that time, I will never forget how uncomfortable and symptomatic she was. Her care team never mentioned hospice, and I truly believe she suffered during her final moments. I always wondered what we could’ve done differently and how that could’ve been handled better.
After finishing my Bachelor of Science in Nursing (BSN) RN program, a close friend recruited me to her hospice agency. I began to learn more about end-of-life care and have devoted my entire nursing career to this specialty ever since.
HSPN: What’s a misconception you had about this work before you started – and how has reality differed?
Mara: I once believed hospice was only necessary when imminent death is near. Now I know that’s already considered late.
Poor or terminal prognosis is a progressive journey that requires an interdisciplinary team to support the patient and family as a unit throughout the entire process. It starts the moment there are enough prognostic indicators to certify for hospice services.
I believe starting early, when appropriate, also gives an opportunity for the family to prepare, cope with anticipatory grief, and identify bereavement needs.
HSPN: Was there a moment in your career when you realized, “This work really matters”? What happened?
Mara: I’ve had those moments many times in my career. Unfortunately, these moments mostly happen when families begin to withdraw and engage less with the patient towards the end. It could be for a variety of reasons: poor coping, busy schedule, etc. It can be quite lonely for these patients.
During my visits, I can see how much my time, companionship, and acknowledgement means to them. It brings me to tears just thinking about that human experience and the importance of that connection. My patients never failed to make me feel appreciated through their words, gestures, or body language. Seeing the joy our interaction brings them is all I need to feel like my work matters.
HSPN: What’s the most valuable skill you’ve developed on the front lines that people often overlook?
Mara: Hospice RN case management requires many skills that may never fully develop, even with time. It is a difficult nursing specialty. I cannot limit it to just one because there are two that go hand-in-hand: communication and problem-solving skills.
Communication is necessary to achieve goals because it builds trust and provides the clarity necessary to create strong collaborative efforts. Problem-solving skills are essential because symptom management needs to be done in a timely and effective manner. These two skills improve quality, patient-centered care and foster success within the industry.
HSPN: What’s one decision leaders make that has a bigger impact on frontline workers than they might realize?
Mara: Leaders that actively monitor to prevent burnout or fatigue are important. This can be accomplished through effective staffing decisions. Work needs to be distributed in a realistic way that maximizes everyone’s abilities instead of only relying on a select few. The impact this has on work-life balance is tremendous and greatly reduces turnover rates.
HSPN: What’s a simple change – policy, tool, or mindset – that would make frontline work more effective?
Mara: A proper mindset or attitude can go a long way. I believe the most important thing is to limit striving for perfection and focus solely on being of service.
Symptom management is not a perfect process. Interventions or medications are often played by ear. The outcome isn’t always what we expect or want. That can be discouraging and frustrating! However, it’s important to remember that one person cannot solve or do everything alone. We are part of a team!
Hospice team members work together in an attempt to minimize problems. We can’t resolve everything 100% all the time. The goal is not to do things perfectly, but to be of service and simply try our best.
HSPN: What gives you optimism about the future of this industry, despite its challenges?
Mara: Regardless of the views people hold towards death and dying, end-of-life care is absolutely essential. It is a natural process that is unavoidable. Hospice is a specialty that requires a specific team to care for patients properly. That perpetual need will always drive positive changes to promote better outcomes.
