Tireless advocate for person-centred care and more equitable integration of palliative care approach

Mahoganie’s story

It’s a pretty safe bet that Mahoganie Hines is the only pioneering nurse who started out studying fashion design with a dream of becoming a tattoo artist. When having completed that fashion course Mahoganie bought a one-way ticket to Australia, from her native Canada, any prospect that she might one day become a leading light in palliative care nursing was slim.

It took a chance meeting in the bar where she was working in New Zealand (where she’d moved on to from Australia), to start Mahoganie on the nursing pathway. A regular customer asked if Mahoganie would like to visit her mother with dementia in her care facility.

“I certainly didn’t think nursing was something I’d go into. I didn’t take science in high school and I really didn’t think I had the skills for it. But I did love old people and so I thought I would give it a try.”

Mahoganie developed a relationship with the lady and as she watched the nurses in the care unit go about their business, she began to think it was a job she could do.

She returned to Canada and went to nursing school. Whilst there, she worked part-time caring for an elderly woman. “During this time I learned about palliative care. The more I learned, the more it spoke to me. It just felt to me that palliative care was what nursing care was meant to be; it’s the epitome of the values that are entrenched in us in nursing school.”

So determined was Mahoganie to pursue the palliative care path, that upon graduating she turned a full-time post in a local hospital for a part-time, lesser paid job in a hospice.

Incredibly, after a short time, she applied for and secured the job she still holds today – Palliative Pain and Symptom Management Consultant. Her role is split. She spends half her time teaching health providers and volunteers, and half in consultation across 16 care homes in Niagara, for whom she is a main clinical resource, providing them with critical support on challenging issues like pain or life limiting diagnosis.

That’s just the day job. Her influence extends way beyond her immediate remit of the 16 care homes she supports on a day-to-day basis. She is Executive Nursing Officer for Policy and Political Action for both the Niagara Chapter and Palliative Care Nurses’ Interest Group of the Registered Nurses’ Association of Ontario (RNAO) which represents 40,000 nurses. Mahoganie is also a governing board member of the Canadian Hospice Palliative Care Nurses’ Group, and a member of two national task groups for advance care planning.

Mahoganie contributes her expert knowledge in the development of evidence-based nursing resources, which have international impact. She sat on the expert panel of RNAO’s Best Practice Guidelines Committee, revising the most current version of guidelines about end of life care.

Mahoganie has earned many accolades for her remarkable work. In 2018 she was awarded the RNAO President’s award for leadership in clinical practice, and earlier this year she was honoured as one of Niagara Ontario’s ‘40 under 40’.

What drives you to make a difference?

“In my opinion it is our responsibility as health care providers to talk about the inequities we see. And we see so many, especially when it comes to palliative and end of life care, because people’s fear prevents them from confronting the issues until the last minute when they really need it. Because we have a voice, it’s up to us to use it for those people that maybe don’t have a platform.”

As well as advocating for others, Mahoganie is committed to enabling people to advocate for themselves. “As a white, straight, professional woman, I have a responsibility to try and create a platform for people who are marginalised.”

It was in pursuit of this goal that Mahoganie successfully introduced a resolution affirming palliative care as an issue of public health at the 2017 annual meeting of the RNAO.

“It can be a postcode lottery with some people having access to really excellent palliative care, whereas others, particularly in rural and indigenous areas, really don’t. These are things we really have to acknowledge and address.”

She has spoken at Ontario’s legislative assembly in support of the Compassionate Care Act, about the need for equitable and accessible palliative care. This intervention was an inspiration for countless people who are not accustomed to hearing nursing voices at the highest level of health policy.

Mahoganie is taking the public health approach a step further and in her masters is hoping to address substance abuse as a life-limiting illness and treat it with trauma-informed care, as well harm reduction and a palliative care approach. This she believes would be much more effective than the traditional approach, thereby reducing morbidity.

What can  palliative care nursing offer the wider profession?

Mahoganie is passionate about what palliative care nursing can teach every other nursing discipline, believing that adoption of its principles could have a hugely positive impact on all types of other nursing, resulting in vastly improved outcomes for patients.

“The flaw in the system is that there is a complete lack of competence when it comes to every other area where palliative care interacts. For example, in labour delivery, mental health and paediatric care. Any area of health care will be impacted by people dying and the component is often missed. It’s really the essence of everything we are taught in palliative care.”

There are those in modern nursing who shy away from using the word ‘kind’. Mahoganie believes nurses should reclaim the word with pride.

“It’s not about being nice. Being kind is a general compassion for others. Kindness is one of the underpinning tenets of what I do. I say palliative care is an approach to care, but people are not palliative, the care they receive is palliative and people are people first and foremost. We are not defined by our diagnosis.”

How can nurses strengthen their leadership and impact?

Mahoganie is convinced that nurses can lead and have an even greater impact, but to do that she is adamant that the profession needs greater support.

“We say we value nurses, but actions speak louder than words. I’m hopeful that the pandemic has shone a light on the cracks in the system. I believe it has been illuminating for those who hold the purse strings and that we will see nurses valued more. But they’ll have to prove it with their actions.

My message to nurses is that the most important thing is for us to lean into the discomfort. We have this opportunity where we know what it’s like to live in those grey margins, and we have an opportunity to show people the beautiful work palliative care clinicians do. Because it is really a privilege and honour to care for someone at the end of life as well as their family.”

Mahoganie Hines
Ontario Canada