Hospice Nurse Career Guide

    May 29, 2020
    Hospice Nurse Career Guide

    Though many think of hospice nursing as a difficult or even depressing job, those who have chosen it as their career speak in glowing terms of how much they love what they do and how rewarding their experience is. Hospice nurses care for patients in their final weeks of life, providing both acute clinical care and compassionate palliative care meant to deliver a high quality of life and to help them and their families as the end draws near. 

    Being a hospice nurse is not for everybody, but if you find the role compelling there are many questions you need answered. To help you make this important decision we’ve put together a helpful guide to provide you with the information you’re looking for including what a hospice nurse does, how much you can make, and how to become one.

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    Part One What is a Hospice Nurse?

    Hospice nurses are Registered Nurses that completed either an ADN or BSN and have been trained to work with terminally ill patients. They have many roles, providing comprehensive care for patients who are in their last weeks of life, as well as support for their caregivers and loved ones. While providing critical hands-on care to patients, they also guide them and their families through the end-of-life transition. 

    Their role requires strong clinical skills so that they can constantly assess, evaluate and respond to their patient’s needs, and strong communication skills so that they can provide valuable information to the rest of the care team and educate the patient and family as to what each development means. 

    The work of hospice nurses is distinguished from other types of nursing in that there is no expectation that the patient will improve. Rather the care they provide is meant to provide an improved quality of life, to diminish pain and to increase comfort, as well as to provide emotional and spiritual support to the patient and to those around them.

    Though hospice nurse duties are not curative, they are clinically rigorous. They are constantly assessing and evaluating their patients’ conditions both to react to them appropriately and keep the medical team, spiritual professionals and the family aware of any changes or transitions. They assist with patient hygiene and medication, managing symptoms and easing pain while at the same time educating the family about what to expect and acting as their advocate as they manage the various decisions involved with end-of-life.

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    Part Two What Do Hospice Nurses Do?

    As the lead caregivers for terminal patients during the final stages of their lives, hospice nurses provide for all of their patient’s medical needs with an eye towards maintaining the highest quality of life and comfort. They work one-on-one with their patients in a variety of settings that can include the patient’s home, a hospice center, a hospital or skilled nursing facility, or a nursing home. They establish real and meaningful relationships with their patients in their last weeks of life, as well as with their family members and other caregivers.  

    Hospice nurses’ roles and responsibilities are wide-ranging and can include the tasks listed below and many others as well.

    • Patient assessments for admission into hospice
    • Evaluating patient needs
    • Providing compassionate end-of-life education regarding hospice care to both patient and their family and caregivers
    • Ensuring that any medications or specialty care equipment that the patient needs is available
    • Wound care
    • Administration of medication
    • Documentation of all care
    • Communication of patient status and changes in condition to the rest of the hospice team
    • Responding to emergency calls 
    • Acting as liaisons to other caregivers and spiritual guides
    • Providing emotional, psychosocial and spiritual support to patients and family
    • Providing respite care for family caregivers

    Part Three What is the Average Salary for a Hospice Nurse?

    The work that hospice nurses perform is invaluable and is rewarded by solid salaries throughout the country. Though the pay scale for hospice nurses varies based upon where in the country they work, the years of experience and level of education they have, and the certifications that they’ve earned, according to the U.S. Bureau of Labor Statistics (BLS) the median salary for a registered nurse in 2019 is $73,300 per year, or $35.24 per hour, but conditions in your area may vary. The BLS doesn't list the specific salary for hospice nurses, however; ZipRecruiter.com surveys reveal an average national salary of $81,417, with only a $21,000 swing between the 25th percentile and the 75th percentile. This small variation reflects significant consistency in the compensation that hospice nurses make around the country. 

    In addition to salary, hospice nurses are also likely to receive a range of benefits that include medical and dental insurance, tuition reimbursement, paid sick leave and vacation leave, and other perks including access to discounted childcare, life insurance and prescription insurance coverage.

    Part Four How Do You Become a Hospice Nurse?

    Though many of the skills and personal characteristics that make a good hospice nurse come naturally, there is still a significant amount of education and experience required before taking on this invaluable role. Hospice nurses care for critically ill patients, and therefore need expertise in evaluation and assessment, as well as to be clinically capable to respond quickly to bedside emergencies and provide pain and symptom relief. 

    The total timeline expected for becoming a hospice nurse is:

    • 2-5 years to earn ADN, BSN or MSN degree
    • Pass NCLEX-RN exam
    • 3 years working in an acute care setting 

    Step 1: Become a Registered Nurse

    In order to ensure that they are qualified for their role, those who aspire to become hospice nurses begin by becoming a registered nurse. This can be done by graduating with an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing. Some nurses may decide to invest an additional year to earn a Master of Science in Nursing (MSN), which is increasingly preferred by many healthcare employers. After earning your degree you will need to pass the NCLEX-RN exam in order to become a licensed registered nurse in your state.  

    Step 2: Gain 2-3 Years of Experience

    After meeting these educational requirements, nurses who want to work in hospice will need to gain essential experience in an acute care setting. Whether this is provided by working in an Intensive Care Unit, an Emergency Department or another setting, spending a minimum of two to three years in these high-needs environments will expose you to patients who need immediate assessment, attention and management. You’ll learn the clinical skills that you’ll apply to patients in hospice as well as your own threshold for stress, developing the coping mechanisms that every hospice nurse needs to face the eventual loss of each of their patients.

    Step 3: Get Certified

    Nurses who want to distinguish themselves in hospice care are also advised to pursue any of the certifications offered by the National Board for Certification of Hospice and Palliative Care Nurses (NBCHPN). These certifications are offered for a variety of positions and roles within hospice and palliative care, and those appropriate for registered nurses include:

    • Certified Hospice and Palliative Care Administrator (CHPCA)
    • Certified Hospice and Palliative Nurse (CHPN)
    • Certified Hospital and Palliative Pediatric Nurse (CHPPN)
    • Advanced Certified Hospice and Palliative Nurse (ACHPN)

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    Part Five What is the Career Outlook for Hospice Nurses?

    Nurses considering hospice as a career need not include job stability in their list of concerns. In addition to the continued national nursing shortage, there is remarkable growth in the use of and need for hospice in the United States. 

    According to a report in the New England Journal of Medicine, for the first time since the early 20th century, more Americans have chosen to die at home than in the hospital. And the journal Hospice News reported that more than half of Medicare patients who died in 2018 did so while in hospice. Much of this has to do with the rapid aging of the population combined with the increased acceptance of palliative measures. 

    Part Six What are the Continuing Education Requirements for Hospice Nurses?

    Once a hospice nurse has been certified as a Certified Hospice and Palliative Nurse, they need to be recertified every four years through the Hospice and Palliative Accrual for Recertification process. 

    Recertification involves a series of steps and benchmarks, including meeting practice hour requirements and participating in a variety of professional development or continuing education activities. They also must complete the Situational Judgment Exercise (SJE), which is meant to ensure that the hospice nurse is still capable of dealing with the real-life clinical situations that hospice nurses face every day.

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    Part Seven Where Can I Learn More About Becoming a Hospice Nurse?

    Hospice nursing is a specialty area that is unique, and nurses who are interested in pursuing this career can learn more about the role by seeking guidance from the numerous organizations, societies and agencies that support this specialized field. These include:

    You can also find helpful articles on the Nurses.org website, including these:

    In addition to clinical excellence, hospice nursing requires a tremendous level of dedication and a deep well of emotional resilience. But nurses who work in this specialty say that the challenges that the career holds are far outweighed by the rewards, and their patients and their families agree. 

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    • What is a hospice nurse?

      •  Hospice nurses provide care to terminal patients in the final weeks of their lives. They have clinical duties for hands-on care ranging from patient assessment to providing medication and symptom relief, but also provide emotional and practical support to families as they deal with the realities and grief of losing their loved one.
    • How do you become a hospice nurse? 

      • Hospice nursing begins with becoming a Registered Nurse, either by graduating with an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) and then passing the National Council Licensure Examination (NCLEX-RN). Following that nurses should gain a few years of clinical experience in an acute care setting and pass the Hospice and Palliative Nurses Certification Exam.
    • Is it hard to be a hospice nurse? 

      • Hospice nursing has both advantages and disadvantages. Those who practice as hospice nurses say that it is an emotionally rewarding experience to be able to offer comfort and support to people when their needs are greatest, but they also admit that there is significant grief and that the work can take an emotional toll.
    • What makes a good hospice nurse? 

      • A good hospice nurse possesses all of the skills needed for any acute care nursing position, but also the personal characteristics of honesty, patience and empathy. The position requires critical thinking skills and organizational skills and great attention to detail, but more than anything else it requires resilience and a deep well of compassion. 

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