Hospice nurse complete career guide

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What does a hospice nurse do?

A hospice nurse is a specially trained registered nurse (RN) who cares for patients at the end of their lives. This role involves helping patients and their families feel more comfortable through the end-of-life transition. They provide individualized care focused on quality of life tailored to each patient’s needs.

The job responsibilities of a hospice nurse may vary from patient to patient but generally can include:

  • providing end-of-life education to patients and families
  • ensuring appropriate medication administration
  • assessing patient’s healthcare vitals and comfort level
  • communicating the patient’s status with the hospice care team

The role is not curative but involves many clinical duties. In contrast with other types of nursing roles, there is no expectation that the patient will recover. Nonetheless, hospice nurses are expected to make the patient as comfortable as possible through medical and non-medical interventions. A hospice nurse can also serve as a liaison person to other caregivers or spiritual guides and provide emotional support to patients and families.

Hospice nurses can work in a variety of settings ranging from hospitals, skilled nursing facilities, and specialized hospice centers. As the role focuses on making a patient’s remaining days comfortable, the patient’s home is often the desired setting and hence the hospice nurse will come to the patient.

The use of medicine is not the only tool that is critical in this area of healthcare.  Being able to listen and stay present during the dying process can mean a less emotionally and physically painful experience for patients and their loved ones.

As one of the lead caregivers for terminal patients in the final stages of life, hospice nurses can also be responsible for educating families on what to expect and ensuring that they are included in the care process if they want to be. To do this, a hospice nurse can teach families what and how to monitor symptoms and alleviate discomfort. Changes in the patient’s status is constantly communicated with the hospice team and family to determine how best to proceed with patient and family wishes.

A hospice nurse has the clinical knowledge and skills of a nurse in an acute care setting.  Their personal traits include being compassionate, honest, patient and empathetic. Some hospice nurses consider their role to be a higher-level calling. This role goes beyond being simply caring. It taps into feeling honored to hold someone’s hand in their time of death, experiencing the value of selflessness, and understanding healing even in dying. It is not a path for those who are faint of heart or for those have a difficulty dealing with loss.

How to become a hospice nurse

The first step to becoming a hospice nurse is to become a RN and to gain experience in an acute care setting. To do this, individual must first earn a bachelor’s of science in nursing (BSN) or an associate degree in nursing (ADN) and pass the National Council Licensing Examination for Registered Nurses (NCLEX-RN).

Associate degree in nursing (ADN)                                                       

The ADN curriculum is comprised of 2-3 years of general education and clinical training. Approximately 70 credits are required for the degree, although requirements vary by program. Coursework typically includes:

  • health assessments
  • medical and surgical care
  • microbiology
  • immunology
  • general courses like English, biology, chemistry and psychology

Prerequisites to an ADN program vary but generally consist of:

  • a high school diploma or completion of a GED program,
  • school transcripts  
  • minimum GPA of 2.0
  • prerequisite courses such as algebra, chemistry or microbiology

Some programs may require an entrance exam in addition to or in lieu of prerequisite courses. As a nurse you are in close contact with others and have to ensure your own health status. A health assessment is required to confirm that. CPR and basic life support certifications may be required prior to enrolling in a program or may be offered to incoming students.

Bachelor’s in science in nursing (BSN)                                                      

The curriculum for a BSN program combines general education and clinical training courses. The degree entails approximately 120 credits, although there are slight variations between programs. Coursework is similar to that listed above for the ADN program, although will be more in depth. 

Prerequisites to a BSN program can include:

  • chemistry and lab coursework
  • microbiology
  • anatomy
  • physiology
  • liberal courses such as social sciences, arts, communication, English literature
  • GPA minimum of 3.0
  • personal statement
  • letters of recommendation
  • previous experience in healthcare

Some programs are available with part-time and online components, although clinical and lab-based subjects require in-person attendance.  Look to the individual program you are interested in applying for to check degree program flexibility.

Specializing as a hospice nurse

After becoming a registered nurse, those who aspire to becoming hospice nurses will need to gain 2-3 years experience working in a clinical acute care setting such as an intensive care unit or emergency department at a hospital.  This period will allow the nurse to gain the essential skills needed in hospice care, and to also evaluate how they cope in high-stress situations.

Following this period, nurses can apply for admission to certification courses provided by the National Board for Certification or Hospice and Palliative Care Nurses (NBCHPN) or Hospice and Palliative Credentialing Center (HPCC).  The HPCC offers six different certificate programs relevant to healthcare professionals working in palliative and hospice care:

  • Certified hospice and palliative care nurse
  • Certified in perinatal loss care
  • Certified hospice and palliative care pediatric nurse
  • Advanced certified hospice and palliative care nurse
  • Certified hospice and palliative care administrator
  • Certified hospice and palliative licensed nurse

Certification needs to be renewed every 4 years by the Hospice and Palliative Accrual for Recertification process to ensure that the nurse is following up-to-date nursing practices and protocols and that they are psychologically able to continue dealing with the stress of the role.

Why pursue a career as a hospice nurse? 

Someone with vast clinical care experience seeking a different healthcare focus may choose to become a hospice nurse. This role may be a shift from managing multiple patients to a single patient. A nurse pursuing a more holistic and patient-directed approach to care may want to purse this path.

There are opportunities to advance to higher management roles for individuals with vast experience in the field of hospice nursing and a passion for leadership and guidance of other hospice nurses. These roles are mostly internal to the setting where a nurse may have spent years practicing as a hospice nurse.

Who might not be best suited for such a career? Hospice nurses are required to be able to move and lift their patients if necessary, therefore the role is not suited for individuals with limited mobility. Individuals unable to remain composed in the presence of death or unable to cope with high stress may also not be suited to this career.

This role may be suitable for career-change nurses hoping to make an impact in a different healthcare focused setting. A seasoned nurse with years of acute care experience would be more suited for the position. A recent nurse graduate is advised to first focus on gaining more clinical experience needed to succeed as a hospice nurse.

Career flexibility

Being a hospice nurse can sometimes be on a part-time basis, which can be an advantage to nurses with young families.

There may also be the option of opening your own hospice care agency.  Research into legislation on state and national healthcare regulations, including insurance, would be required before making this a future plan.

Hospice nurses also find positions working in other industries such as pharmaceutical companies, health insurance offices, and managed care agencies. 

In 2021, the average hourly rate of pay for a hospice nurse is $30.25.

Final words

A hospice nurse in an advocate for a patient’s final life wishes, who provides support to patients and their loved ones in their time of need. Hospice nurses help patients continue to live life to the fullest as much, and as safely as possible. This role is suitable for someone interested in healthcare, with a focus on quality of life until the very end of life.

Advancing Expert Care

The organization represents the specialty of palliative nursing, which includes hospice and palliative nurses. They support the profession through education programs, research initiatives, and advocacy.

National Hospice and Palliative Care Organization

The nations’ largest membership organization for providers and professionals who care for people affected by serious and life-limiting illness. Its members include local hospice and palliative care providers.