What is Hospice Nursing? The Ultimate Guide
Hospice care is an increasingly popular option for people nearing the end of their lives. In fact, according to the National Hospice and Palliative Care Organization, the number of people receiving hospice care increased more than seven times—from 210,000 to over 1.5 million— between 1990 and 2013. Likewise, the number of hospice providers increased by more than three times—from 1,600 to 5,800—during that same period.
Do you see yourself working as a hospice nurse? In this ultimate guide, you will learn everything you need to know about this nursing specialty to help you decide if hospice nursing is for you.
What Does Hospice Mean in Medical Terms?
Hospice is the compassionate care offered to people in the final stages of life-limiting illnesses. This type of care neither attempts to hasten nor postpone death; it generally begins when patients are expected to live for six months or less. The purpose of hospice care is not to cure illnesses but simply to treat symptoms and manage pain so that patients can live as comfortably as possible. It is essential to understand that although treatment is not aimed at curing an illness, patients may still receive medication and treatments to improve their quality of life.
Hospice care is an essential service that people are choosing increasingly often. Hospice patients are more likely to receive adequate pain management and are less likely to undergo unnecessary tests and procedures than people who are not in hospice. Family members of hospice patients also tend to be more satisfied with the end-of-life care their family members receive compared to families who do not receive hospice services. Considering all these advantages, it is unfortunate that many people do not begin hospice care as early as possible.
Although most hospice care is offered in homes, it is not tied to a specific location. It also may be provided in hospitals, nursing homes, assisted living facilities, or hospice centers. Regardless of location, hospice may be covered by Medicare and other insurance companies.
Since most hospice recipients live at home, care is primarily provided by family members and friends. However, a hospice care team visits hospice recipients often, coaches family members on offering appropriate care, and takes over care for periods (anywhere from hours to weeks) to give primary caregivers a break. Furthermore, someone is usually available over the phone around the clock.
What Does HH Stand For?
The abbreviation HH is often used in hospice care, but it stands for home health. Although home health is not synonymous with hospice, most hospice care is offered in recipients’ homes and therefore falls under the category of home health care. Another term that often overlaps with hospice care is palliative care. Palliative care refers to the treatment of symptoms and is offered to patients with serious illnesses. However, patients receiving palliative care may also receive treatment for their diseases, whereas hospice recipients, by definition, no longer receive treatment aimed at curing their illnesses.
What Is a Hospice Unit in a Hospital?
Even though most hospice care is provided in recipients’ homes, hospitals often have hospice programs and may even have hospice units to help manage symptoms, especially pain, when these symptoms cannot be controlled in the home setting. Hospice programs give patients and their family members access to support services and offer around-the-clock care to help manage patients’ symptoms. This care may be provided in hospice units or may be offered by hospice teams in recipients’ homes. Hospitals that don’t have hospice units treat hospice patients in other wards, and that ward’s staff acts as a hospice team. Patients usually leave the hospital once they are comfortable and continue receiving hospice care at home.
Hospice care in the hospital setting may include the following components:
- Palliative care
- Coordination among the hospice team, the patient, and family members
- Support for family members, including the presence of a hospice nurse at the time of a patient’s death
- Grief follow-up for the family
The Hospice Care Team?
Regardless of location, a hospice care team usually includes the following members:
- Doctors: Hospice recipients can choose a primary care doctor to oversee their care.
- Nurses: Hospice nurses coordinate care with other members of the care team. They also visit recipients in their homes to provide care.
- Home health aides: Home health aides assist patients with activities of daily living, such as eating, bathing, and dressing.
- Spiritual counselors: Spiritual counselors of any religion or other belief system provide spiritual care and guidance for the whole family.
- Social workers: Social workers provide counseling, support, and referrals to other support systems.
- Pharmacists: Pharmacists oversee recipients’ medications and suggest effective ways to relieve symptoms.
- Volunteers: Volunteers may provide company for recipients or a break for caregivers and help with transportation or other practical needs.
- Other professionals: If needed, speech, physical, and occupational therapists may provide therapy.
- Bereavement counselors: Bereavement counselors support and guide family members after the death of hospice recipients.
What Is the Role of a Hospice Nurse?
All hospice nurses care for people who have a life expectancy of six months or less and have chosen hospice care. They focus on making recipients comfortable and offer them individualized care. Nevertheless, hospice nurses may carry out significantly different roles.
Admission Nurse
An admission nurse is one of the first persons in a hospice organization that potential recipients meet. This nurse will work closely with each patient’s physician to help determine whether patients are eligible for hospice care. If a patient is eligible for hospice care, an admission nurse will provide compassionate education regarding the hospice care philosophy and the type of care they can expect. An admission nurse will also help formulate a care plan for hospice recipients and may order any equipment or medications the patient might need.
Case Managers
A hospice case manager coordinates a patient’s care throughout their time in hospice. They work closely with the rest of the hospice team, making decisions regarding patient care and the allocation of resources. These decisions include determining what education, care, and counseling a hospice recipient’s family members need.
Visit Nurses
Visit nurses supplement the care provided by case managers. They provide routine care, such as administering medications and documenting care.
Triage Nurses
Triage nurses work remotely, assisting patients or their caregivers in case of an at-home emergency. When they get a call, they assess the situation to understand the patient’s needs and advise care. They also inform the hospice case manager, the visiting nurse, and the patient’s doctor to determine whether a visit is necessary.
Hospital Liaisons
Hospital liaison nurses work closely with hospitals, private care organizations, other healthcare professionals, and patients to help connect patients with relevant organizations and provide them with the best possible care. These nurses work closely with patients and their families to help them enroll in hospice and help patients receive the care they desire.
What Does a Hospice Nurse Do?
Although duties vary depending on each hospice nurse’s role, here are some responsibilities that hospice nurses have in common:
- Perform patient assessments and review medical histories
- Discuss and explain a patient’s prognosis
- Manage pain
- Monitor vitals
- Ensure patients’ living spaces are safe
- Obtain the necessary equipment and medication
- Educate patients and family members regarding patient care, the disease process, and the hospice philosophy
- Create care plans
- Supervise other nurses and certified nursing assistants (CNAs)
- Collaborate with other healthcare providers
- Confirm the death of hospice recipients
How to Become a Hospice Nurse?
Nurses at all levels of qualification may work in hospice. Hospice care requires certified nursing assistants (CNAs) to assist patients with activities of daily living, such as eating, bathing, and dressing. Licensed practical nurses (LPNs) are required to assist registered nurses (RNs) with monitoring patients, maintaining records, and providing basic treatment. Registered nurses care for patients and also serve as case managers and patient advocates. Finally, nurse practitioners (NPs) often serve as liaisons between doctors and nurses and make recommendations regarding patients’ eligibility to remain in hospice.
Since many different types of nurses may work in hospice, becoming a hospice nurse depends on the path each person chooses. According to the US Bureau of Labor Statistics, here are the requirements for entry-level hospice positions:
- CNAs require post-secondary non-degree awards.
- LPNs also require post-secondary non-degree awards.
- RNs require associate’s or bachelor’s degrees in nursing.
- NPs require master's degrees in nursing.
That said, each job opening may have different requirements. A job opening for a hospice RN may give preference to RNs with bachelor’s degrees in nursing or nursing certifications. Furthermore, some facilities may require one or two years of work experience. Finally, most hospice positions require nurses to have valid driver’s licenses as well as their own insured cars.
Hospice Nurse Certification?
The Hospice & Palliative Credentialing Center (HPCC) offers various certification options for hospice nurses with different levels of education.
- Experienced hospice and palliative advanced practice registered nurses (APRNs) are eligible for the Advanced Certified Hospice and Palliative Nurse (ACHPN®) examination.
- Experienced registered nurses can take the Certified Hospice and Palliative Nurse (CHPN®) examination.
- Experienced hospice and palliative pediatric registered nurses can obtain the Certified Hospice and Palliative Pediatric Nurse (CHPPN®) credential.
- Experienced hospice and palliative licensed practical/vocational nurses are eligible for the Certified Hospice and Palliative Licensed Nurse (CHPLN®) examination.
- Experienced hospice and palliative nursing assistants are eligible for the Certified Hospice and Palliative Nursing Assistant (CHPNA®) credential.
Furthermore, HPCC offers additional examinations for nurses wishing to maintain credentials through recertification.
- Certified Hospice and Palliative Care Administrator (CHPCA®)
- Certified in Perinatal Loss Care (CPLC®)
Finally, in addition to hospice certifications, hospice nurses should maintain Basic Life Support (BLS) certification.
How Long Does It Take to Become a Hospice Nurse?
The time required to become a hospice nurse varies widely depending on the level of education potential hospice nurses choose. Potential nurses can become CNAs in just four weeks, LPNs in as little as one year, RNs in two to four years—depending on whether they complete associate’s or bachelor’s degrees—and APRNs in four to six years or more. Furthermore, hospice nurses who decide to pursue certification must contemplate an additional one or two years of work experience before certification.
Hospice Nurse Salary?
The salary of a hospice nurse depends on many factors, including state and city of residence, years of work experience, certifications, etc. Nevertheless, two main factors can help nurses estimate their salary as hospice nurses: level of education and work setting.
Certified Nursing Assistant Salary
CNAs earn, on average, $33,250 annually, but their salary can vary significantly depending on the facilities where they work.
- General medical and surgical hospitals: $35,190
- Nursing care facilities (skilled nursing facilities): $32,090
- Assisted living facilities for the elderly: $31,520
- Home health care services: $29,930
Licensed Practical Nurse Salary
Licensed practical nurses earn, on average, $51,850 per year. Here are different facilities where hospice LPNs may work and the average salaries in each work setting:
- Nursing care facilities (skilled nursing facilities): $53,670
- Home health care services: $52,670
- Assisted living facilities for the elderly: $52,460
- General medical and surgical hospitals: $48,050
Registered Nurse Salary
Registered nurses earn an average annual salary of $82,750. Here are the average salaries for RNs in different work settings:
- General medical and surgical hospitals: $85,020
- Specialty hospitals, not including psychiatric and substance abuse hospitals: $84,800
- Home health care services: $78,190
- Nursing care facilities (skilled nursing facilities): $72,260
Nurse Practitioner Salary
Finally, nurse practitioners, or APRNs, earn, on average, $118,040 per year. The following salaries represent averages for nurse practitioners in different healthcare settings:
- Home health care services: $133,170
- General medical and surgical hospitals: $122,960
What Is Hospice Nursing Like?
Demand, salary, and nursing responsibilities are all important factors that can help nurses determine if a specialty is right for them. Nevertheless, what matters the most is finding a specialty that is right for each nurse’s personality. These hospice nurse testimonials will help you understand what this specialty is really like and whether or not it’s right for you:
“LPN with 16yrs hospice experience. Have done IPU, CC, admissions and on call. I've seen a lot of staff over the yrs, generally employees either get out within a yr or are long haulers that can't imagine doing anything else…Much of my work is PR, education, emotional support, and simple symptom management…Oddly satisfying to ask a diabetic if they want one scoop or two.” Reddit – u/AddieGSD
“Being a hospice nurse DID change my view of death. It demystified the process. Before becoming a hospice nurse, the dying process was something that you handed off to another department to handle, or something that was fought against until the last possible second…In this branch of nursing, the dying process is embraced, and the nuances of each person's journey is appreciated.” Reddit – u/desertilluminati
Is Hospice Nursing Hard?
Even though many hospice nurses wouldn’t change their jobs for any other, this specialty certainly has its challenges. Here are some of the aspects of hospice nursing that nurses find most challenging:
“I worked at an inpatient hospice facility, and it was tough. Some nights I would have three deaths in one shift…I’ve seen lots of peaceful deaths, but also deaths so horrible, I will never forget them. Also, post Mortem Care can be really difficult. Lots of family dynamic issues too with hospice. It could be a very rewarding and wonderful job, but ultimately, for my mental health, I had to leave my Job, and am much happier working in assisted living.” Reddit – u/ohmicorazoninwv
“Families/neighborhoods...well, I stay aware of my surroundings and even the prettiest houses can have bedbugs.” Reddit – u/AddieGSD
Why Choose Hospice Nursing?
Despite challenges, these are some reasons why hospice nurses love their jobs:
“I love Hospice. I use my brain 10x more than I did in the ICU. You have to figure stuff out without all the data given to you by monitors and lab results. It's like practicing super independently and you have to have really strong communication and nursing skills. Hospice nursing is unlike any other nursing I have ever done (cardiac step down, CVICU, clinical research). I love it!” Reddit – u/osuelf
“Pts are generally wonderful and symptoms fairly predictable. Occasionally itch, hemmorage, diarrhea, N/V, constipation and fever but mostly restlessness, SOB and pain. It's amazing to give meds and actually have the time to provide diversional activities until they kick in. Convo with manicure, pulling out ye old family album etc..” Reddit – u/AddieGSD
What Makes a Good Hospice Nurse: Tips for New Nurses?
Are you a newly graduated nurse considering a job in hospice? In addition to the knowledge and skills acquired during nursing school, here are some abilities and skills that all hospice nurses should develop:
- Stay calm and effective during times of high stress, such as emergencies or when speaking with confused or distressed patients or family members.
- Possess a sensitive attitude toward death.
- Focus on patient comfort.
- Listen to patients and family members.
- Collaborate effectively with others and work well independently as well.
- Work with patients and family members of all ages and backgrounds.
- Be trustworthy and maintain patient confidentiality.
- Meet the job's physical demands, such as lifting and repositioning patients.
- Assess situations quickly and respond appropriately.
- Adapt to changing needs and priorities.
- Communicate effectively orally and in writing.
- Be self-motivated.
- Be organized.
- Prioritize adequately.
- Use electronic medical records.
Final Thoughts on Working as a Hospice Nurse
As with all nursing specialties, hospice nursing is not for everyone. Aspiring hospice nurses should feel comfortable with death, be compassionate, and be respectful of diverse philosophies and values. As you read this ultimate guide on hospice nursing, how did you feel about this specialty? Can you picture yourself being one of the primary sources of support for terminally ill patients in the last months, weeks, or days of their lives? Can you see yourself offering support and guidance to these patients’ family members during the end of their loved ones’ lives and after their deaths?
If you would like to gain more nursing experience before pursuing a career in hospice nursing, consider picking up some per diem nursing shifts in long-term care settings. Working per diem is an excellent way to not only gain experience but also explore different healthcare settings. Each shift gives nurses the chance to explore a new facility or nursing role. Pick up a shift today!
