A hospice nurse cares for patients with a serious illness who are facing end of life. Most reimbursement models for adult patients—including Medicare—require that the patient have a life expectancy of six months or less if the disease process follows its natural course.
The hospice nurse is part of an interdisciplinary team that provides physical, psychosocial, and spiritual support to both the patient and family. In addition to the hospice nurse, interdisciplinary team members may include hospice physicians, social workers, counselors, chaplains, home health aides, volunteers, and other healthcare professionals—such as pharmacists, physical therapists, and speech therapists. The patient’s physician is also part of the interdisciplinary team.
The hospice nurse’s credentials and state practice laws determine the scope of practice permitted. The setting in which care is provided also influences a hospice nurse’s duties. The majority of hospice nurses are RNs, who typically function as case managers coordinating all aspects of the patient’s care. The hospice nurse functioning in this role is responsible for establishing and overseeing the patient’s plan of care and is responsible for supervising LPNs and HHAs who are also caring for the patient.
Hospice care focuses on providing comfort care only, but the hospice nurse may be required to provide highly-skilled types of care to address the patient’s pain and symptom management needs. Although all medications are ordered by the patient’s physician—who may be a hospice physician—it is important that hospice nurses be familiar with calculating appropriate dosages for initiating and titrating pain medications according to the patient’s needs.
Depending on the hospice agency and the services available, hospice nurses may also care for children. When a hospice provides pediatric hospice services, there may be a pediatric hospice nursing staff that specifically cares for pediatric patients.
The duties of a hospice nurse may include:
Assess and monitor the patient’s status
Document the patient’s medical history and symptoms in the patient’s record
Create and update the patient’s plan of care
Collaborate with the patient and family, members of the interdisciplinary team, and other healthcare professionals as needed
Administer medications and treatments—such as wound care
Perform various procedures to address symptoms—such as the insertion of urinary catheters
Operate and monitor medical equipment—such as infusion pumps and oxygen delivery systems
Teach patients and their families about symptom management—including the administration of medications
Provide emotional support to the patient and family—including discussions related to death and dying
Attend the patient’s death to provide support to the family, care for the patient’s body, and to attend to additional details that are necessary at that time—including communication with the patient’s physician, the interdisciplinary team, and the funeral home the patient and family have selected
Provide bereavement support as needed in collaboration with the interdisciplinary team
Depending on the setting in which they work, hospice nurses may be required to share on-call duties to ensure 24-hour nursing coverage for patients in the community. They may also be required to work evenings, nights, weekends, and holidays if caring for patients in a hospice facility.
Although hospice nurses function as part of an interdisciplinary team, they often work independently in the community and must possess a specialized skillset and knowledge related to hospice care. They must have excellent problem-solving skills, be able to remain calm in a crisis, and provide the kind and compassionate support needed by patients at end of life and their families.
How Is a Hospice Nurse Different From a Palliative Care Nurse?
A hospice nurse cares for patients with a life expectancy of six months or less if the disease process follows its natural course. According to Medicare regulations, the patient’s prognosis must be certified by both the patient’s attending physician and the hospice medical director. Additionally, hospice care involves the provision of comfort care only (aka palliative care) to address pain and symptom management needs. It does not include curative care, which is meant to cure an illness or condition.
A palliative care nurse cares for seriously ill patients at any stage of the disease process who need support for pain and symptom management. Unlike hospice patients, patients who are receiving palliative care can continue to receive curative care. Since some hospice organizations also have a stand-alone palliative care program, a hospice nurse may function in both roles.
How Much Does a Hospice Nurse Make Per Year?
According to salary data from the Bureau of Labor Statistics (BLS), the median annual wage for registered nurses was $77,600 in May 2021—with half of nurses earning more than that amount and half earning less. The wages of nurses in the lowest 10 percent were less than $59,450, while the wages of nurses in the highest 10 percent were over $120,250.
The BLS does not provide a pay breakdown according to specialty but does provide median annual wages for registered nurses according to general categories of work location. Since most hospice nurses care for patients in their homes, the Home Health Services category would likely provide the most comparable salary data with an annual mean wage for registered nurses of $78,190 in May 2021.
Although hospice nurses may care for patients in other settings, they are typically not employed by these entities but by the hospice agency—which would determine salary ranges for all nurses on staff.
The salary of a hospice nurse is also influenced by factors such as education, experience, and geographical region of the country.
Since most hospice patients receive care in their homes, this is the setting in which a hospice nurse typically works. However, a hospice nurse may also provide care to patients in assisted living facilities, skilled nursing facilities, hospitals, and hospice facilities.
When hospice nurses provide care to patients in assisted living and skilled nursing facilities, they typically do not provide direct care but function as case managers who collaborate with the facility staff to oversee and coordinate the patient’s hospice care.
Medicare-certified hospices are required to provide four levels of hospice care, which also may influence where a hospice nurse works:
Routine home care—the most common level of care in hospice, usually provided for patients in their home
General inpatient care—short-term hospital-level care intended to get uncontrolled pain and/or other symptoms under control. May be provided in an acute care setting, but is often provided within a hospice facility.
Continuous home care—in which nurses provide “shift” care for the patient, usually in their home
Respite care—which provides family caregivers with time to rest and renew
How Do I Become a Hospice Nurse?
Although there are certainly exceptions, many hospice nurses have experience working in other areas of nursing prior to starting with hospice. A solid nursing foundation such as this can be quite helpful, since hospice nurses often work independently with patients in their homes and must possess excellent assessment and problem-solving skills.
The path to becoming a hospice nurse depends upon the credentials involved. Hospice nurses who are registered nurses must attend an accredited nursing program that leads to a bachelor’s degree in nursing, an associate’s degree in nursing, or a nursing diploma.
RNs must also be licensed in the state in which they work. Licensure can be obtained by passing the National Council Licensure Examination (NCLEX-RN) and meeting any additional requirements of the state’s board of nursing. The National Council of State Boards of Nursing (NCSBN) offers a resource to determine state-based nursing licensure requirements. A hospice nurse who is an RN can also obtain specialty certification by meeting eligibility requirements and taking the Certified Hospice Palliative Nurse (CHPN®) exam.
Hospice nurses who are LPNs and LVNs must complete a state-approved educational program and obtain licensure for their state by taking the National Council Licensure Examination (NCLEX-PN) and meeting any additional state-based requirements. A hospice nurse who is an LPN or LVN can obtain specialty certification by meeting eligibility requirements and taking the Certified Hospice and Palliative Licensed Nurse (CHPLN®) exam.
Hospice nurses who are advanced practice nurses, such as nurse practitioners, are licensed registered nurses who obtain at least a master’s degree in their specialty role, pass a national certification exam, and hold an APRN license in their state. A hospice nurse who is a nurse practitioner can obtain specialty certification by meeting eligibility requirements and taking the Advanced Certified Hospice and Palliative Nurse (ACHPN®) exam.
Additional specialty certification exams related to hospice nursing include the Certified Hospice and Palliative Pediatric Nurse (CHPPN®) and the Certified Hospice and Palliative Nursing Assistant (CHPNA®).
What Are the Benefits of Being a Hospice Nurse?
Hospice nurses who work in the community typically enjoy a great deal of independence and autonomy—while also enjoying the support of colleagues within the interdisciplinary team.
Working with death and dying on a regular basis may be difficult for some, but there are rich rewards involved when caring for individuals who are facing end of life. In addition to possessing the expertise to manage the physical challenges patients may be facing with pain and other symptoms, hospice nurses provide holistic care that empowers patients, helps them remain in charge of their healthcare decisions, and improves their quality of life.
Although every patient and family is different, patients who know they are in their final season may be more introspective and focused on attending to what matters most to them. Hospice nurses have the privilege of getting to be part of this process as they accompany patients and families on this journey and assist them in meeting end-of-life goals.
Additional Resources About Becoming a Hospice Nurse
To learn more about becoming a hospice nurse, these additional resources may help:
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