GUIDE
April 19, 2022
By: Nurse.org Staff
Medically reviewed by: Kathleen Gaines MSN, RN, BA, CBC
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.
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.
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.
What Does it Take to Be a Hospice Nurse?
The role of a hospice nurse 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.
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 Nurse Duties
Hospice nurses’ roles and responsibilities are wide-ranging and can include the tasks listed below and many others as well.
- Act as liaisons to other caregivers and spiritual guides
- Administration of medication
- Advocate for patients and their families wishes
- Arrange spiritual support services from chaplains, ministers and priests
- Assist patients and their families with appropriate paperwork
- Communication of patient status and changes in condition to the rest of the hospice team
- Create a plan of care for caregivers
- Documentation of all care
- Ensure that any medications or specialty care equipment that the patient needs is available
- Evaluate patient needs
- Maintain and update medical charts, patient files, and health records.
- Order medical supplies for the patient
- Patient assessments for admission into hospice
- Perform prescribed and recommended treatments
- Provide appropriate wound care
- Provide compassionate end-of-life education regarding hospice care to both patient and their family and caregivers
- Provide crisis care that alleviates symptoms
- Provide emotional, psychosocial, and spiritual support to patients and family
- Provide respite care for family caregivers
- Respond to emergency calls
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 2021 is $77,600 per year, or $37.31 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 $79,867 in September 2022, with only a $23,000 swing between the 25th percentile and the 75th percentile. The low national average is $39,500 and the high national average is $111,000.
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Highest Paying Cities for Hospice Nurses
According to ZipRecruiter.com, the top five paying locations for hospice nurses is as follows:
| City | Annual Salary | Hourly Salary |
| Atkinson, NE | $110,347 | $53.05 |
| Bridgehampton, NY | $95,474 | $45.90 |
| San Mateo, CA | $94,123 | $45.25 |
| Boston, MA | $93,617 | $45.01 |
| Deer Park, CA | $91,922 | $44.19 |
Hospice Nurse Benefits
In addition to salary, hospice nurses are also likely to receive a range of benefits that may include,
- Access to discounted childcare
- Dental insurance
- Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs)
- Life insurance
- Medical insurance
- Nursing conference reimbursem*nt
- Paid sick leave
- Prescription insurance coverage
- Retirement plans
- Short term and long term disability
- Tuition reimbursem*nt
- Vacation leave
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.
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:
- Advanced Certified Hospice and Palliative Nurse (ACHPN)
- Certified Hospice and Palliative Nurse (CHPN)
- Certified Hospital and Palliative Pediatric Nurse (CHPPN)
The Certified Hospice and Palliative Care Administrator (CHPCA) is no longer available for initial certification; however, those nurses with a current certification can renew it by recertification.
The most common certification for hospice nurses is the Certified Hospice and Palliative Nurse (CHPN).On the other hand, if you have an advanced degree, the Advanced Certified Hospice and Palliative Nurse (ACHPN) would be more appealing. This certification is only for those holding an NP or CNS degree.
The Certified Hospice and Palliative Pediatric Nurse certification is very similar to the CPHN however, it is specific to the pediatric population.
How Long Does it Take to Become a Hospice Nurse?
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
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.
Specifically, it is reported that estimated 10,000 people in the United States become Medicare-eligible each day, a trend that many expect to continue until 2029, according to the Medicare Payment Advisory Commission. With that being said, more and more patients will be expected to pass in the next decade. Much of this has to do with the rapid aging of the population combined with the increased acceptance of palliative measures.
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.
Regardless of certification, all hospice nurses are required to maintain CEUs for their nursing license. Continuing education requirements for the license differ for each state. Monetary fees and other state-specific criteria are also associated with all license and certification renewals.
Examples of continuing education requirements for RNs are as follows:
- California - 30 CEUs every two years
- Florida - 24 CEUs every two years
- Hawaii - 30 CEUs every two years
- Oklahoma - 24 CEUs every two years
- Pennsylvania - 30 CEUs every two years
A comprehensive list can be found here.
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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:
- American Academy of Hospice and Palliative Medicine
- Hospice and Palliative Care Nurses Association
- National Coalition for Hospice and Palliative Care
- National Hospice and Palliative Care Organization
- National Palliative Care Research Center
You can also find helpful articles on the Nurse.org website, including these:
- How to Stay Positive When You Work in Hospice
- Joe Biden Thanks Hospice Nurses Who Cared for His Family
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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FAQs
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.
>>Ask Nurse Alice Podcast: This is What It's Like To Work as a Hospice Nurse (with Beth Cavenaugh, RN, BSN, CHPN)
