What is a Hospice Nurse in the USA?

By ShiftMed Team//Nursing Profession
Hospice nurse standing over an older patient

A hospice nurse specializing in end-of-life and palliative care may be one of the most challenging nursing specialties. They support patients with terminal diagnoses and their families and ensure they are comfortable and content. 

What does hospice mean?

Hospice is a type of medical care given to people nearing the end of their lives. Hospices are medical facilities that house terminally ill individuals. A hospice nurse specializes in providing care to patients in these facilities, as well as in hospitals and people’s homes. 

Instead of focusing on healing and recovery, hospice centers around comfort, pain management, and quality of life. A hospice nurse strives to ensure that their patients feel as comfortable as possible and enjoy as much of life as they can, despite their deteriorating conditions. 

Most patients in hospice live for less than six months. Nurses often get to know them and their families/caregivers during their stays, and they are a significant source of comfort and solace as a patient near the end of their life. 

What is the difference between a hospice nurse and a registered nurse (RN)?

Hospice nurses are RNs with specialized training in hospice care. They often have a Certified Hospice and Palliative Nurse certification. 

They can perform the same procedures as a registered nurse, but they focus primarily on the quality of care services, pain relief, and emotional support. 

They will often manage patients who require airway assistance and use catheters and medical equipment. 

The skill set that hospice nurses use focuses more on end-of-life care, whereas RNs focus on treating illnesses and injuries to help patients recover.

What qualifications does a hospice nurse need?

To become a hospice nurse, you’ll need an associate’s or bachelor’s degree in nursing and a valid RN license in your state. 

You may also need a CHPN certification to qualify for specific jobs. Experience in palliative care and hospice is also a must.

To earn your CHPN, you must be a registered nurse with at least 500 hours of hospice care and palliative nursing experience in the last 12 months or 1,000 hours within the previous 24 months.

Educational requirements aside, you must also be willing to open your heart to patients you know will die. Unfortunately, this is not easy for many nurses, so they avoid working with hospice because of the emotional impact. 

This nursing specialty requires an open heart, selflessness, and commitment. Your patients and their families and caregivers are at their most vulnerable. You will be one of the most influential people in their lives until they pass away.

A willingness to care for them, love them, and bond with them despite the fact they’re dying is the most crucial qualification outside direct skills and experience. 

What does a hospice nurse do day to day?

Depending on where they work, hospice nurses tend to one or several patients. They may be in someone’s home, managing their pain medications, feeding them, bathing them, and comforting their families. They answer questions honestly, provide information on the end-of-life process, and do what they can to make this challenging time a little easier.

Hospice nursing is not passive, despite patients' poor health. On the contrary, you will rely heavily on clinical skills such as IV and catheter insertion and maintenance, administering medication, maintaining medical equipment, and taking vitals.

Many hospice nurses also take on additional care for their patients, such as changing diapers, grooming, brushing teeth, bathing, and preparing meals.

Where do hospice nurses work?

Hospice nurses work in hospitals, hospices, nursing homes, assisted living facilities, and in-home care.

What is it like to be a hospice nurse?

Many people can’t imagine what hospice nurses do. It is emotionally exhausting and mentally draining.

You give all your time and energy to your patients and their families. You extend yourself emotionally to people during periods of fear, anxiety, and grief. You are choosing to be a support for both dying people and their loved ones. 

Hospice nursing can be a beautiful experience. Your patients and their families will change your life. They teach you to appreciate every moment of your existence. They help you live more presently and not take anything for granted.

To stay positive, hospice nurses focus on the people they care for, not the fact that they’re dying. Of course, they know their patients won’t survive, but that is a more significant reason for them to focus on caring for them as people — not just patients — and providing them with the best possible care.

How much do hospice nurses make?

The average hospice nurse's salary in the US is $70,717. As the population ages and hospice nurses are in greater demand, that pay will likely increase. Furthermore, certifications, education, and nursing experience also affect how much you are paid.

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Are there different specialties of hospice nurses?

All hospice nurses have the same goal — to give their patients the best possible end to their lives. However, some may specialize in particular fields. For example, you can bring prior experience in cardiology, oncology, or gerontology into your job. You can also pursue certification as an advanced certified hospice and palliative nurse (ACHPN) or certified hospital and palliative pediatric nurse (CHPPN). 

Hospice care is a specialization, but you can always benefit from learning more about other branches of medicine. 

Advantages and disadvantages of a career as a hospice nurse

Becoming a hospice nurse is possibly one of the most questionable nursing jobs. When people hear you want to specialize in end-of-life care, they often ask why. The “why” is personal for every nurse, but it also serves as one of the most significant advantages of their job. Their unique motivation helps them stay positive and care for patients with short life expectancies.

If you are interested in hospice nursing, you should consider some pros and cons before pursuing this career. 

Advantages of choosing a career as a hospice nurse

1) The patients

Hospice nurses grow close to their patients, even when they only live for a few short weeks. Being able to stand by their side and witness them in their most vulnerable states is a gift that hospice nurses do not forget.

People often thank hospice nurses for changing their lives as their loved ones died, but they don’t realize the patient affected the nurse just as much. Hospice nurses genuinely give everything to their patients and always grieve when they die, even if they don’t show it in front of others. 

2) Supporting families and friends

Many people are resistant to pain management and comfort measures at the start of hospice care. However, the nurses gradually help them accept the reality of their loved one’s condition and guide them to make better choices for their care. They allow people to accept death and grief as a part of life and make the process more bearable with empathetic, compassionate support. 

They hold their hands, hug them, and allow them to grieve. They create space for people moving through what is likely the most challenging moment of their lives. Many hospice nurses help families as much as their patients. 

3) Good salary

Hospice nurses earn between $69,000 to over $100,000 annually. However, their hard work and dedication can provide them with reliable income and financial stability.

Disadvantages of choosing a career as a hospice nurse

1) Watching your patients die

It is never easy to stand by someone as they take their last breath. Sometimes, you might be the only one with them because family and friends couldn’t reach them fast enough. Or, they may have entered hospice care alone, and you are the only person there to comfort them and mourn their loss.

Despite the experience hospice nurses have, every patient’s death hurts. But unfortunately, some patients also never fully accept that they’re dying, and it’s painful to see them suffer so much fear and anxiety toward the end of their lives.

Having a support system and things that make you happy outside of work are essential. You need activities you can rely on to feel good and always bring your mind back to the present. Because they experience death so frequently, hospice nurses must prioritize living to the fullest. 

2) Challenging work

Clinically, hospice nurses are busy and may have shifts where they can’t sit down for hours at a time. So although people envision hospice care to be slow and low-key, it is a physically demanding job that requires you to be alert and available at all times. 

There is also a lack of control in many hospice settings. When working in a patient’s home, patients or families may not always comply with care recommendations. You will face challenges as you try to provide the best care for your patients while respecting their wishes or their family’s wants. 

3) Lack of predictability

Even though nursing is an exciting job, there are often routines, and protocols nurses grow accustomed to. For example, if something happens in the hospital or a clinic, they know exactly what to do and who to contact for support.

Many hospice nurses work independently and can’t always anticipate how a patient’s needs may rapidly change. Often, they have to provide pain management and assistance to extremely ill, acute patients with limited supplies or resources. 

Even in formal hospice settings, you can never know when a patient will suddenly take a turn for the worse. So you must be able to handle the stress and possibility of anything happening.

How to become a hospice nurse

Start by earning a degree in nursing, then passing the NCLEX exam. Once you’ve become a registered nurse, you can start working with patients in different healthcare facilities. It’s best to start working with patients who aren’t imminently dying first. This helps you build confidence and hone your skills.

After several years of nursing, you can look for palliative and hospice care opportunities. This will allow you to work directly with patients with short life expectancies. After 500 hours in 12 months or 1,000 in 24 months, you can apply for certification as a certified palliative and hospice nurse (CPHN). 

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Frequently asked questions about hospice nurses

How long does it take to become a hospice nurse?

It takes four to six years to become a hospice nurse. Therefore, you will need first to become an RN, then gain several years’ experience treating patients. Most employers for hospice nurses want an RN with at least three years of experience before they have them work with terminally ill patients. 

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What is the role of a nurse when a hospice patient dies?

The nurse comforts family members, answers questions, and offers support as they process the loss of their loved one. They can also provide them with resources for grief counseling. They actively listen, give people space, and are present to comfort them whenever they need it.

Nurses also prepare patients’ bodies for transportation after they pass away. 

What are some key points of hospice nursing?

In addition to direct medical care, hospice nurses perform pain management, provide emotional support, assist during crises, and partake in case management. Psychosocial support for loved ones is another critical component of the job. Many hospice nurses are the ones who help family members finally accept their loved one’s impending death and be more present with them during their final days.