Hospice Nurse Overview
- What You Will Do: Provide professional nursing care for terminally ill patients, ensuring their quality of life during their remaining time.
- Where Will You Work: Typically hospice nurses are primarily employed in hospice centers or home care agencies, hospitals, or in long-term care facilities.
- Employment Projections: Nursing is expected to be the fastest-growing professions, with growth projected at 16% – 23%. Similarly, the employment outlook for hospice nurses is excellent.
- How Much Will I Earn: The median annual salary for certified hospice nurses ranges from $50,000 to $82,000. An advanced practice hospice RN makes an average salary of $96,000 per year.
- Requirements to Become One: Become an RN, obtain experience in hospice and palliative care nursing, then obtain certification as a hospice and palliative care nurse.
Steps to Become a Hospice Nurse
- Earn Your RN degree: You must earn an RN degree from an accredited associate degree (ADN) or bachelor degree (BSN) program. Many employers prefer a BSN degree. To further advance as a hospice nurse, a master’s degree (MSN) is recommended.
- Pass the NCLEX-RN Exam: All RNs must pass the NCLEX-RN exam to obtain licensure to practice professional nursing.
- Specialize in hospice and palliative care nursing: On obtaining licensure, RNs seeking to specialize in hospice and palliative care must first gain professional nursing clinical experience working with patients with cardiac disease.
- Obtain Hospice and Palliative Care Nursing Certification: You must have a minimum of 2 years professional nursing experience in hospice/palliative care
What is a Hospice Nurse?
Hospice nurses provide professional nursing care for patients during the end of life. The term “hospice nurse” is used to denote both hospice and palliative care; the focus of palliative care is to provide relief from the symptoms and stresses associated with serious illness, improving the quality of life for patients and families. While palliative care is a component of hospice care, it is not restricted to end of life situations.
Hospice nurses provide holistic care beginning with admission to hospice care through the final stages of the end of life. On admission, the hospice nurse works to understand patients’ needs and establish eligibility for hospice care. The case manager direct and coordinate patient care, as well as care for the family, allocating resources and developing the plan of care. For care provided in the home, visit nurses follow up on the plan of care and related interventions, and ensure proper documentation of care and outcomes. Triage nurses act during an emergency, assessing the situation, identifying patient care needs and providing guidance. They inform the case manager, visit nurse and physician about the situation, to determine if an immediate visit is needed. Hospital liaison nurses work with hospitals and patients to identify potential hospice care providers and guide patient enrollment in hospice care.
Hospice nurses provide the highest quality of care for patients and for their families and caregivers. As a major tenent of hospice care is the principle that no one should die alone, hospice nurses work to ensure that at least one member of the hospice care team is present during the final hours of life.
How Do I Become a Hospice Nurse?
The first step toward becoming a hospice nurse is to become a Registered Nurse, earning an associate (ADN) or bachelor of science degree (BSN) from an accredited nursing program. It is important to note that many employers prefer at least a BSN. After graduation, you must obtain RN licensure by taking the NCLEX-RN examination in your state. Once you have achieved licensure, you will need to obtain professional nursing clinical experience in hospice/palliative care nursing.
To be eligible to obtain certification as Certified Hospice and Palliative Nurse (CHPN), offered through the Hospice and Palliative Credentialing Center (HPCC), you must:
- Hold current, active RN licensure
- Have a minimum of 2 years full-time professional nursing experience
- Have a minimum of 500 hours of clinical practice in hospice/palliative care nursing within the most recent 12 months, or 1000 hours within the most recent 24 months prior to applying to take the certification examination.
Certification is valid for 4 years, after which it must be renewed by meeting the renewal requirements in place at the time of renewal, such as specialty-related professional development and practice activities. If this is not possible, the certification exam must be retaken. HPCC also offers specialty certification related to pediatric hospice care and administration.
Advanced practice certification, as an Advanced Certified Hospice and Palliative Nurse (ACHPN) requires;
- Current, unrestricted licensure
- A master’s or doctor of nursing practice degree
- Active practice as a nurse practitioner or clinical nurse specialist
- A minimum of 500 hours of clinical practice in hospice/palliative care nursing within the most recent 12 months, or 1000 hours within the most recent 24 months prior to applying to take the certification examination.
This certification is valid for 4 years. Recertification requires meeting the renewal requirements in place at the time of renewal, such as specialty-related professional development and practice activities. If this is not possible, the certification exam must be retaken.
Additional Ways to Earn Your Nursing Degree
Where Do Hospice Nurses Typically Work?
Hospice nurses typically work with terminally ill patients expected to live 6 months or less, providing care in a variety of settings, most often in the patient’s home, or in a hospice care facility. Other venues for care include hospitals, and skilled nursing/residential care facilities.
How Much Do Hospice Nurses Earn?
Nursing, in general, is identified as one of the fastest growing professions in the US in terms of salary, with a projected growth of 16% +, much higher than the national average. This is dependent on the job, and the geographical area. Salaries are generally higher in urban areas, however, the cost of living is typically higher, as well. In addition, bachelor’s prepared nurses tend to earn higher salaries than nurses with associate degrees. According to the Bureau of Labor Statistics the top five states for general nursing salaries are (range 96,470 – 81,380);
Specialty certification can increase earnings significantly. The median annual salary for certified hospice nurses (CHPN) ranges from $50,000 to $82,000. An advanced practice hospice RN (ACHPN) makes an average salary of $96,000 per year.
Hospice and Palliative Care Nurse Programs
At the undergraduate level, specialty-related education consists of continuing education activities, such as conferences or online CEU providers.
Becoming a hospice nurse practitioner or clinical specialist requires earning a master’s degree in nursing (MSN). The typical program consists of offering an APRN sub-specialty in hospice/palliative care nursing within an Adult/Gerontology care specialty. A post-graduate fellowship or certification are also potential options. Some examples of universities/programs offering hospice/palliative care advanced practice nursing (APRN) subspecialty or advanced practice fellowship or certification include:
- University of Alabama at Birmingham School of Nursing; Advanced Palliative Care Subspecialty. Birmingham, AL. https://www.uab.edu/nursing/home/msn/palliative-care-subspecialty
- Columbia University Irving Medical Center School of Nursing; Palliative and End-of-Life Care. New York, NY. http://nursing.columbia.edu/academics/academic-programs/sub-specialty-programs/palliative-and-end-life-care
- California State University Institute for Palliative Care; Advanced Practice RN Certificate in Palliative Care. San Marcos, CA. https://csupalliativecare.org/programs/aprn/
- University of South Alabama College of Nursing; Palliative Care Subspecialty. Mobile, AL. https://www.southalabama.edu/colleges/con/dnp/palliativesubspec.html
- Memorial Sloan Kettering Cancer Center; Nurse Practitioner Fellowship in Hospice and Palliative Care. New York, NY. https://www.mskcc.org/hcp-education-training/fellowships/pain-and-palliative-care-nursing-fellowship
- Harvard Medical School Center for Palliative Care; Nurse Practitioner Fellowship. https://pallcare.hms.harvard.edu/training/nurse-practitioner-fellowships
- Metropolitan Jewish Health System institute for Innovation in Palliative and Hospice Care; Nurse Practitioner Fellowship. New York, NY. https://www.mjhspalliativeinstitute.org/fellowships/
- Drexel University College of Nursing and Health Professions; Holostic Hospice and Palliative Care. Philadelphia, PA. https://drexel.edu/grad/programs/cnhp/holistic-hospice-and-palliative-care/
What is a Typical Hospice Nursing Curriculum?
Continuing education at the undergraduate level focuses on broad range of related topics, including;
- Clinical manifestations, expected progress, and prognosis for advanced disease states.
- Evidence-based pain assessment and management interventions
- Pharmacological and non-pharmacological interventions available to manage symptoms
- Ethical issues related to hospice and palliative care
At the graduate level, nurses typically begin with pursuing an MSN as an Adult Primary Care Nurse Practitioner or Gerontology Primary Care Nurse Practitioner. Typically, hospice/palliative care is offered as a sub-specialty, or as post-graduate certificate or fellowship program beyond the MSN. These programs focus on aspects of hospice and palliative care, including;
- Philosophy and principles of hospice/palliative care
- Pain and symptom assessment and management
- Patient advocacy
- Chronic disease and prognoses
- Education for patient, family and caregivers
- Non-pharmacologic management of symptoms
- Advanced pharmacology
- Advanced hospice/palliative care clinical practicum
The Role of the Hospice Nurse in the Nursing Shortage
The Bureau of Labor Statistics cites that employment for nurses will increase at a rate of 16% by 2024. There is a national shortage of nurses in general related to the Baby Boomer population entering retirement, and the increased health needs of the growing aging population. It is projected that the South and West will be hardest hit by the nursing shortage. The 12 states expected to have the most acute shortages are; Florida, Georgia, Texas, Virginia, Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada and New Mexico.
Similarly, employment opportunities for nurses specializing in hospice and palliative care are expected to expand, making this specialty a very stable career path for professional nurses.
Hospice and Palliative Care Nurse Resources
- National Hospice and Palliative Care Organization – https://www.nhpco.org
- National Association for Home Care and Hospice – https://www.nahc.org/
- Hospice & Medicare – https://www.medicare.gov/coverage/hospice-care
- Hospice & Palliative Nurses Association/Credentialing Center – https://advancingexpertcare.org/
- Crossroads Hospice Charitable Foundation – https://crhcf.org/Blog/understanding-the-role-of-a-hospice-nurse/
- Hospice & Palliative Nurses Association/Credentialing Center – https://advancingexpertcare.org/
- Study.com – https://study.com
- US Department of Labor; Bureau of Labor Statistics – https://www.bls.gov/