What Does a Hospice Nurse Do?

It takes a special type of person to become a successful hospice nurse. Registered Nurses (RNs) who choose to specialize in hospice care are providing symptom management and quality of life care to their patients who have an anticipated life expectancy of six months or less.

Hospice nurses provide physical, spiritual, and emotional support to terminally ill patients as well as the patients’ loved ones or family members, such as their children, spouses or close friends. 

Ultimately, hospice nurses are called upon to provide comfort, especially in administering medications or IVs that keep the patient’s pain controlled, ensure that dignity is preserved, and that care is received in consistency with personal wishes and beliefs.

Hospice RNs carry an enormous mental load, as end-of-life can be difficult for loved ones to accept. Family members might express feelings of helplessness, anger, or fear of the unknown. A great hospice nurse works closely with patients and loved ones to provide a feeling of calm and reassurance.

Hospice Nurse Job Duties and Responsibilities
Hospice nurses are a part of a care team that usually consists of doctors, spiritual advisors, social workers, nurses, home health aides, and even volunteers (hospice volunteers are usually present in hospital settings).

Hospice RNs focus on a variety of specialized duties while caring for their patients, especially since each individual will have a different level of acuity. The following duties are typically performed in a patient’s home, though hospice care can be provided in a hospice care setting, nursing centers, hospitals, and other care settings:

• Assessing comfort levels (focusing on pain management and wound care)
• Monitoring vitals and breathing patterns*
• Administering medication as necessary
• Educating family members and providing updates on progression (this can include making funeral arrangements, finalizing living wills, and planning for the care of any pets)
• Offering emotional support to the patient and loved ones to help them cope with grief and loss
• Collaborating with additional specialist who might provide care or support to hospice patients, such as a religious leader

*As a hospice patient is approaching the end of life, their breathing patterns will change significantly. This is completely normal, but may seem concerning to loved ones who are not familiar with what to expect. For example, there may be periods of apnea, or no breathing, followed by quick, shallow breaths.  This is known as Cheney-Stokes respiration.

• RN Case Manager. Typically, these nurses do not visit patient homes. Rather, they assist in reviewing treatment plans and coordinating amongst the care team. Case management nursing roles can be done remotely.
• Hospice On Call/After Hours RN. A nurse in this role is responsible for providing after-hours care for patients and families by responding to requests via telephone. They can also be responsible for admissions to hospice as well as providing direct bedside care.
• Hospice Admissions RN. This role is focused on visiting patients and families in their place of residence to assess what is needed and explain services, monitor conditions, and provide continuous support.
• Hospice Nurse. A hospice nurse will provide in-person bedside care as well as on-call support for the patient, their families, and loved ones. Hospice nurses can visit anywhere from six to 13 patients per day in a variety of settings.

What Types of Patients Receive Hospice Care
The types of patients that receive hospice care can have a variety of conditions or diagnoses. Most often, we think of hospice patients as older adults who have an aggressive type of cancer. But they can also include individuals who have ALS, Alzheimer’s or dementia, Parkinson's disease, end-stage renal disease, COPD, heart disease and more. Ultimately, we understand that the disease will run its natural course and is not able to be treated or cured. 

According to the National Hospice and Palliative Care Organization (NHPCO) Facts and Figures Report, the average lifetime length of stay (LOS) for individuals with Medicare who were enrolled in hospice in 2021 was 92 days. However, patients with a neurological primary diagnosis have the longest average length of stay, which is 155 days.

Is Hospice Different than Palliative Care?
Hospice care is most similar to palliative care, but there is a distinct difference. We often see that palliative care patients end up transitioning into hospice care. With palliative care, patients are receiving ongoing treatment. When a physician or care team believe that treatment is no longer helping the patient, meaning that the patient isn’t responsive to it or that the treatment is unable to slow the progression of the disease, the care team may suggest moving to hospice care.

Is Hospice Nursing The Right Career Path for Me?
A career in hospice can be incredibly rewarding. However, it can also be emotionally challenging at times. A successful hospice nurse will possess high levels of empathy, be an excellent listener, and feel comfortable fielding tough questions and uncomfortable scenarios.

Additionally, hospice nurses might get the pleasure of taking patients on their last trip, helping them to finally get married, or go to an important even like a grandchild’s graduation. All in all, hospice is really about making the most of the precious time that the patient has left. Here are a few scenarios to consider when thinking about if it could be the right fir for you:

• Do you feel mentally equipped to cope with losing a patient?
• How do you handle stress, both in the workplace and in your personal life?
• Are you comfortable communicating with patients who might have limited verbal abilities or are non-communicative?
• What would give you a feeling of satisfaction in this role? Do you think it could be equally rewarding and challenging at times?
• Are you able to remain calm and professional in situations where heightened emotions are visible amongst multiple family members?

Hospice Certifications
Do you think that hospice care might be a good fit for you? If you’re considering changing nurse specialties, you will want to consider getting certified (though this is not always required) to help you stand out from other applicants. The following hospice certifications are available via the Hospice and Palliative Nurses Association (HPNA):

• ACHPN (Advanced Certified Hospice and Palliative Nurse which is designed for Advance Practice Registered Nurses, or APRNs)
• CHPN (Certified Hospice and Palliative Nurse, for RNs)
• CHPPN (Certified Hospice and Palliative Pediatric Nurse, for RNs)
• CHPLN (Certified Hospice and Palliative Licensed Nurse, for LPNs or LVNs)

Still unsure if hospice seems like the right fit in your nursing career? We encourage you to chat with fellow hospice RNs to gain insights about their first-hand experience to truly decide if it's the right fit. To get started, consider joining this Hospice Nursing Support Group on Facebook.

Just as with other nurse specialties, there are both permanent and interim/contract hospice nurse jobs available. 

If you're open to an interim contract position in a hospice setting, take a look at our job board to explore openings.