Being a hospice nurse, or end-of-life nurse, is one of the most challenging and rewarding career paths you can take. It is an intimate opportunity to really support and care for someone on their end-of-life journey. Every day brings new, unique experiences as each individual has different needs and wishes, making it imperative to customize care based on individual needs and preferences.
Most hospice nurses treat their patients like members of their own family, nurturing connections through compassionate dialogue. Although being an end-of-life nurse does bring about challenges, building meaningful relationships with those in need can be incredibly gratifying, professionally and personally.
Table of contents
- What is a Hospice Nurse?
- How to become a Hospice Nurse
- Job outlook for Hospice Nurses
- What do Hospice Nurses do?
- FAQs
- Conclusion
- Next steps
- Resources
TLDR
- A Hospice Nurse provides care for people who are terminally ill.
- The median annual Hospice Nurse salary is $80,530.
- Most employers want candidates to have at least a BSN, and some roles require an MSN, but there are several roles for those who hold an ADN.
- You will need to have your RN state licensure, and it is recommended to obtain certification (though not mandatory).
What is a Hospice Nurse?
A Hospice Nurse provides care for people who are terminally ill. Hospice nursing is a specialized field that requires knowledge and skills in dealing with death and dying. Hospice nursing focuses on comfort and quality of life rather than cure and treatment and is considered palliative care.
How to become a Hospice Nurse
- Obtain an RN licensure
- Gain 2-3 years of experience in a related setting
- Get certified as a Hospice and Palliative Care Nurse (there are different options)
To become an end-of-life nurse, you must possess the compassion and empathy that make this such a unique role and extensive training and experience in assessing patients’ needs. These nurses provide critical care for those nearing death, which is why they must have expertise in quickly responding to bedside emergencies, providing pain relief, and evaluating symptoms.
Educational requirements
Hospice nurses typically need at least a bachelor’s degree in nursing (BSN) through an accredited nursing program. Although some positions may require a master’s degree (MSN), there are several roles for those who have obtained an associate’s degree in nursing (ADN).
The education requirements for hospice nurses will depend on which type of role you choose. Here are some of the different types of hospice nursing roles and their corresponding educational requirement:
- Certified Hospice and Palliative Nursing Assistant (CHPNA) – GED or high school diploma.
- Certified Hospice and Palliative Licensed Nurse (CHPLN) – ADN, BSN, or a diploma from a state-approved vocational (nursing) program.
- Certified Hospice and Palliative Nurse (CHPN) – ADN or BSN.
- Advanced Certified Hospice and Palliative Nurse (ACHPN) – BSN, though most hold an MSN or DNP, and most employers will look for this.
In addition to traditional nursing education, end-of-life nurses also need to take counseling and grief management courses. Some facilities also require certification in Hospice and Palliative Care Nursing (CHPN).
Certification requirements
Becoming a registered nurse (RN) is essential (and mandatory) to be able to practice hospice nursing.
Certified Hospice and Palliative Nurses (CHPNs):
- RN license is required
- At least two years of experience in a related field
- Pass the HPCC CHPN Examination
- Certification is valid for four years
- Recertification requires participating in the HPAR process*^
Advanced Certified Hospice and Palliative Nurses (ACHPNs):
- RN license is required
- Must have completed 500 hours as a Nurse Practitioner (NP) or a Clinical Nurse Specialist (CNS) within the past calendar year or 1,000 hours over the last two years.
- Pass the ACHPN Examination
- Recertification requires participating in the HPAR process*^
* The Hospice and Palliative Accrual for Recertification (HPAR) process includes completing a certain number of practice hours and obtaining a set amount of points through activities for professional development.
^ACHPNs and CHPNs must also complete the Situational Judgment Exercise (SJE), which tests and retests to ensure that they can handle the complexities of real-life clinical situations during a crisis.
Recommended experience
While specific roles within the hospice field, such as nursing or hospice aide, do not require prior experience in nursing, most roles require formal education, certification, and experience. The list above shows that the roles require specific amounts of experience per each certification.
Necessary skills
As a Hospice Nurse, several skills and traits are necessary to provide the high-quality, compassionate care this field of nursing requires. Above all else, an empathetic attitude towards patients and their family members is essential.
Additionally, end-of-life nurses must have excellent communication and interpersonal skills to build strong relationships with their patients and the patient’s support system. Organization and prioritization are also vital components of providing the best end-of-life care possible, as there are often many pieces of information to track, from test results to physical symptoms and medications.
Understanding the legal boundaries that can come with such intimate patient care is also crucial for success within this position. Finally, resilience is necessary due to the complex emotions that arise when interacting with patients nearing the end of life.
Soft skills:
- Empathy
- Communication
- Interpersonal skills
- Compassion
- Resilience
- Organization
- Prioritization
Technical skills:
- Monitoring vitals
- Administering medications (pills, injections, IVs)
- Assessing patient’s condition and symptoms
- Clinical skills
- Pain management
- Patient hygiene
Job outlook for Hospice Nurses
Hospice Nurse salaries can climb up to $111,000 a year. ZipRecruiter’s data shows that most Hospice Nurses’ salaries are within the range of $67,000 (25th percentile) – $91,500 (75th percentile), while top earners can make as much as $104K annually. Location and skill level have proven to be large influences on pay. There are chances for career advancement and higher earnings based on proficiency and experience across various locations in the US.
Median annual Hospice Nurse salary:
Top 10 highest-paying states for Hospice Nurse salaries
- Hawaii – $91,732
- Nevada – $90,043
- Massachusetts – $89,780
- Rhode Island – $88,620
- Oregon – $87,439
- Alaska – $86,705
- North Dakota – $85,448
- Washington – $83,902
- New York – $82,022
- Maryland – $80,950
Top 10 highest-paying cities for Hospice Nurse Salaries
- Bridgehampton, NY – $97,019
- San Mateo, CA – $94,583
- Boston, MA – $94,219
- Daly City, CA – $93,215
- Renton, WA – $93,160
- Santa Monica, CA – $92,775
- Berkeley, CA – $92,710
- Laytonville, CA – $91,646
- Lowell, MA – $91,438
- Green River, WY – $91,148
What do Hospice Nurses do?
The main focus of an end-of-life nurse is to provide comfort and support to patients and families rather than cure the underlying illness. End-of-life nurses are skilled at managing pain and symptom control. These nurses work closely with the patient’s doctor to develop a care plan that meets the patient’s needs to maintain the highest quality of life and comfort. End-of-life nurses educate patients and families about what to expect during the dying process, help them prepare for death, and offer support in dealing with grief and loss.
Hospice nursing exists in various settings, including hospitals, nursing homes, hospice centers, or at home. Typically, end-of-life care is provided by a team of healthcare professionals, including doctors, social workers, chaplains, and volunteers, in addition to nurses.
Some Hospice Nurse responsibilities include:
- Collaborating with healthcare providers and specialists
- Administering medication
- Monitoring and documenting vital signs
- Managing symptoms/pain
- Providing emotional, spiritual, and physical support
- Educating family members/loved ones
FAQs
1. Where do Hospice Nurses work?
A Hospice nurse can work in any of the following settings:
- At the patient’s home or family’s home
- At a hospice center
- At a skilled nursing facility
- At a geriatric nursing home
- At a hospital
- Private care center
- among others
2. How long does it take to become a Hospice Nurse?
It could take 4 – 7 years to become a hospice nurse (depending on your chosen role). The typical route toward becoming an end-of-life nurse typically looks something like this:
- 2-5 years of school to earn an ADN, BSN, or MSN
- Pass the NCLEX-RN exam
- Minimum of two years experience working in an acute care setting
- Pass the CHPN Examination
3. What is the Situational Judgment Exercise (SJE)?
As part of their re-certification, Advanced Certified Hospice and Palliative Nurses (ACHPNs) and Certified Hospice and Palliative Nurses (CHPNs) must complete the SJE. This exam utilizes a series of case-based scenarios to evaluate critical thinking skills and clinical application beyond what is tested during initial certification exams. With an extensive evaluation process that covers assessment and treatment decisions, as well as ethical/professional topics, including communication, team building, policy research, etc., the SJE provides insight into how certified individuals handle real-life clinical situations.
Conclusion
Hospice nurses help give dignity and comfort to patients by providing physical care and offering psychological support, companionship, 24/7 emotional assistance, and much more. The reward for these nurses comes in seeing the difference they make in people’s lives. Seeing elders pass with grace allows nurses to understand that they are helping others make peace with whatever life has dealt them while transitioning into the afterlife peacefully and with dignity.
Next Steps
- Obtain certification
- Become recertified
- Find a job as a Hospice Nurse
Resources
- 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
- Medicare – Hospice Care
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Some links in this article were updated in October 2024.