Are you passionate about connecting with others? Do you radiate compassion and empathy? Are you an expert at pain management? Are you interested in complementary therapies? Do ethics and advocacy intrigue you? Do you enjoy collaboration and supporting others through challenging situations? Is a slower pace more your style? Hospice may be your nursing niche!
What is Hospice Nursing?
Hospice, the care of people with terminal illnesses, focuses on pain and symptom management while supporting the patient and their family as they navigate the complexities of end-of-life experiences. Patients receiving hospice care have a life expectancy of less than 6 months.
Hospice nurses are skilled at managing a multitude of terminal diagnoses. Some of the more common diagnoses seen in the hospice setting are cancer, dementia, heart disease and HIV. Hospice nurses are experts at navigating the intricacies of end-of-life care. They understand the shift from prioritizing cure to comfort care.
Hospice nurses guide patients and members of their support system through one of the most challenging and intimate healthcare moments. Death is often scary, requires mental and emotional energy, and a multi-faceted support system. Hospice nurses frequently collaborate with a multitude of disciplines.
- Nurse Practitioners
- Social Workers
- Case Managers
- Nurse Aides
- Chaplains or Spiritual Advisors
A deeply meaningful nursing specialty, hospice allows nurses to practice holistic models of nursing. Hospice nurses frequently work with complementary therapies – such as pet therapy, music therapy, or aromatherapy. These therapies support symptom management and help patients and caregivers cope with end-of-life experiences. It is important to know that even in hospice, there are success to be celebrated – a pain free day, reminiscing on a wonderful life, or simply a smile. Hospice nurses play a major role in these beautiful moments.
Dealing with different aspects of death on a daily basis can be mentally and emotionally exhausting. Burnout, ethical and moral dilemmas, and developing deep connections with patients who then end their journeys in death are not uncommon experiences in hospice nursing. Making time for self-reflection, processing experiences and self-care are critically important for hospice nurses to maintain their own mental and emotional health when working in this environment.
Where do Hospice Nurses Work?
The majority of hospice nurses work in the home setting. They may also work in long-term care, on hospice units in the inpatient or outpatient setting, or in telephone triage. Home health offers more autonomy than other settings but can also create problematic situations. For example, supplies or help from other team members may not be immediately available. A hospice nurse must be good at problem solving and creative workarounds, when necessary.
Over a quarter of patients in hospice receive care for less than one week. Others receive care for much longer – sometimes beyond the 6 months of a terminal diagnosis. Similar to admissions and discharges in the inpatient setting, hospice admissions are continuous. Hospice nurses who work in admissions may split their time between an office, patient homes, and intensive care units. They identify patients qualified for hospice, educate families on what hospice care involves, and ensure that reimbursement requirements are met.
Education and Experience Requirements
Licensed Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are eligible to work in hospice without prior experience. Certification as a hospice nurse requires at least 500 hours of direct care experience. Several certifications are available through professional nursing organizations. The Hospice and Palliative Nurses Association offers multiple hospice nursing certifications.
- Certified Hospice and Palliative Nurse (CHPN)
- Certified Hospice and Palliative Pediatric Nurse (CHPPN)
- Certified Hospice and Palliative Licensed Nurse (CHPLN)
It is important for nurses to consider the emotional burden that exists before taking on a role in hospice and reflect on how witnessing death on a regular basis might impact them. For new graduate nurses, the stress of being a new nurse may be enough to handle in the first year, before moving into hospice as a specialty.
Characteristics Employers Look For
End of life care may offer only a single chance to choose the right words. Nurses skilled in empathetic communication, who patiently educate others, and maintain professional boundaries make stellar hospice nurses. Expert medication management skills, the ability to understand the emotions of others, and manage flexible scheduling are key characteristics that employers are seeking in hospice nurses.
Centers for Medicare and Medicaid Services (CMS) reimburses the vast majority of hospice services. Nurses with CMS experience – especially those seeking employment as hospice admissions nurses – are in high demand.
Hospice nursing can be deeply rewarding. You will be a guiding light to those facing the most difficult moments of life. You will bring the caring, art and science of nursing to support the transition from life to death. You will bear witness to extraordinary moments of vulnerability, letting go, loss, grief as well as the powerful impact of kindness, compassion and understanding.
Chelsea Bostelman, RN, BSN, OCN, RYT is a bilingual nurse, yoga teacher, writer, and military spouse. She is working on a master’s degree in nursing from East Carolina University and takes online courses from her current home in beautiful southern Germany.