Hospice Nursing - Compassionate Care at the End of Life

All nursing jobs are difficult, but Hospice Nurses have a particularly tough job because from the outset, these nurses know that the patient for whom they are caring is terminally ill. The care Hospice nurses provide is not meant to cure but rather to reduce pain. Hospice nurses have the unique opportunity to share in a patient's final moments.

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Hospice Nursing - Compassionate Care at the End of Life

The Hospice Nurse

One of the realities of health care is that not all patients can be cured. The time comes for all of us when we face death. For some, it comes quickly and unexpectedly. For others, a terminal illness or condition is diagnosed, giving more time to consider end-of-life care. In this case, as the patient's health declines, the care of a hospice nurse can be very effective in making the end days more tolerable.

The goal of hospice care is to allow patients to live as fully as possible, while focusing on helping them remain comfortable during the final stages of life in the comfort of their own homes with their families at their side. The hospice doctrine states that terminally ill patients have the right to spend their last days in the comfort of their own homes, with their families. Hospice care provides professional medical care as well as supportive social, emotional, and spiritual services to accomplish this.

Education

Hospice nurses can be Licensed Practical/Vocational Nurses, Registered Nurses, or Advanced Practice Nurses, depending on the setting and the patient's needs.

All must graduate from an accredited nursing program, successfully pass their individual NCLEX-RN or NCLEX-PN examinations, and possess current, unencumbered licenses in their respective U.S. state(s) of practice.

Certification

The National Board for Certification of Hospice and Palliative Nurses strongly recommends that nurses who want to pursue certification should practice for at least two years in a hospice or palliative care setting. Some schools offer formal training in the subject, as well. To become certified, candidates must apply for and pass the board's exam. Certified Hospice and Palliative Nurses, or CHPNs, must maintain their certification through continuing education.

Roles / Duties

Most of the duties that the hospice nurse performs are focused on minimizing pain and maximizing comfort. The medications the nurse administers and the symptoms she/he records are not meant to assist patients in their recovery, but instead are aimed at making his/her remaining days as comfortable as possible.

The main purpose of the hospice nurse is to provide effective management of pain and other symptoms of end-stage illness and to offer supportive services for patients and families. The physical, emotional, social, and spiritual needs of patients and families are addressed as a way to offer hope, comfort, and support.

The hospice nurse carries out these goals as she/he:

  • Performs traditional nursing duties such as observing, assessing, and recording symptoms.
  • Coordinates care through an advising physician
  • Provides direct patient care
  • Changes bandages, catheters, and dressings
  • Provides basic hygiene
  • Administers medications
  • Provides emotional support to patient and family members
  • Educates family on how to care for the patient at home
  • Provides the family with an understanding of what to expect as death approaches and addresses their questions and fears
  • Serves as a case manager and advocate for their patient
  • Serves as the eyes and the ears of the physician
  • Makes cultural patient assessments and creates an appropriate plan of care
  • Orders supplies and obtains necessary medical equipment for home care
  • Coordinates with chaplains, ministers, priests or other spiritual advisers to meet the spiritual needs of the patient and family
  • Communicates with other members of the hospice care team
  • Provides supportive crisis care and helps to alleviate symptoms by administering medications rather than attempting heroic measures aimed at extending life

Work Environment

Hospice care provides support at home for persons in the end stages of incurable diseases. Inpatient hospice care may also be offered to patients with symptoms that can no longer be managed in the home. Hospice can also be provided in a nursing home or other healthcare facilities.

The hours are those of the patient, so work on late nights and weekends are involved

Skills / Qualities

Dealing with a dying person on a daily basis requires an exceptional disposition. The hospice nurse must personify compassionate caring, patience, and dedication. The nurse must also possess expert assessment skills and be a compassionate, yet critical thinker. It is also important that the hospice nurse has an understanding of the end-stage processes of many diseases.

Job Outlook

With the aging baby boomer generation and rises in terminal disease rates, hospice nurses who work with the elderly will remain in high demand.

Salary (2020)

The annual Staff RN Hospice salary in the U.S. is $75,565 and falls between $68,896 and $86,449, according to Salary.com.

However, a number of factors can affect a hospice nurse's salary, including years of experience, types of certifications, region of the country, and whether working in a metropolitan or rural area.  Advanced practice nurses earn significantly higher salaries on average.

Resources

Hospice and Palliative Care Nurses Association (HPNA)

The National Association for Home Care & Hospice

The Hospice Foundation of America

National Hospice Foundation

The American Journal of Hospice & Palliative Medicine

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tnbutterfly - Mary

About tnbutterfly - Mary, BSN

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tnbutterfly has been in nursing for more than 30 years, with experience in med-surg, pediatrics, psychiatrics, parish nursing, and disaster nursing. She is currently a parish nurse.....a position which she has had for the past 15 years. As the allnurses.com Content & Community Director, don't hesitate to contact her if you have suggestions or need assistance.

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Specializes in LTC, Hospice, Case Management.

I've been a nurse since 1986 & a hospice nurse since August. I absolutely love being a hospice nurse. I'm not sure if I've ever felt like more of a nurse or had patients that I felt like needed me as much as these folks do. I never feel like I have a new patient assigned to me, but a new family assigned to me because this job really entails caring for the entire family.

The common myths I've encountered are 1) this job is depressing or 2) you really don't use your nursing skills as a hospice nurse.

Yes, my patients die & yes it makes me sad, but, most of the time there is so much good stuff in between. I love having the 1:1 time to really get to know my patient & their loved ones. I have the awesome ability to help these folks down the final path of life. My goal at the end of that path is to know my patient arrived there peacefully & the family members are able to carry on with their lives knowing their person was peaceful at the end and they aren't forced to live with regrets or "what ifs". Maybe I'm a little odd (haha), but in the moments after a patient has peacefully died & the family is hugging me good bye while accepting & grieving appropriately I walk away feeling like I just took first place in some big event. Now I know they don't all end like that but I also know some really have that may not have without our intervention.

Don't use my nursing skills - oh please! Foleys, an IV ABT, major wound care, pain management, etc. Surprisingly, I'm finding Drs are pretty uninvolved in hospice decision making. I call the Dr with a med request & frequently hear "you all know more about hospice pain. Use whatever you think will work & titrate dose as needed" (dial tone). That's still kind of intimidating to me!

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for sharing. I agree.......it is not all sad. It can be very rewarding.

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Thank you for writing this. I only hope that I can obtain that degree of balance in character required to be a good hospice nurse. I truly feel that is my calling and I thank you for all the information! I I agree that it an be very rewarding!

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First of all, thank you for what you do, and the compassionate care you provide. I am currently working in the military, but leaving soon to pursue something different. I am interested in hospice nursing and was wondering how difficult it was to get into this field. Any advice you may have would be greatly appreciated.

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Specializes in Women's health & post-partum.

I was on the other side of hospice this year. My husband was diagnosed with Alpha1 Anti-tripsin Deficiency last spring. Because he was diagnosed late, his condition was determined to be terminal and he was placed on hospice care. The nurses, social workers and chaplains were all wonderful. I would not have been able to have him at home, to die at home as he wished, without their care--care for him and for me. I did have some idea of what was involved in working in hospice, but was very comforted by not only their expertise, but by their caring.

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Specializes in Pediatrics.

Thank you for this article. I'm not a nurse, yet. But when I do finally have my license, I really feel like I need to work in hospice. This article really helped solidify that, and the above posts as well. :)

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Specializes in Women's health & post-partum.

A Friend in Need: Randy Cassingham's Blog

An interesting blog about a hospice patient in Colorado.

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Yes this is a very difficult field of nursing and can be emotionally taxing. I can't imagine doing anything else, though! They say it takes a special kind of nurse to do hospice. I look at it a little different. Every nurse has a set of skills and abilities. Some of us are better at caring one on one for dying patients. If this is you, then hospice care is an appropriate fit. Other nurses fit into other roles. It takes someone special to be a nurse, regardless of your specialty.

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Specializes in critical care, LTC.

After 22 years in critical care trying to save people who couldn't be saved (and in some cases shouldn't be) and the last 5 working LTC, I am starting in an in patient hospice unit and couldn't be more excited! (Is that wrong?) I have thought about working in hospice for a long time but didn't care for the home visit part of it. Positions in the inpatient unit are few and far between so when I saw one listed in the paper I jumped on it. I feel this is where I need to be.

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