In nursing school, I learned very little about hospice and palliative care services. I was already familiar with hospice since my grandmother past away on hospice services the summer before I got into nursing school. But overall, I don’t remember spending much time learning about hospice in school.
It was not a field that got much attention in school. For this reason, I think many people have unanswered questions about hospice.
I want to take this time to answer some of the top questions it appears that people have about hospice nursing.
If you are interested in pursuing a career in hospice, then this is the post for you!
How do you become a hospice nurse?
In order to become a hospice nurse you must first obtain your license as either a licensed vocational nurse (LVN) or registered nurse (RN).
Once you receive your license, most hospice companies prefer nurses gain 1-2 years of experience before applying for a hospice job.
You can gain experience in a wide variety of fields such as med-surg, ICU, etc.
In order to get hired for a hospice nurse position you do not have to have a specialty license or a specialized degree. An Associates Degree in Nursing or a Bachelors of Science in Nursing is sufficient.
However, after one year of working in hospice, you can be eligible to become a Certified Hospice and Palliative Nurse if you choose to do so.
How much money does a hospice nurse make? What is the annual salary for a hospice nurse?
The pay rate for a hospice nurse will depend on geographical location and years of experience.
You can go to Salary.com to view the exact numbers according to your location. They list that the average annual salary for a hospice nurse in The United States is $75,711.
When I first began as a hospice nurse I had about two years of prior experience as a med-surg nurse. I was offered $27/hour plus $5 shift differential for working nights.
My pay rate was $32/hour.
After working for a few months, all the PRN nurses received a raise, so my base pay was increased to $35/hour plus the $5 shift differential.
This brought my pay rate up to $40/hour.
Keep in mind that this is the rate as a PRN nurse. I am unaware of the hourly rate that the full time nurses receive at the facility that I work.
What do hospice nurses do?
The company that I work for employs nurses to work in the homecare setting and nurses to work in the hospice inpatient center.
The job descriptions of the nurses differ, so I will talk about each one individually.
Homecare
The majority of nurses in hospice will work in the homecare setting.
The homecare nurses are referred to as RN case managers because they manage a case of patients. The number of patients per case load will depend on census and staff availability.
They are called “homecare” nurses because they visit patients in their homes. This could be their house, apartment, nursing facility, car, etc. Wherever the patient lives is where the nurse will visit them.
During weekly visits with the patient the nurse will do a physical assessment of the patient to evaluate the patient’s status.
Hospice nurses are trained to pay close attention to signs that a patient is declining. This decline will be reported to other members of the interdisciplinary team as well as documented in the patient’s electronic chart.
During the homecare visits the nurse will also review the patient’s medication regimen and identify any areas that need improvement. Symptom management is a big part of hospice, so the nurse must pay close attention to the effectiveness of prescribed medication. If a patient’s pain, for instance, is not being properly controlled, then the nurse will need to consult with the physician about possible dosage increase or a change in pain medication.
The nurse will also assess for a need to consult any of the other interdisciplinary team members. Chaplains and social workers also make routine visits but are available for PRN visits if deemed necessary.
As all nurses do, hospice nurses perform a holistic nursing assessment to provide holistic nursing care.
The RN case manager does this for each patient on their case load. They visit their patients according to their weekly schedule and make PRN visits upon request by the family.
The nurses also do pronouncements of the death of their patients if the death occurs during their shift. If a patient on their case load dies during the night, then the on-call nurse goes and pronounces the patient.
Hospice nurses also complete admissions of patients to hospice services. The admission includes a thorough history and holistic nursing assessment. Many hospice companies will have designated “admissions nurses” whose job is to complete these admissions. However, sometimes the RN case managers will be responsible for admitting a patient to hospice services.
Inpatient Center (IPC)
Not all hospice companies have an IPC. In fact, most hospice companies do not have an IPC.
The IPC is sometimes referred to as the “ICU for hospice patients”.
Patients who are already on hospice services are eligible for admission to the IPC if they are experiencing an acute symptom. This can include problems such as shortness of breath, unmanaged pain, nausea and vomiting, etc.
Inpatient centers also will accept patients who are admitted to hospice after a hospital stay and are too fragile to go home or to a nursing home. Sometimes these patients will come to the IPC and die shortly after and sometimes these patients will be transferred to their homes or to a nursing facility.
The work that a hospice nurse does at the IPC can be compared to the work nurses do in the hospital setting.
The IPC nurse is responsible for assessing the patients, administering medications according to the MAR, managing invasive devices (foleys, NG tubes, IV sites, etc.), monitoring patients, and consulting physician when needed.
IPC hospice nurses are still heavily involved with the IDT and work closely with the team to provide continuity of care.
The nurses who work at the IPC will pronounce patients they are assigned to if they pass during their shift. The nurse then provides post-mortem care and calls the funeral home whenever the family is ready.
You can check out this post where I walk through what a day in the life of a hospice nurse looks like if you want even more info. 🙂
Is hospice nursing stressful?
Yes. But all jobs are stressful at times and all for different reasons.
Many people may assume that hospice nursing is stressful because of all the death.
“All the death” is sad to witness but I do not think that most nurses find that aspect to be the most stressful part of the job.
Each hospice nurse that you speak to may have different aspects of the job that they find particularly stressful.
Personally, the most stressful part of hospice nursing that I have experienced working at the IPC is the family’s response to the imminent death of their loved one.
Some family members will fight you on every little thing. This can become overwhelming and stressful. However, this is not a phenomenon that is exclusive to hospice.
Hospice nursing can be stressful but, in my opinion, there are more positive things that I have experienced working in hospice than negative.
Is it hard to be a hospice nurse?
When its good, it’s really good. When it’s bad, it’s really bad.
Hospice nurses can have a good flow going for a while but then get hit by a curveball out of nowhere.
This can occur if their case load is increased, their company is short staffed, if one of their “favorite patient” dies, or when a very young individual is admitted to hospice services.
The actual job of being a hospice nurse is not any more difficult than any other nursing job. It is often the being a human part of being a hospice nurse that is difficult.
What makes a good hospice nurse?
Hospice nursing is a passion.
No doubt about it.
There are great nurses out there that would simply not make a great hospice nurse. Just as there are great hospice nurses that would not be a good fit in other nursing specialties.
With every field of nursing there are certain personality types that do not fit.
A “good hospice nurse” is someone who is compassionate, patient, and understanding.
A hospice nurse should be comfortable talking about death and should be comfortable educating others about the dying process.
A hospice nurse should understand that the goal of hospice is not to cure a patient of their terminal illness. The goal is to keep patients comfortable and promote their well-being during their final stretch here on Earth.
A good hospice nurse must be a team player and not be afraid to call on other members of the IDT.
Nurses who work in hospice also must be able to set boundaries with their patients. It can be difficult, but hospice nurses must keep the relationships with patients and their families professional.
Hospice nurses also should be comfortable doing home health, since the majority of hospice nursing is done inside the patient’s home.
What do you love about hospice?
There are many things that I personally love about hospice.
Hospice profoundly changed my life and my perspective on several subjects.
My favorite thing about hospice is the support that is available to the patients and their families. It is not just medical care that Is provided, it is holistic care.
When I worked in the hospital, the care was so fragmented.
However, in hospice there is a higher degree of continuity of care. That is a nurse’s dream!
Hospice nurse tips?
Here are a few of my personal tips for hospice nurses:
- Learn how to educate patients and their families. This takes time to perfect, but you can utilize certain phrases and scripts when you first start out.
- Study the common medications used for hospice patients. Medications such as morphine, Roxanol, Dilaudid, Zofran, Levsin, etc. are commonly prescribed for patients at the end of life. Know these medications well so that you can educate patients and their families about them.
- Rest and relax on your days off. Partake in activities that you enjoy and spend time with friends and family. It is important to take time to recuperate on your days off.
- Consider becoming a Certified Hospice and Palliative Nurse when eligible in order to provide the highest level of care for your patients. The increased education will also help you feel more competent
You can check out these tips for new hospice nurses over at Nurse Advisor if you want even more tips! The more tips the better, in my opinion. 🙂
Those are all the questions I could find out there on the Googs, but if you have more questions about hospice nursing I would love to answer them for you.
If you want to know more about hospice, then you can also check out my post “6 Lessons Hospice Nursing Taught Me“.
Happy Nursing!