how to become a hospice nurse

What Is Hospice Nursing?

Hospice Nurses are health care professionals that care for patients at the end of their lives. The term "hospice nurse" is used by many as an umbrella term for a number of different professions. When individuals refer to themselves as hospice nurses, they're most likely employed as one of the following kinds of nurses: Certified Hospice and Palliative Nursing Assistants (CHPNA) or Certified Hospice and Palliative Licensed Nurse (CHPLN). Hospice nurses typically work with terminally ill patients and help ensure their and quality of life during their remaining days, as opposed to working to cure or fix a patient. Their primary responsibility is to help people live as comfortably and independently as possible and with the least amount of pain during their last days.

Becoming a Hospice Nurse

One of the main parts of being a Hospice Nurse involves helping patients, and their families feel more comfortable about death and providing them with the emotional support they need. Additionally, hospice nurses will do their best in assisting family members to manage any practical details that may be involved when caring for a dying loved one.

What Are the Educational Requirements for Hospice Nurses?

For Certified Hospice and Palliative Nursing Assistants (CHPNAs):

CHPNAs will have a high school diploma or GED
Must have to have at minimum 500 hours of hospice and palliative nursing assistant experience in the most recent 12 months, or 1,000 hours in the past 24 months, all under the supervision of a registered nurse in the United States.

For Certified Hospice and Palliative Licensed Nurses (CHPLNs):

Individual must have attended college or university and have obtained a BSN, ADN, or have graduated from a state-approved program in vocational nursing
Must currently be a licensed RN or LVN in state of residence
Should have at least two years of related experience

For Certified Hospice and Palliative Nurses (CHPNs):

Individual must have attended college or university, earning either a BSN or ADN
Must currently be a licensed RN in state of residence
Should have at least two years of related care settings

For Advanced Certified Hospice and Palliative Nurses (ACHPNs):

Will hold a master's or doctoral degree in advanced practice nursing program from an accredited university that includes both clinical and didactic segments
Must currently be in possession of an unrestricted active registered nurse license in the US.
Must be a functioning Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) with 500 hours of hospice and palliative nursing practice in the most recent 12 months, or 1,000 hours in the past 24 months before applying to take the ACHPN Examination

Are Any Certifications or Credentials Needed?

Certified Hospice and Palliative Nursing Assistants (CHPNAs)

Must pass standardized HPCC CHPNA® Examination to obtain credential
Certification is valid for four years; to renew one's certification, one must retake and pass the recertification examination and keep current in the field through continuing education courses

Certified Hospice and Palliative Licensed Nurses (CHPLNs)

Must pass standardized HPCC CHPLN Examination
Certification is valid for four years; recertification is given to those that take and pass the recertification examination and stay up to date on happenings in the field through continuing education courses

Certified Hospice and Palliative Nurses (CHPNs):

Must pass standardized HPCC CHPN Examination
Certification is valid for four years; recertification is granted either by taking and passing recertification exam or by submitting approval for continuing education and other approved activities

Advanced Certified Hospice and Palliative Nurses (ACHPNs)

Must pass standardized ACHPN Examination
Candidates who sit for and pass the ACHPN examination are granted the credential of ACHPN

Where Do Hospice Nurses Work?

Typically, hospice patients are expected to live six months or less. It is for this reason that most hospice care takes place at the patient's place of residence. Hospice nurses will work:

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

What Does a Hospice Nurse Do?

Hospice care helps patients who are terminally ill to die in a dignified way in their own home instead of in a hospital setting. One of the main jobs of a hospice nurse is to provide emotional support to assist their patients to live as independent and as comfortable as possible near the end of their lives. Often, hospice nurses are expected to stay in communication with family members, physicians, priests, or other spiritual advisers. Hospice nurses should comfortable navigating in crisis situations. In most cases, hospice nurses are part of a larger interdisciplinary health care team, which administers nursing care to individuals and their families. A hospice nurse's role will depend on the certification they hold (i.e. CHPNA, CHPLN, or CHPN).

What Are the Roles and Duties of a Hospice Nurse?

Because they're RNs, Certified Hospice and Palliative Nurses (CHPNs) are considered the senior nursing professional on the hospice team. CHPNs are responsible for providing education, supervision, and direction to the other nursing staff. Certified Hospice and Palliative Nursing Assistants (CHPNAs) and Certified Hospice and Palliative Licensed Nurses (CHPLNs), on the other hand, are responsible for providing hands-on nursing care around the clock. CHPNA's and CHPLN's are in charge of day to day nursing activities like managing the patient's pain symptoms, and comfort level. They are also responsible for maintaining the patient's hygiene and making sure they take their prescribed medication at the correct times.

Both CHPNA's and CHPLN's must keep an open line of communication with the CHPNs and Advanced Certified Hospice and Palliative Nurse on the case. Advanced Certified Hospice and Palliative Nurse's (ACHPNs) are on the periphery of the hospice team, but maintain a vital role in evaluating the overall condition of the patient and appropriately prescribing the most effective medication.

Hospice Nurse Salary & Employment

Hospice nurses who are registered nurses with advanced degrees will almost invariably have larger salaries than their nursing counterparts that do not have advanced degrees.

According to payscale.com, Certified Hospice and Palliative Nursing Assistants (CHPNAs) and Certified Hospice and Palliative Licensed Nurses (CHPLNs) will on average make an hourly wage between $11.35 to $17.53 per hour or $58,000 annually. The salary of Certified Hospice and Palliative Nurses (CHPNs) ranges between $49,831 at the low end all the way up to $82,023 annually. Lastly, Advanced Certified Hospice and Palliative Nurses(ACHPN) make an average of $96,126 annually.

Helpful Organizations, Societies, and Agencies

National Hospice and Palliative Care Organization
Hospice & Medicare
Hospice & Palliative Credentialing Center

Hospice Nurse FAQs

Can an RN Pronounce a Death?

To date, more than 20 states in the U.S., including California, Kentucky, Ohio, and New York allow for nurses to pronounce death under very defined circumstances.

Determination of death typically refers to the absence of spontaneous breathing, lack of breath sounds on auscultation, lack of pulse or heart sounds, lack of pupillary response or response to painful stimuli. Facilities or organizations with processes in place for the RN to pronounce death for their organization should also include clear assessment procedures for determining death. In the age of the electronic medical record, most software programs will include pre-fabricated documentation tools to ensure all steps have been taken in the process as well as completion of the required documentation. Nurses caring for patients through hospice, skilled nursing facilities, or an inpatient hospital setting may have the ability to pronounce death for patients in their care. Nurses must check with their local board of nursing as well as the specific institutional policy and procedure to ensure they are following the legal steps in supporting the physician and the family in pronouncing death.