In this article, we will explore whether medical-surgical or critical care experience is necessary to become a hospice nurse, the benefits and challenges of working in hospice care, the educational and licensure requirements for hospice nurses, and the resources and opportunities for professional development and networking in hospice nursing.
What Is Hospice Nursing and What Do Hospice Nurses Do?
The Role and Responsibilities of Hospice Nurses
Hospice nurses are specialized nurses who provide care and support to patients with terminal illnesses and their families. They work in various settings, such as hospice facilities, hospitals, nursing homes, or patients’ homes. Hospice nurses are responsible for assessing the patient’s physical, emotional, and spiritual needs and developing a personalized care plan. They also administer medications, manage symptoms, monitor vital signs, and educate and counsel the patients and their families. Hospice nurses collaborate with other hospice team members, such as physicians, social workers, chaplains, and volunteers, to ensure the quality and continuity of care.
Examples of the Skills and Qualities that Hospice Nurses Need
Hospice nurses need various skills and qualities to perform their role effectively. Some of the essential skills are:
Clinical skills: Hospice nurses need strong clinical skills to provide safe and competent patient care. They need to know the types of terminal illnesses, treatments, and complications. They must also be proficient in pain and symptom management, wound care, infection control, and palliative care.
Communication skills: Hospice nurses need excellent communication skills to interact with patients, their families, and other hospice team members. They must listen actively, express empathy, provide clear and accurate information, and address concerns or questions. They also need to be able to document and report the patient’s condition and progress.
Critical thinking skills: Hospice nurses must have strong critical thinking skills to make sound clinical judgments and decisions. They need to be able to assess the patient’s situation, identify potential problems, prioritize interventions, and evaluate outcomes. They also need to adapt to changing circumstances and cope with uncertainty.
Emotional skills: Hospice nurses need strong emotional skills to cope with the stress and challenges of working with dying patients and their families. They must manage their emotions, such as grief, anger, or guilt, and provide emotional support to others. They also need to be able to maintain a balance between professional detachment and personal involvement.
Desirable Qualities of Hospice Nurses
Compassion: Hospice nurses must have compassion for patients and their families. They must understand and respect their feelings, values, and preferences and be able to show them kindness, care, and comfort.
Commitment: Hospice nurses must be committed to their role and their patients. They must be dedicated to providing the best possible care and support to the patients and their families and loyal to their hospice organization’s mission and vision.
Courage: Hospice nurses must have the courage to face the difficulties and risks of working with dying patients and their families. They must overcome their fears, doubts, and insecurities. They must also be able to advocate for their patient’s rights and needs.
The Benefits and Challenges of Working in Hospice Care
Working in hospice care can be both rewarding and challenging for nurses. Some of the benefits are:
Personal satisfaction: Hospice nurses can experience personal satisfaction from making a positive difference in the lives of the patients and their families. They can help them achieve a peaceful and dignified death and ease their suffering and pain. They can also witness the patients’ and their families’ gratitude, love, and appreciation.
Professional growth: Hospice nurses can enhance their professional development by learning new skills and knowledge and expanding their scope of practice. They can also gain valuable experience and insights from working with diverse patients, families, and hospice team members. They can also pursue various opportunities for career advancement and specialization in hospice nursing.
Spiritual growth: Hospice nurses can enrich their spiritual growth by exploring their beliefs and values and connecting with the patients and their families on a deeper level. They can also experience a sense of meaning and purpose from being part of the patient’s final journey and witnessing the transcendence of life and death.
Some of the challenges are:
Emotional stress: Hospice nurses can experience emotional stress from dealing with the loss and grief of patients and their families. They can also experience compassion fatigue, burnout, or moral distress from witnessing the suffering and pain of the patients and facing ethical dilemmas or conflicts. They can also feel isolated or unsupported from working in a demanding and complex environment.
Physical stress: Hospice nurses can encounter physical stress from working long and irregular hours and performing physically demanding tasks. They can also be exposed to various health risks, such as infections, injuries, or violence. They can also suffer from fatigue, exhaustion, or sleep deprivation from the lack of rest and recovery.
Social stress: Hospice nurses can endure social stress from facing the stigma and misunderstanding of hospice care from the public, the media, or even their colleagues or friends. They can also experience role conflict or ambiguity from balancing their personal and professional lives. They can also struggle with maintaining relationships or hobbies due to lacking time and energy.
Educational and Licensure Requirements for Hospice Nurses
The Minimum Education and Licensure Requirements for Hospice Nurses
To become a hospice nurse, you must have a nursing degree and a registered nurse (RN) license. You can earn a nursing degree from an accredited program that offers an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN). Some employers may prefer a BSN over an ADN. After completing your nursing program, you must pass the NCLEX-RN exam to obtain your RN license in your state.
The Different Types of Hospice Nursing Certifications
There are several types of hospice nursing certifications that you can obtain to demonstrate your expertise and competence in hospice and palliative care. The Hospice and Palliative Credentialing Center (HPCC) offers these certifications and requires you to meet certain eligibility criteria and pass a certification exam. The certifications are valid for four years and can be renewed by meeting the recertification requirements. Some of the hospice nursing certifications are:
Certified Hospice and Palliative Nurse (CHPN): This certification is for experienced hospice and palliative RNs with at least 500 hours of hospice and palliative nursing practice in the last 12 months or 1,000 hours in the last 24 months.
Advanced Certified Hospice and Palliative Nurse (ACHPN): This certification is for advanced practice nurses who have a master’s or doctoral degree in nursing and specialize in hospice and palliative care. They also need at least 500 hours of clinical practice in hospice and palliative care in the last 12 months or 1,000 hours in the last 24 months.
Certified Hospice and Palliative Pediatric Nurse (CHPPN): This certification is for RNs who provide hospice and palliative care to children and adolescents. They need to have at least 500 hours of pediatric hospice and palliative nursing practice in the last 12 months or 1,000 hours in the last 24 months.
The table below summarizes the main differences and similarities among the four types of hospice nursing certifications:
Certification
Education
License
Experience
CHPLN
ADN, BSN, or state-approved vocational nursing program
RN or LVN license
2 years of related experience
CHPN
ADN or BSN
RN license
500 hours in the last 12 months or 1,000 hours in the last 24 months of hospice and palliative nursing practice
ACHPN
Master’s or doctoral degree in nursing
Advanced practice nurse license
500 hours in the last 12 months or 1,000 hours in the last 24 months of clinical practice in hospice and palliative care
As you can see, the requirements for each certification vary depending on the level of education, license, and experience. The ACHPN certification is the most advanced and requires a graduate degree and an advanced practice license. The CHPLN and CHPN certifications are intermediate and require an RN or LVN license and a nursing degree. All certifications require hospice and palliative care experience in the last 12 or 24 months.
Do You Need Medical-Surgical or Critical Care Experience to Be a Hospice Nurse?
Pros and Cons of having Medical-surgical or Critical Care Experience First
Having medical-surgical or critical care experience can benefit hospice nurses, as it can help them develop the clinical skills, confidence, and resilience needed to care for terminally ill patients and their families. However, it is not a mandatory requirement, and some hospice nurses may prefer to start their career in hospice care directly after obtaining their nursing degree and license. Some of the pros and cons of having medical-surgical or critical care experience are:
Pros:
Medical-surgical or critical care nurses can gain exposure to various patients, conditions, and interventions, enhancing their knowledge and competence in hospice and palliative care.
Medical-surgical or critical care nurses can learn how to cope with stress, uncertainty, and ethical dilemmas, which can prepare them for the emotional and moral challenges of hospice nursing.
Medical-surgical or critical care nurses can build strong relationships with other healthcare professionals, such as physicians, pharmacists, and social workers, facilitating interdisciplinary collaboration and communication in hospice care.
Cons:
Medical-surgical or critical care nurses may face difficulties transitioning from a curative to a palliative approach, as they may have to unlearn some of the practices and values ingrained in acute care settings.
Medical-surgical or critical care nurses may experience burnout, compassion fatigue, or moral distress from working in high-intensity and high-pressure environments, which can affect their well-being and performance in hospice care.
Medical-surgical or critical care nurses may have limited opportunities to develop the specific skills and competencies required for hospice nursing, such as symptom management, end-of-life communication, and bereavement support.
Some of the sources and statistics that can support the arguments are:
According to a survey of 1,000 hospice nurses conducted by the Hospice and Palliative Nurses Association (HPNA) in 2019, 62% of the respondents reported having prior experience in medical-surgical nursing, and 36% reported having prior experience in critical care nursing.
According to a study by McMillan et al. (2005), hospice nurses with prior experience in medical-surgical or critical care nursing scored higher on a test of hospice and palliative care knowledge than those who did not have such experience.
According to a study by Beckstrand et al. (2008), critical care nurses reported higher levels of moral distress than hospice nurses. They identified several sources of moral distress, such as futile care, inadequate pain management, and family demands.
According to a study by Coyle et al. (2010), hospice nurses with prior experience in acute care settings reported more challenges in adjusting to the hospice philosophy and culture than those who did not have such experience.
Common Myths and Misconceptions about Hospice Nursing
Some of the common myths and misconceptions about hospice nursing are:
Myth: Hospice nursing is depressing and hopeless.
Reality: Hospice nursing is rewarding and meaningful. It allows nurses to provide comfort, dignity, and quality of life to patients and their families at the end of life. Hospice nurses also experience joy, gratitude, and satisfaction from witnessing the positive impact of their care.
Myth: Hospice nursing is easy and simple.
Reality: Hospice nursing is complex and challenging. It requires nurses to have advanced clinical skills, emotional intelligence, and cultural competence. Hospice nurses face various barriers and difficulties, such as a lack of resources, time constraints, and ethical conflicts.
Myth: Hospice nursing is only for the elderly and the dying.
Reality: Hospice nursing is for anyone with a life-limiting illness and a prognosis of six months or less, regardless of age or diagnosis. Hospice nurses also care for patients with diverse backgrounds, preferences, and goals.
Transitioning from Medical-Surgical or Critical Care
If you are a nurse who wants to switch from medical-surgical or critical care nursing to hospice nursing, you may face some challenges and opportunities in your career transition. Here are some tips and advice to help you prepare and succeed in your new role:
Do your research. Before applying for a hospice nursing position, ensure you understand the scope and expectations of the role. Hospice nursing differs from acute care nursing in many ways, such as the focus on palliative care, the interdisciplinary team approach, the home-based setting, and the emotional and spiritual aspects of care. You can learn more about hospice nursing by reading articles, books, journals, and websites or talking to hospice nurses in your area.
Get some training. Although you may have much clinical experience and skills as a medical-surgical or critical care nurse, you may need additional knowledge and competencies specific to hospice nursing. For example, you may need to learn more about pain and symptom management, end-of-life communication, advance care planning, bereavement support, and cultural and ethical issues in hospice care. You can enroll in continuing education courses, workshops, seminars, or online programs that offer hospice and palliative care education. You can also pursue a hospice nursing certification, such as the Certified Hospice and Palliative Nurse (CHPN) credential, demonstrating your expertise and commitment to the specialty.
Seek mentorship. Transitioning to a new specialty can be challenging and stressful, especially if you are unfamiliar with the hospice culture and philosophy. You can benefit from having a mentor who can guide you, support you, and provide you with feedback and advice. You can ask your employer or your professional association to match you with an experienced hospice nurse who can serve as your mentor. You can also seek informal mentorship from your colleagues, supervisors, or educators in hospice care.
Be flexible and open-minded. As a hospice nurse, you may encounter situations and scenarios different from what you are used to in acute care settings. You may have to adapt to a different pace, environment, and workflow. You may also have to deal with complex and sensitive issues, such as death, dying, grief, and loss. You may face resistance or misunderstanding from patients, families, or other healthcare providers unfamiliar with hospice care. To overcome these challenges, you need to be flexible and open-minded. It would be best to respect your patients’ and their families’ preferences and beliefs and collaborate with your hospice team members. Learning from your experiences and seeking feedback and support when needed would be best.
Resources and Opportunities for Professional Development and Networking
There are many resources and opportunities for professional development and networking in hospice nursing. Some of them are:
Professional associations. Joining a professional association can help you access educational programs, certification opportunities, publications, research, advocacy, and networking events related to hospice and palliative care. Some of the prominent associations for hospice nurses are the Hospice and Palliative Nurses Association (HPNA), the American Academy of Hospice and Palliative Medicine (AAHPM), and the National Hospice and Palliative Care Organization (NHPCO).
Conferences and seminars. Attending conferences and seminars can help you update your knowledge and skills, learn from experts and peers, and network with other hospice professionals. Some popular conferences and seminars for hospice nurses are the Annual Assembly of Hospice and Palliative Care, the NHPCO Interdisciplinary Conference, and the HPNA Clinical Practice Forum.
Online learning. Online courses, webinars, podcasts, or modules can help you enhance your learning and competence in hospice and palliative care at your own pace and convenience. Some online learning resources for hospice nurses are the HPNA E-Learning Center, the End-of-Life Nursing Education Consortium (ELNEC), and the Palliative Care Network of Wisconsin (PCNOW).
Local chapters and groups. Participating in local chapters and groups can help you connect with other hospice nurses in your area, share best practices and challenges, and engage in community outreach and advocacy. You can find local chapters and groups affiliated with your professional association or start your group with your colleagues and friends.
Testimonials and Stories from Nurses Who Have Successfully Transitioned to Hospice
Here are some testimonials and stories from nurses who have successfully made the transition from medical-surgical or critical care nursing to hospice nursing:
“I worked as a medical-surgical nurse for five years before switching to hospice nursing. I was drawn to hospice nursing because I wanted to provide more holistic and compassionate care to patients and their families at the end of life. I was nervous at first because I didn’t know much about hospice care, and I had to learn a lot of new skills and concepts. But I was lucky to have a great mentor who helped me through the transition. She taught me how to manage symptoms, communicate effectively, and cope with emotions. She also introduced me to the hospice team and the hospice philosophy. I learned that hospice nursing is not about giving up or losing hope but about celebrating life and honoring dignity. I love being a hospice nurse because I make a difference in the lives of my patients and their families daily.” – Amy, a hospice nurse for three years.
“I was a critical care nurse for seven years before I switched to hospice nursing. I enjoyed working in the ICU but felt missing something in my career. I wanted to have more meaningful and lasting relationships with my patients and their families and to help them cope with their illness and death. I applied for a hospice nursing position and was hired after a rigorous interview and orientation process. I was impressed by the hospice organization and team, who were very supportive and professional. I was also amazed by the hospice patients and their families, who were courageous and grateful. I learned that hospice nursing is not only about providing physical care but also about providing emotional, spiritual, and social care. I learned that hospice nursing is a job and a calling. I am proud to be a hospice nurse because I give and receive much love and joy in my work.” – Brian, a hospice nurse for two years.
Conclusion
Medical-surgical or critical care experience is not mandatory to become a hospice nurse. Still, it can be beneficial for developing the clinical skills, confidence, and resilience needed to care for terminally ill patients and their families. Hospice nursing can be rewarding and challenging, requiring nurses to have advanced clinical skills, emotional intelligence, and cultural competence. Hospice nurses can experience personal satisfaction, professional growth, and spiritual growth from working in hospice care, but they can also face emotional, physical, and social stress. To become a hospice nurse, you need to have a nursing degree and a registered nurse (RN) license, and you can obtain various hospice nursing certifications to demonstrate your expertise and competence in hospice and palliative care. There are many resources and opportunities for professional development and networking in hospice nursing, such as professional associations, conferences and seminars, online learning, and local chapters and groups. Suppose you are a nurse who wants to switch to hospice nursing. In that case, you can prepare and succeed in your new role by doing your research, getting some training, seeking mentorship, being flexible and open-minded, and learning from the testimonials and stories of other nurses who have successfully transitioned to hospice.
