Hospice Nursing - Compassionate Care at the End of Life

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 nurses, registered nurses, or advanced practice nurses, depending on the setting and the patient's needs.

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 goal 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 patient at home
Provides family with 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 alleviates 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 con 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 have 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

The average annual salary for a hospice nurse is $62,000, 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. Some hospice nurses are earning more that $75,000 per year. Advanced practice nurses also earn significantly higher salaries on average.

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