The population is getting older. According to the U.S. Census Bureau, the number of U.S. adults over age 65 is expected to reach 94.7 million by 2060. This, coupled with increased numbers of those under 65 living with chronic illnesses, has created a shift to person-centered care, allowing patients to be in their homes or other facilities where they are most comfortable. It has also given rise to the specialities of hospice and palliative care and a growing need for those at the center of it: hospice and palliative nurses.
As part of Berxi’s commitment to supporting the possible for nurses, we take a closer look at these growing specialities, the qualifications and responsibilities they require, as well as other information to help you determine whether a career in hospice or palliative care nursing is right for you.
Hospice & Palliative Care Nursing: Specialized Medical & Helpful Care for End of Life
Healthcare professionals in hospice and palliative areas provide quality-of-life care to support the needs of patients and their families. Both specialties prioritize the patient’s care goals, including symptom management. They emphasize the following:
- Clarifying or creating an advanced directive to guide medical treatments and assist with difficult decisions
- Following treatment plans, such as a Do Not Resuscitate (DNR) for some patients (generally hospice)
- Providing medications that offer pain relief and symptom management
- Delivering medical equipment and supplies in the care environment, such as hospital beds, nebulizers, skincare-like creams, and diapers
- Educating patients and their family members
The nurse's role is a critical part of hospice and palliative interdisciplinary teams, which also include physicians, home health aides, social workers, nutritionists, and chaplains.
How Do Hospice & Palliative Care Nursing Differ?
There are both similarities and differences between hospice and palliative care. The main differences are around:
- Payment. Hospice is paid by Medicare, Medicaid, or insurance, while palliative is paid by insurance or the individual.
- Start time. Hospice typically starts when a patient has six months or less life-expectancy. Palliative care can be added to the care plan of a chronic illness without death being imminent.
- Curative treatment plans. Hospice care does not include a plan to cure the patient, which palliative care typically works with as part of a treatment plan.
- Location. Hospice care can happen at home, in a hospital, or in a home healthcare setting. Palliative care is usually part of doctors’ appointments or in a hospital setting.
What Is Hospice Care Nursing?
When you hear the term “hospice,” it may conjure up images of a patient with a terminal illness in their final days, final weeks, or final months at home, surrounded by family members. This is just a sliver of what hospice can entail.
According to the Hospice Foundation of America, hospice care is person-centered coordination of care that involves goals, care communication, and emotional and spiritual support. It is also the only medical care that includes bereavement care for the dying patient’s family members both during the illness and for more than a year after their loved one passes.
With hospice, patients have decided to stop curative care and aggressive treatments, making quality of life the priority. The American Cancer Society explains that emotional support for the whole family is at the forefront of the clinical services provided: “A team of professionals work together to manage symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. Hospice care is also family-centered – it includes the patient and the family in making decisions.”
Hospice care for a person's illness is paid for by Medicare & Medicaid Services as well as private insurance plans, including those from health maintenance organizations. In addition, Veterans Affairs offers hospice coverage to those who have served.
The one-to-one care a hospice nurse provides can be delivered at home, in a hospital (including veterans' facilities), a hospice residence, a skilled nursing facility, or an assisted living environment.
Responsibilities of a hospice care nurse
- Providing physical care, such as monitoring vital signs
- Assisting with pain management by administering pain medications
- Advocating for patients and family members
- Offering psychosocial support to patients and family members through empathy and communication
- Coordinating spiritual care, grief support, and bereavement services
- Helping educate the primary caregiver and other family members
- Responding to emergency calls from family members
Typical qualifications & degrees of a hospice care nurse
Becoming a hospice nurse requires some important skills, including strong clinical skills to be able to assess and manage patients' needs, as well as excellent communication skills to keep family members, healthcare professionals, and members of the hospice team informed. In addition, you must meet the following criteria/requirements:
- Obtain a nursing degree, either an Associate Degree in Nursing (ADN), a Bachelor of Science (BSN), or a Master of Science in Nursing (MSN)
- Pass the National Council Licensure Examination (NCLEX), which is required by every state
- Have two to three years of clinical experience working at a facility such as a hospital, intensive care unit, or nursing home that provides end-of-life care
To further your experience, you can also pursue certifications, including becoming a Certified Hospice and Palliative Nurse, which requires passing a certification exam and having a minimum of 500 hours of end-of-life nursing experience in the last year or 1,000 hours over the last two years
Employment opportunities & average salary for hospice nurses
According to the Bureau of Labor Statistics, the hospice industry is projected to have the fastest employment growth in the healthcare and social assistance sectors, and several occupations employed by hospice providers are projected to add many jobs, including nursing. In fact, the national average salary for a hospice nurse as of April 2023 is $80,519, though it varies by state, experience, education, and certifications.
Top risks & malpractice data associated with hospice nurses
Providing end-of-life care often requires juggling many responsibilities and making difficult decisions that could lead to potential liability. Just like all nursing specialties, there are risks of malpractice involved.
For example, a family may believe that a medical error was made that caused their loved one to pass sooner than expected and may file a wrongful death claim. Or, if a patient is hurt while in hospice, the family may file a negligence claim. Some of the claims made against hospice professionals include:
- Errors in administering medication/treatment
- Withholding treatments
- Not documenting medications/treatments/intervention
- Failure to adhere to standards of care
- Elder abuse
What Is Palliative Care Nursing?
So now that we've looked at hospice care in depth, let's look at its sister service, palliative care. According to the World Health Organization, "Palliative care is a crucial part of integrated, people-centered health services that improve the quality of life of patients and their families who are facing challenges associated with life-threatening illnesses."
There are some important differences between hospice and palliative care. The latter covers a broader range of patients whose illnesses are not considered terminal. Unlike hospice care where patients forgo curative care, palliative care can include curative treatments and be administered at any stage of disease at the discretion of the patient or the physician. It focuses on symptom management and advanced care planning for patients' conditions that involve complex, chronic illnesses and serious diagnoses, including:
- Chronic liver disease
- Chronic obstructive pulmonary disease
- Heart disease, including congestive heart failure
- End-stage renal disease
- Degenerative neurologic conditions, such as Parkinson’s disease or ALS
- Dementia, such as Alzheimer's or Lewy body
- Trauma or orthopedic patients facing a long or complex recovery
Medicare Part B and Medicaid may also pay for some palliative care treatments, as well as some private health insurance plans.
Responsibilities of a palliative care nurse
- Administering medical care and treatment of patients with serious life-limiting illnesses
- Monitoring and managing symptoms and delivering compassionate care
- Providing pain relief to ensure patient comfort
- Communicating with patients, physicians, other healthcare providers, and family members
- Providing emotional support to patients and family support
- Helping transition patients to hospice care
Typical qualifications of a palliative care nurse
Though a specialized palliative care degree isn't required, you can obtain certifications through the Hospice and Palliative Credentialing Center. The qualifications for becoming a palliative care nurse are similar to those for hospice. It requires:
- Earning an undergraduate or graduate degree in nursing
- Passing the NCLEX exam
- Working in acute or critical care settings
Employment opportunities/average salary for palliative care nurses
With the increase in population and the shift to providing better-quality personalized care, an increasing number of hospitals are offering palliative services, creating a growing demand for palliative care nurses in hospitals as well as at home. In fact the average salary for a palliative care nurse, as of August 2022 was $76,500. Salaries do depend on geographical region, experience, education level, and certifications.
Risks & malpractice data associated with palliative care nursing
The level of skilled care required with palliative care nursing does present some risks and challenges, including the ability to provide quality care and treatment when a patient's health continues to deteriorate. Nurses must also deal with the ethical and often cultural responsibilities of administering care while honoring a patient's wishes.
Final Thoughts: Palliative Care Nursing vs. Hospice Nursing
Hospice and palliative care nursing are two very rewarding careers that help improve the quality of life for patients and their loved ones. Nurses can be powerful educators and drivers of patient and family satisfaction with the care they receive, especially as patients near the end of their lives.
Symptom management, advanced care planning, and patient and family member care are the main goals for hospice and palliative care nursing. Experience and knowledge from a wide variety of nursing backgrounds, as well as the support of an interdisciplinary team, can make for a very rewarding job.
And when it comes to protecting yourself against claims of negligence and malpractice, nurses in either industry should make sure they document all patient developments accurately, communicate all changes to the patient and family (and make notes of these updates), and ask for help when you need it. It’s also incredibly important to know your malpractice insurance provider and amount of coverage (independent contractor nurses might not be covered by insurance).
Alexandra Prabhu, RN, and Gina Gallagher contributed to this article.