What Does a Hospice Nurse Do?

Jul 29, 2020
Kathy Quan, RN, BSN, PHN

Hospice nursing takes a special kind of soul. Assisting patients and their loved ones through a  patient’s final journey can be overwhelmingly sad and uncomfortable. It can also be exceedingly rewarding to help patients transition on their own terms and pass away with dignity. 

However, not every nurse is cut out to be a hospice nurse. Are you? 

What are typical responsibilities of hospice nurses?

Hospice is an Interdisciplinary Team that consists of the:

  • Patient
  • RN case manager
  • Certified Home Health Aide
  • Hospice Physician
  • Social Worker
  • Spiritual Counselor or Chaplain

The hospice team makes decisions as a group based on the patient’s specific needs. Any changes to the plan of care must be authorized by a minimum of three team members as well as the patient or designee.

At each nursing visit, a physical assessment is performed on each of the patient’s body systems. The RN also assesses any symptoms or changes in the status of the terminal illness or quality measures such as pain, dyspnea, or constipation. Management of these and any other symptoms is critical to keeping the patient comfortable and on-track to pass away in peace. This process may take six months or more.

Hospice patients will experience a number of changes in body function, emotional factors, and abilities for self-care. These typically include weight loss, loss of appetite, and increasing needs for assistance with ADLS. Incontinence of bladder and bowel will most likely occur at some point. 

Other patient issues may include changes in mental status such as confusion, anxiety, agitation, depression, insomnia, or increased somnolence. It is the nurse’s responsibility to anticipate changes and educate the patient and caregivers on how to safely provide assistance and manage these symptoms.   

hospital bed in foreground with medications in the background hospice nursing

What should nurses entering hospice care expect on a regular basis?

Hospice nursing involves a great deal of teaching, myth-busting, and assisting caregivers in  achieving a sense of confidence and reward for helping their loved one through this last leg of their life. Hospice care is about helping patients and their families make the most of those final months or days. 

Acting as case manager, the RN manages the team and is responsible for assessing the patient and plan of care at least every 15 days. (This should be done every 14 days if the patient has a Certified Home Health Agency (CHHA) to be supervised.) 

During the meetings, known as Interdisciplinary Group or Team meetings (IDG or IDT), the case manager leads a review of what has transpired in the past 15 days and how to plan for the next 15 days. Decisions are made as a team and presented to the patient for approval. 

Can you share a personal perspective? 

I started working with hospice patients in the late 1970s. At that time, hospice was a whole new concept and a part of skilled home health care. Hospice has evolved significantly since then. I cherish the privilege of caring for my own aging parents and in-laws as they transitioned on hospice. 

What are some of the not-so-great parts of working as a hospice nurse?  

Hospice is a very challenging nursing role with many long and exhausting visits. As a hospice nurse, self-care is not just an option; it’s an absolute necessity. Hospice care is available 24/7, which means that hospice nurses are required to be on-call during a set number of nights per month as well as weekends and holidays.

Over time, this workload—and the realities accompanied by it—can certainly lead to moral injury or compassion fatigue.

This responsibility is typically rotated across field staff. It’s not fun to be woken up in the middle of the night, but it’s important to remember that you will make a meaningful difference for a patient at that moment. Some on-call issues can be triaged over the phone, but others will require a visit at any time of the day or night.

Hospice nurses pronounce patients and lend emotional and spiritual support to the caregivers and family until the mortuary is able to come and pick up the body. Patients often die in the middle of the night. The hospice nurse will attend to the body, as well as dispose of unused medications and document the counts. 

Depending on the time of day, the hospice nurse will notify the team members, the patient’s MD, and any designated family members when appropriate. By notifying the hospice office, arrangements for equipment pick-up can be made. 

Depending on the time of death, the case manager may or may not be called to pronounce. In these circumstances, the case manager can reserve the right to be called for specific patients. It’s important for families to understand they might not have their “own” case manager make that last visit, but hospice nurses operate as a team.

What are some of the benefits of working as a hospice nurse? 

One of the most rewarding aspects of the role is meeting such a wide variety of people and hearing their life stories. Learning about places people have been, the things they have done, and the love they have to share is something nurses don’t always have the privilege of experiencing in other roles. 

Name one of my favorite pieces of advice for new grads or students

Could hospice nursing be your next passion? If you’re a student, new grad, or seasoned nurse with an interest, seek out a ride-along with a hospice nurse and follow your heart. This is the best way to figure out for sure.

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