Learn How to Become a Hospice Nurse in 12 Steps

hospice nurse with patient

Hospice Nurse Career Snapshot

Where you’ll work: Hospitals, long-term care facilities and patients’ homes.

What you’ll do: Specialize in the care of terminally-ill patients by managing their symptoms to maximize their comfort at the end of life. Hospice nurses also provide emotional support to patients and their families.

Minimum degree required: ADN or BSN, though many employers prefer or require nurses to have a BSN or higher.

Who it’s a good fit for: Being a hospice nurse can be a great fit for someone who wants to make a difference at the end of peoples’ lives, which can be quite meaningful and spiritually rewarding. However, hospice nurses by definition will see their patients die, and so they must be able to withstand the emotional turmoil that comes with that reality.

Job perks: Hospice nurses tend to have more autonomy than other nurses. They often get to make decisions on their own and manage their own cases.

Opportunities if you pursue a higher degree or certification: Although it is not required, becoming a Certified Hospice and Palliative Nurse (CHPN) through the Hospice and Palliative Credentialing Center could make you a stand-out job applicant for future nursing positions.

Median annual salary: $81,220

What Is a Hospice Nurse?

Hospice nurses provide hands-on care for terminally ill patients and help support family, loved ones, and other care providers. Instead of treating patients, hospice nurses focus on managing symptoms at the end of life. While this care isn’t curative, it requires the same clinical rigor as medical treatment.

Steps to Become a Hospice Nurse

Find nursing programs that offer electives related to end-of-life care.

potential hospice nursing student doing research on computer

If hospice nursing is a specialty you want to pursue, look at a program’s course offerings. Most nursing programs cover end-of-life care, but some also may offer elective coursework that delves deeper into this area.
Other important things to look for in a program:

School and program accreditation: If your program isn’t accredited, you won’t be able to apply for financial aid or take the national nursing exam required to obtain a license.
Support services: Some programs provide career counseling, job placement, or help students prepare for the national licensing exam.

National nursing exam pass rates: A high first-time pass rate could indicate a strong program that prepares nursing students for their field.

Online programs: If you’ll need to juggle work or family responsibilities while you attend school, an online program may give you flexibility in your coursework and studies. However, keep in mind that all nursing programs require some level of in-person clinical and lab work.

Decide whether a BSN or ADN better fits your priorities.

nursing student in classroom

Hospice nursing requires at least an Associate Degree in Nursing (ADN), but employers often prefer a Bachelor of Science in Nursing (BSN). An ADN takes two years to complete, so you might be able to begin your career sooner and spend less money by taking this path. A BSN is a four-year degree that offers a more in-depth education and can prepare you for future advancement into management roles.

Apply to a program.

student doing research into nursing programs

Both ADN and BSN programs require a high school diploma or GED. Some schools and programs may also require ACT or SAT test scores and a minimum GPA. Once you’re admitted to a program, you will likely need to complete prerequisite courses in English, biology, chemistry, and math before you can begin your nursing studies.

Complete your coursework and clinicals.

nurse working in medical facility

Studies for both degrees typically include:
• Microbiology
• Basic anatomy
• Pharmacology
• Sociology
• Psychology

A BSN program also will cover more advanced coursework, such as:
• Nursing theory and management
• Leadership
• Public health

Students do their clinical work in a healthcare setting such as a simulation lab, hospital, or community health clinic. Registered nurses may oversee this training, which includes learning basic tasks like giving injections and more complex skills like determining the difference between a healthy and problematic heart rate. Most BSN programs require students to complete 700 to 800 clinical hours.

Pass the NCLEX-RN.

students taking nclex exam

After you graduate, your next step is to take the National Council Licensure Examination-RN (NCLEX-RN), which is administered by the National Council of State Boards of Nursing (NCSBN). All aspiring RNs must pass this six-hour, computer-based exam before they can apply for a nursing license. Many nursing programs help students prepare for the test, which covers topics including:

• Patient safety and infection control
• Care management
• Risk reduction
• Pharmacology

Exam questions are based on your answers to previous questions. Depending on your performance, you may answer as few as 75 questions or as many as 265.

Meet your state’s licensing requirements.

student researching state requirements at home

With a passing NCLEX score in hand, you’re ready to apply to your state nursing board for an RN license. While all states require applicants to pass the NCLEX-RN, many have other requirements as well. For example, some require a background check, fingerprints, or references. The NCSBN maintains a database of state requirements

Gain experience as a nurse.

nurse working in medical facility looking at computer and taking notes

It’s rare to go right from nursing school into a hospice position, so you’ll want to get one to two years of clinical nursing experience—if possible in an area related to hospice care—before you pursue the specialty.

“I have a long background in critical care, including almost a decade in the intensive care unit, and more years in case management where I worked with geriatric patients and those with dementia,” says Ryan H. Catan, RN, CM-DN, a nurse care coordinator at Hospice of the Chesapeake in Pasadena, Maryland. “Those are the kinds of patients we tend to have.”

Jon Fitzke, RN, RNCM, a case manager at Willamette Valley Hospice in Salem, Oregon, worked with ventilator-assisted ALS patients and did a stint in a burn unit before he became a hospice nurse. “I learned a lot about compassion from these jobs,” Fitzke says. “That helped lead me to hospice care.”

Consider earning a hospice nursing certification.

hospice nurse caring for patient

Certification is optional for hospice nurses, but it can help you stand out in a field of candidates, open doors to advancement, and help you qualify for higher pay. Certification demonstrates knowledge beyond what you learn in a classroom and tells others that you have deep expertise in your field.

There are two hospice certifications available for RNs:

Certified Hospice and Palliative Care Nurse (CHPN)
Who Offers It: The Hospice and Palliative Credentialing Center (HPPC)
Who It’s For: Experienced hospice nurses
Requirements: At least 500 hours of clinical hospice experience in the previous 12 months or 1,000 hours in the previous 24 months.

Certified Hospice and Palliative Pediatric Nurse (CHPPN)
Who Offers It: HPPC
Who It’s For: Experienced pediatric hospice nurses
Requirements: At least 500 hours of clinical pediatric hospice experience in the previous 12 months or 1,000 hours in the previous 24 months.

Prepare for the certification exam.

student preparing for exam

The HPPC provides study tips and a list of suggested fee-based study materials and books for both certifications. It recommends that hospice nurses spend at least six months preparing for the exam. 

Pass the certification exam.

students taking certification exam

Both tests are online, three hours long, and consist of 150 questions that cover assessment and planning, pain and symptom management, advocacy, education, and practice issues. The pediatric exam also covers child and family-centered care.

You can take a practice test of 15 questions prior to the formal test. You can also make comments on the questions as you take the test.

Keep your certification current.

nurse working on computer

Recertification is required every four years. During that time, hospice nurses must complete a certain number of clinical hours in hospice care—500 in the last 12 months or 1,000 in the last 24 months. They must also participate in a variety of professional development activities, such as conferences and online courses, and complete a situational judgment exercise.

Catan says many of the patients he has seen in the last few years have entered hospice as a result of opioid addiction and suggests continuing education on this topic.

Advance your training.

medical professionals meeting

Pursuing a Master of Science in Nursing (MSN) can often lead to advancement into managerial and administrative positions. However, Catan and Fitzke say that if you’re not interested in these roles or leadership, you can probably get the job of your dreams through certification and the continuing education that goes with it.

By its very nature, hospice nursing requires deep compassion. It also requires nurses to be able to disconnect and separate the emotional aspect of their work from their personal lives.

“I have cared for patients over long periods,” says Catan. “I get attached, and I feel the loss. So it’s important to learn to compartmentalize. I tell myself: I am here to help in this situation, and this situation can be better because I am part of it.’ That helps me feel fulfilled and not drained.”

Fitzke, who has cared for children, says working with them can be more challenging due to the nature of their age and the loss for parents and siblings alike. “The needs of family are always important, but what siblings require from hospice is much more important with child patients than it is with adults.”

Fitzke stresses that hospice nursing is not goal or task-driven.

“This is more gentle care,” he says. “It is not ticking items off a list. This is a different kind of critical thinking, designed not to figure out how to make a patient better, but to determine the best ways to provide comfort to the patient and the family, to help them come to a place of acceptance.”

By its very nature, hospice nursing requires deep compassion. It also requires nurses to be able to disconnect and separate the emotional aspects of the work from their personal lives.

Hospice nurses make many decisions on their own and manage their own cases. If you aren’t comfortable in a role with little supervision or guidance, this specialty might not be for you.

A Day in the Life of a Hospice Nurse

  • Catan begins a typical day reviewing emails and phone calls that came in overnight. Some are from physicians’ offices, while others are from patients with symptoms, he says. Catan can handle many of the responses by email or a phone call, but sometimes he needs to visit a patient to solve a problem.
  • He spends the bulk of his day driving from patient to patient. “Each visit is about 40 minutes, and I see four to six patients a day,” he says.
  • Catan also updates patient medical charts, orders supplies, and communicates with providers and families. “I make sure everyone talks to everyone,” he says. “Communication is a cornerstone of hospice work.”
  • Between patients, Catan answers calls and triages patient needs. “Are they having a crisis and need to be walked through it? Are more meds required? A lot is allaying people’s fears,” he says.
  • Catan suggests that nursing students take psychology courses about fear and its responses as part of their coursework. “You will use information about anticipatory grief, family dynamics, and personality disorders throughout a career in nursing,” he says.

How Long Does It Take to Become a Hospice Nurse?

The time it takes to become a hospice nurse will depend largely on the education you choose. An ADN will take two years to complete and a BSN four years. Add one to two years of general nursing experience and six months for certification, and the timeline generally will be four to six years. 

Where You’ll Work

Hospice nurses work in hospice and palliative care departments in hospitals, long-term care facilities, and assisted living and memory care centers.

They also work for hospice agencies, which assign nurses to patients who may be in nursing care or another facility.

Hospice nurses also see patients in their homes. These patients have chosen to spend their last days at home, some intentionally returning from a hospital stay.

Hospice nurses also see patients in their homes. These patients have chosen to spend their last days at home, some intentionally returning from a hospital stay.

Some hospice nurses also work for insurance companies, where they review hospice care billing and services.

Pros and Cons of a Career as a Hospice Nurse

As with any career, there are advantages and drawbacks to hospice nursing. Here are some to think about as you consider this specialty.

  • Meaningful Work:
    Fitzke says hospice nursing “fills me up more than it depletes me.” The work is rewarding, he says, and “has taught me that it is never too late to develop meaningful relationships.”
    Catan says he gets a lot of validation and appreciation from patients and families, and his colleagues also provide a boost for him. “I get to work with my heroes every day, a whole bunch of people who want to be there. That’s a gift.”
  • Emotionally Draining:
    Fitzke says it’s important to take care of himself after a patient dies. His organization provides access to grief counselors, and it encourages staff to take paid leave.
  • Difficult Interactions:
    Hospice care can be emotionally fraught, and hospice nurses need to be able to accept people as they are. They don’t have control over the homes they visit or the people who live there.

The Difference Between Hospice and Palliative Care

Palliative and hospice care are different nursing specialties focused on different patients.

Hospice care is for patients who are approaching the end of life. Generally, this means they’re expected to live for up to six months. Hospice care begins after treatment has stopped and is designed to manage a patient’s symptoms and provide physical comfort.

Palliative care generally is designed to ease the pain and discomfort of patients who are trying to cope with an illness, disease, or medical treatment. Cancer patients, for example, often receive palliative care to help manage pain and other symptoms that may be caused by the disease or treatment.

How Much Does a Hospice Nurse Make?

Jobs for RNs overall are expected to grow 5.6% through 2032, according to the U.S. Bureau of Labor Statistics. The agency says nurses will be more in demand in some settings, including homes and residential care facilities, because older people prefer to be cared for in those places over medical facilities like hospitals.

The median annual salary for RNs is $81,220, the BLS says, and though the bureau doesn’t break out salaries for nursing specialties, there are many factors that can influence how much an RN makes, including:

  • Level of education
  • Experience
  • Location
  • Workplace
  • Certification

Catan says a well-trained and experienced hospice nurse can make more than they would in a medical/surgical unit in a hospital. Take a look at median annual RN salaries by state, according to BLS data.

Registered Nurses

National data

Median Salary: $81,220

Projected job growth: 5.6%

10th Percentile: $61,250

25th Percentile: $66,680

75th Percentile: $101,100

90th Percentile: $129,400

Projected job growth: 5.6%

State data

State Median Salary Bottom 10% Top 10%
Alabama $63,090 $48,820 $82,760
Alaska $102,260 $80,950 $127,280
Arizona $82,330 $66,040 $105,520
Arkansas $64,130 $37,630 $83,700
California $132,660 $84,700 $177,670
Colorado $82,430 $66,130 $107,260
Connecticut $95,210 $71,050 $119,600
Delaware $82,230 $64,100 $101,110
District of Columbia $98,970 $66,260 $135,260
Florida $77,710 $61,190 $100,060
Georgia $79,440 $60,400 $118,270
Hawaii $120,100 $76,640 $137,710
Idaho $77,940 $61,530 $100,440
Illinois $78,980 $62,180 $102,080
Indiana $73,290 $55,200 $95,600
Iowa $65,000 $56,330 $83,360
Kansas $66,460 $52,010 $93,120
Kentucky $75,800 $56,120 $98,540
Louisiana $73,180 $57,500 $95,540
Maine $77,340 $61,170 $100,910
Maryland $83,850 $64,680 $106,910
Massachusetts $98,520 $67,480 $154,160
Michigan $79,180 $64,270 $100,920
Minnesota $84,060 $65,500 $107,960
Mississippi $63,330 $49,980 $84,030
Missouri $71,460 $51,440 $94,340
Montana $76,550 $62,930 $98,970
Nebraska $74,990 $58,900 $93,230
Nevada $94,930 $74,200 $130,200
New Hampshire $80,550 $62,790 $104,270
New Jersey $98,090 $76,650 $118,150
New Mexico $81,990 $64,510 $106,300
New York $100,370 $64,840 $132,950
North Carolina $76,430 $59,580 $100,430
North Dakota $69,640 $60,780 $91,150
Ohio $76,810 $61,860 $98,380
Oklahoma $74,520 $53,560 $97,520
Oregon $106,680 $81,470 $131,210
Pennsylvania $78,740 $61,450 $101,450
Rhode Island $85,960 $65,260 $104,790
South Carolina $75,610 $52,620 $93,190
South Dakota $62,920 $51,240 $80,860
Tennessee $65,800 $51,270 $95,490
Texas $79,830 $61,950 $105,270
Utah $77,240 $61,850 $98,000
Vermont $77,230 $60,900 $101,570
Virginia $79,700 $61,970 $104,410
Washington $101,230 $77,460 $131,230
West Virginia $74,160 $47,640 $96,470
Wisconsin $79,750 $65,110 $100,820
Wyoming $77,730 $60,910 $102,010

Source: U.S. Bureau of Labor Statistics (BLS) 2022 median salary; projected job growth through 2032. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Professional Resources

As you embark on your career, you’ll want to keep up with trends in hospice nursing and take advantage of opportunities to advance. Here are some resources to help you do that.

lisa jaffe

Written and reported by:

Lisa Jaffe

Contributing Writer

With professional insight from:

ryan catan

Ryan H. Catan, RN, CM-DN

Nurse Care Coordinator, Hospice of the Chesapeake

jon fitzke

Jon Fitzke, RN, RNCM

Case Manager, Willamette Valley Hospice