What Are the Pros and Cons of Hospice Nursing?
Upon mentioning hospice nursing, the first thing that comes to most people's minds is end-of-life care for the elderly. However, hospice nurses may provide care to patients of many different ages with a wide range of conditions.
Because many misconceptions exist about hospice care and hospice nursing, we've interviewed two hospice nurses, Angela Collins RN, CHPN, MBA, and Nena Hart, MSN RN, CHPN, RAC-CT, C-DONA. They explore what you can expect from a typical day as a hospice nurse, how to tell if hospice nursing is the right career for you, and the pros and cons of working in hospice care.
The Pros of Hospice Nursing
Hospice nurses provide care for patients and advice and education for their families. Hart says, "When I told people I was a hospice nurse, everyone would comment, 'How do you do it? How depressing.' My response would always be, 'It could not be more opposite.'"
Providing care and comfort to make a patient's last days easier and more peaceful is one of the main motivations for hospice nurses.
1. Greater Autonomy Leads to Improved Clinical Skills
Because hospice nurses provide care outside of hospitals, they must provide all necessary nursing functions on their own. Hart notes that this keeps her nursing skills sharp in a variety of tasks, including complex wound care, chest tubes, drains, administration routes, subcutaneous injections, implanted ports, and other medication management skills.
"Autonomy is another big plus for those of us who don't like to feel like there is someone standing over our shoulder," says Hart. "It encourages the ability to provide a high-level of nursing care to patients while having other clinicians, a physician, and the interdisciplinary team just a phone call away."
2. No Two Days Are The Same
Because patients all have different goals for their end-of-life care, and because hospice nurses support patients with a variety of conditions, each day varies. This also helps you to keep your nursing skills current and flexible. "Flexibility is one of the biggest positives of a career in hospice as a nurse case manager. Often start and finish times are very flexible and based on patient preference and caseload," says Hart.
3. Provide Individualized Care When Patients and Families Need it Most
Collins says one of the most rewarding aspects of being a hospice nurse is making a difference. "Every day, I receive cards, letters, posts, and phone calls about how our team has positively impacted a family or a loved one." Hart adds that working in patients' homes creates a different experience with each patient. "You become part of the solution and the relationships you build with the patient and their family are usually on their terms, on their turf."
Planning for end-of-life care is never easy, but doing so will ultimately provide comfort to those suffering from terminal illnesses. Hospice nurses are responsible for providing this care and easing the pain and anxiety of death.
Collins says, "I always tell people that no one wants hospice, but at some point, everyone will need hospice. When that time comes, you want the best, and that is what I strive to provide to my community every day. No one should end the journey of life alone, afraid, or in pain."
The Cons of Hospice Nursing
There are downsides to working as a hospice nurse. While the first thing that comes to mind is the emotional strain of working with terminal patients, the high level of autonomy and providing deeply individualized care can also take its toll. In some cases, you may be required to work in scenarios that may make you uncomfortable or concerned about your safety.
1. Lack of Consistency
While variety can be energizing and a welcome challenge that keeps hospice nurse work from becoming monotonous, it can also be draining. On any given day, you may need to prepare yourself clinically and emotionally for very different patient needs and situations. Hart comments, "It can also be intimidating and scary to try to figure out how to provide good nursing care to a suffering, high acuity patient with only what you have in your car's trunk."
2. Emotionally Demanding
Hospice nurses must be empathetic with the patient and their families while maintaining healthy detachment so that they aren't emotionally overwhelmed. While they know that they provide comfort and help to the dying and their loved ones, they also experience a sense of loss when a patient dies.
During the COVID-19 pandemic, the challenges multiplied. Collins comments, "In hospice, we pride ourselves on being compassionate, empathic, and caring. And while we are all those things, the burnout [during COVID-19] is driving amazing clinicians away from the bedside . The ability of the hospice nurse to maintain the utmost level of support is being tested."
3. Lack of Control Over the Care Environment
In a hospital or long-term care facility, the environment is designed to promote health and with healthcare worker needs in mind. Nurses and other clinical professionals can shape that environment.
In a patient's home or a hospice setting, things may be different. Hart states, "Dealing with unstable family members and less than ideal activities occurring in the home setting is another common issue for hospice nurses. In the patient's home, there is most often nothing to be done about the choices the patient and family make for themselves and how they comply with hospice care recommendations."
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How to Tell if Hospice Nursing is Right for You
Being a hospice nurse requires a high level of comfort with autonomy, coping with patient loss, and working calmly but compassionately with a patient and their loved ones. You must be capable of providing excellent care under circumstances that are less under your control than work in a hospital.
If this sounds like the kind of challenge you could embrace, Hart says, "Being a hospice nurse is a much more pure and sincere experience, in the family's home with them, caring for their loved one as they die. Even though there is sadness at times, the joy outweighs it by far."
Meet Our Contributors
Angela Collins RN, CHPN, MBA
Angela Collins currently serves as chief operating officer for Nathan Adelson Hospice, the oldest, largest, and only non-profit hospice in Southern Nevada. Collins has more than twenty years of experience in leadership roles among clinical services, acute care, palliative, and hospice care.
Prior to joining the team at Nathan Adelson Hospice in 2019, she held several regional/area vice president roles in the hospice and palliative care industry. Collins is a certified hospice and palliative nurse (CHPN), a certified hospice administrator, a member and CEO/executive director of MyNHPCO's (National Hospice and Palliative Care Organization) Steering Committee, and also serves on NHPCO's quality and standards committee.
Collins earned her bachelor of science in nursing from the University of Wyoming, and a master of business administration from Baker College, Michigan.
Nena Hart MSN RN, CHPN, RAC-CT, C-DONA
Nena Hart, MSN RN, CHPN, RAC-CT, C-DONA, transforms stagnant, struggling hospice locations into thriving operations with high-performing teams. Through more than a decade of leadership, Hart has seen the negative effects of staffing instability on census growth and quality outcomes.
Hart is a certified ACHC and CHAP consultant for hospice and palliative care accreditation and has extensive experience with regulatory compliance. Hart holds a master's in nursing administration and is the owner of Hart Healthcare Solutions, which helps long-term care and hospice companies take back the financial health of their organization, stop the vicious cycle of critical staffing, enhance survey outcomes, and ultimately improve patient care.
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