From the early stages of the hospice admissions process until the final steps of a patient’s end-of-life journey, the skilled and compassionate impact of hospice nurses can be witnessed throughout any hospice organization.

With nurses playing such a vital role in the hospice care team and in many of the day-to-day patient care activities, understanding their role helps form a more complete picture of how hospice provides holistic care for patients, caregivers, and family members.

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The Different Types of Hospice Nurses

The role of a hospice nurse is also a multivariat one. Having such a robust skill set, nurses can apply their knowledge and talents across a host of varying care specialities within a hospice organization.

Admission Nurse Admission nurses are some of the first members of a hospice organization with whom patients come into contact. In this position, admission nurses guide patients and families through the hospice assessment and admissions processes and play a pivotal role in the educational process for patients, families, and caregivers alike. When terminally-ill individuals are considering hospice care, an admissions nurse will work closely with that patient’s physician to understand the patient’s needs and determine whether or not that patient is eligible for hospice care. If that patient is eligible to receive hospice care, the admissions nurse provides compassionate education concerning the holistic hospice care philosophy, as well as the nature of the care they can expect to receive in regard to their specific terminal illness. Admissions nurses also work closely with the patient’s care team in formulating a care plan for the patient. With the admission nurse being one of the first medical professionals from that hospice organization that has met with that patient, their insight is invaluable. Following a patient’s admission, admissions nurses may also play a role in the order of any specialty care equipment that a patient might require as well as all pain relief and other symptom-controlling medications. Case Managers The role of a case manager is one of the most direct, hands-on nursing roles in a hospice organization. Hospice case managers oversee the direction and coordination of a patient’s care — and the care provided for their caregivers and family — throughout their time in hospice. Working closely with the rest of the hospice care team, case managers decide how care resources are allocated and formulate the plan of care for each patient. They also determine what level and what types of counseling, education, and care the patient’s family caregiver and family members will need before, during, and after the patient’s death. Visit Nurses Visit nurses supplement the care provided by a patient’s hospice case manager. In part, their work consists of following up on routine care duties that are laid out in the patient plan of care, such as providing periodic wound care, administering medications, and ensuring proper documentation of all provided care. Triage Nurses When patients or caregivers experience an at-home emergency or need to get receive advisement on care, triage nurses are on call and at the ready. From the moment an emergency call comes in from a caregiver or family member, triage nurses begin assessing the situation, gain an understanding the patient’s specific care needs, and begin advising care. Triage nurses also inform the hospice case manager or visiting nurse of the situation, as well as the patient’s physician, and determine whether or not an immediate visit is required. Their remote work setting, coupled with the high-stress nature of the emergency care calls they receive, demands that triage nurses be critical thinkers who can take control of a situation, understand and prioritize care needs, and execute a plan quickly. Hospital Liaisons Hospitals, seeking to provide their patients with the best care possible, regularly join forces with local hospice organizations as an end-of-life care partner. Through these partnerships, when a hospital diagnoses a patient with a life-limiting illness, they are able to refer them to a partnering hospice organization. Hospital liaisons are key to both of these relationships — at the hospital and patient level — working smoothly. These specially-trained nurses build relationships with hospitals, private care organizations, and other healthcare professionals to ensure they are aware that a local end-of-life care organization is available for any patients they may serve. In addition, hospital liaisons also work closely with the patients and their families to help guide them through the process of enrolling in hospice care and ensuring the end-of-life patient’s wishes are well-established and communicated to all relevant parties.

How Hospice Nurses Care for Patients

The hands-on nature of a hospice nurse’s work branches far beyond simply providing physical care for a patient. Their calm and attentive presence, expert administration of care, and unwavering spirit of compassion creates a bond between patient and nurse that invites comfort and peace throughout the end-of-life journey.

Hospice nurses provide direct care for patients. A large portion of a hospice nurse’s responsibilities lie in the provision of hands-on, direct care for patients. This holds especially true for case managers and visit nurses. Whether administering medications, providing ongoing wound care, or carefully documenting patient vital signs, nurses play a first-hand role in ensuring their patients are as pain-free and symptom-free as possible. Hospice nurses are an emotional and spiritual support to their patients. As nurses and their patients get to know one another, and with nurses being so intimately knowledgeable of a patient’s end-of-life journey, a powerful and unique emotional bond forms. Over time, as patients bond with their nurses, it’s common for them to see their nurse as a trusted confidant. Sharing treasured memories or even deep-seated fears, patients reveal things to their nurse that they may not even entrust to their closest family members. In this capacity, hospice nurses are able to share in these beautiful moments of bonding and glean valuable information that they can use to help coordinate improved care efforts for their patient. For instance, if a patient shares their fears about death and what might await in the hereafter, the hospice nurse can work closely together with a patient’s assigned hospice chaplain to ensure that they take the time to help the patient address those fears and find peace. Hospice nurses provide psychosocial support to their patients. For some, the end-of-life journey can be especially lonesome. This is particularly true when a patient may not have any close friends or family who are with them during their final days. Hospice nurses, with their compassionate spirit and loving disposition, provide patients with a welcome source of social connection and belonging. While seemingly simple, the comfort that a strong social connection provides cannot be understated. Even simple moments, whether it be administering medication or having a quick cup of coffee during a routine visit can help calm a patient’s anxiety and strongly promote overall comfort. Hospice nurses ensure their patients don’t die alone. One of the guiding tenets of hospice is the belief that no one should die alone. In alignment with this belief is the practice of ensuring that at least one member of a patient’s care team is present during the patient’s final hours. Hospice nurses, typically accompanied by the patient’s chaplain, are the care team members most commonly present with patients during their death. During these final hours, hospice nurses provide a loving, reassuring presence while providing comforting care that ensures the patient is as free from pain and discomfort as possible. Hospice nurses help continually improve the quality of patient care. As nurses help carry out a patient’s plan of care, they continually document any changes in the patient’s status and log specific recommendations aimed at improving a patient’s overall level of comfort. Equipped with this information, the hospice nurse submits these recommendations and the latest information surrounding the patient’s condition at the interdisciplinary hospice team meetings. Held at least once every 15 days, these interdisciplinary meetings have every member of a patient’s care team in attendance. During these meetings, each member of a patient’s care team shares any new information concerning the patient’s progression, discusses how to further improve the patient’s quality of life and comfort, and ensures that the care plan is in direct accord with the patient’s end-of-life care wishes.

How Hospice Nurses Care for Family Caregivers

When we think of hospice nurses, we often only consider the direct care applications of their profession. However, a hospice nurse’s role extends beyond the provision of patient care. Nurses also play a crucial role in helping educate and support family caregivers as they adjust to their new role.

Hospice nurses help educate family caregivers. Usually a family member or very close friend of a patient, family caregivers are an instrumental part of providing comforting care throughout a terminally-ill loved one’s end of life. However, caregivers often come into their role suddenly and unexpectedly, and as such, a family caregiver may not have the insight necessary to provide the care that their loved one needs. In light of this, hospice nurses help familiarize caregivers with the aspects of daily care — such as the administration of medications or aiding the patient in daily living activities — so that the caregivers can perform those and ensure their loved one is as comfortable as possible. Nurses also help family caregivers understand what to expect as their loved one’s terminal illness progresses and how to adapt their care in accordance with their loved one’s changing needs. Hospice nurses help provide family caregivers with much-needed respite. Caregiving demands a great deal of physical, mental, emotional, and spiritual effort. Over time, the stress of caregiving, coupled with the daily care responsibilities that the role demands, can lead to full-blown caregiver burnout. To combat caregiver burnout, hospice organizations provide caregivers with the hospice respite care option. Under hospice respite care, a family caregiver may request that their terminally-ill loved one be temporarily checked in to a professional care facility — such as a hospital, hospice inpatient care facility, or nursing home — for a period of up to 5 days per billing period. During this period, caregivers are able to get the rest and relaxation that they deserve while having peace of mind in knowing that their loved one is being cared for by the same trusted hospice nurse and complete care team with whom their loved one is comfortable. Hospice nurses provide emotional support to caregivers. For some family caregivers, their role in providing around-the-clock care can, understandably, leave them feeling isolated and alone. This can make the regular visits that a hospice nurse makes all the more impactful, as they become an opportunity for the caregiver to connect with someone other than their terminally-ill loved one. Over time, it’s not uncommon for hospice nurses to become a confidant of sorts for the family caregiver — a trusted source of helpful insight and a compassionate soul who understands the feelings of fear, anxiety, and uncertainty that are common to new caregivers. By being a regularly present and compassionate presence, hospice nurses provide emotional support not only for the patient, but for the caregiver as well. Hospice nurses communicate the needs of caregivers to the hospice team. Through the relationships that hospice nurses build with caregivers over time, they gain insight into how caregivers are adjusting to the role and the challenges they may be facing. Working closely with the other members of the hospice care team — particularly the patient’s assigned social worker and chaplain — nurses are able to specify a care plan that directly address the unique needs of the caregiver. By understanding the needs of caregivers and helping formulate a plan of care for them, nurses directly support caregivers’ diverse needs and empower them to provide the best care possible for their terminally-ill loved ones.

How Hospice Nurses Care for a Patient’s Family

When a loved one is diagnosed with a terminal illness, the impact of the diagnosis ripples throughout the family. Recognizing this, the holistic care philosophy of hospice ensures that the family members of terminally-ill patients receive the care and support they need during and after their loved one’s time in hospice.

Hospice nurses provide emotional support to families. After electing to enroll in hospice care, many patients choose to move in with their families in order to spend more time in the presence and comfort of their closest loved ones. While visiting patients at their homes, hospice nurses often interact with the family members of the patient. Understandably, during some visits, family members may begin to express some of their fears and anxieties surrounding their loved one’s end-of-life journey. They may feel uncertain that they are able to provide adequate support for their loved one as the illness progresses, or express anxieties — such as feeling ill-suited for the role of family caregiver. During these moments of honest and open connection, hospice nurses can provide helpful insights that help reassure the patient’s family members that are feeling distraught and help them understand that feelings of uncertainty and fear are common. These moments of encouragement and support help family members know that they are more than capable of being the comforting, loving presence that their terminally-ill loved one needs during their final days. Hospice nurses help provide end-of-life education and insight to families. As nurses visit with patients, it’s common for family members to ask questions concerning their loved one’s illness or how they can best support their loved one during the end of life. In these moments, nurses are able to provide helpful insight to family members such as: What to expect as their loved one’s illness progresses

How to support the primary family caregivers

What they can do to help create a comfortable atmosphere for their loved one Additionally, hospice nurses can help families connect with their assigned social workers, chaplains, and bereavement counselors who are specially trained to help families with difficult spiritual and emotional matters.

The Role of the Hospice Nurse on the Hospice Care Team

Hospice nurses are one of the cornerstone members of the hospice care team. By virtue of their frequent interaction with patients, family caregivers, and patient families — coupled with their years of specialized training — nurses are instrumental in the care team’s ability to track a patient’s progression and provide quality care.

Hospice nurses ensure the highest quality of care for patients. The care needs of patients with terminal illnesses can change rapidly and dietary plans, prescribed medications, and care strategies must be ready to adapt in response. Through frequent visits, recording of vitals, talks with patients and caregivers, and by personally witnessing the progression of a patient’s symptoms, hospice nurses are at the forefront of communicating a patient’s changing care needs to the rest of the team. Hospice nurses bridge communication between the hospice team, patients, caregivers, and families. Hospice nurses are on the forefront of many of the day-to-day care activities. Whether dressing a patient’s wounds or walking a new family caregiver through the administration of medications, nurses are often the most direct point of contact for patients, caregivers, and families. Through these daily interactions and conversations, hospice nurses regularly collect new information that provides valuable, actionable insight for the hospice care team. Armed with this information, the care team is able to update the plan of care to adapt in accordance with the evolving needs of everyone involved in the patient’s end-of-life journey.

What Skills and Traits Make an Effective Hospice Nurse?

Attracting some of the most compassionate and resilient medical professionals, hospice nursing is a profession that is rewarding, but can prove to be physically, emotionally, and spiritually demanding.

For those interested in the hospice nursing profession, having an understanding of what traits and skills comprise an effective hospice nurse can help an aspiring healthcare professional establish, in part, a plan for personal and professional development.

Compassion and empathy Whether someone is a patient, caregiver, or family member of a terminally-ill loved one, the end-of-life journey impacts each person differently. During the end-of-life journey, each person — no matter how different — needs the presence of a compassionate heart and empathetic spirit to help guide them. When hospice nurses compassionately and empathetically connect with those they serve, they help patients achieve greater levels of comfort, give caregivers a safe place to vent their emotions, and give families the opportunity to understand one another’s needs and draw closer together. Adept communication skills Communication plays a major role in every nurse’s day-to-day work. Reading charts, reporting to senior staff members, updating care plans, and interacting with patients all requires engaging in some form of verbal or non-verbal communication. The ability to communicate clearly and concisely enables hospice nurses to effectively deliver insight and directives to coworkers and connect with patients on a personal level in order to ensure the highest level of comfort and care possible. Critical thinking skills and a keen attention to detail Nearly every aspect of hospice nursing requires keen attention to detail. Whether measuring medication dosages, updating patient charts, or gleaning important patient data from reports, attention must be paid to even the most minute information to ensure that the highest quality of care is being provided. In addition, hospice nurses — particularly those working as triage nurses — must be able to think critically in difficult situations. When medical emergencies arise, nurses must be able to rapidly assess the situation and respond accordingly with a plan of action in order to quickly help restore comfort to patients. An understanding of the importance of self care Compassion and empathy are foundational skills that allow hospice nurses to form meaningful connections with every person for whom they care. However, just like any caregiver, this continuous physical, emotional, mental, and spiritual output can lead to the complete burnout of even the most seasoned medical professional. In light of this, it’s vital that hospice nurses understand the importance of self care and how it impacts their ability to provide care and perform well in their daily responsibilities.

Hospice Nurses: Skilled, Compassionate, and Dedicated

The impact of nurses can be experienced across every aspect of a hospice organization’s operations and in the lives of the patients, caregivers, and families that they serve.

Though a demanding profession, for many hospice nurses, it is also a calling — a calling to be a compassionate, insightful, and uplifting presence for all those on the end-of-life journey.

Have you met or worked with an incredible hospice nurse? Are you a hospice nurse yourself? We would love to know how nurses have impacted your life or your most memorable experiences from your career in nursing in the Facebook comments below!