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Hospice and palliative care nurses help ease the symptoms and suffering of patients who have progressive, terminal illnesses. Because they work to meet the psychological, spiritual, and social needs of patients and patients’ families during their most difficult hours, hospice nurses are called upon to provide compassionate emotional support through end-of-life decisions, with sensitivity to a patient’s cultural and religious values.
Hospice care provides support and comfort to dying patients and their families, often in the patient’s home, but also in hospitals, hospice centers, nursing homes, and other long-term care facilities. According to the publication, Nurses for a Healthier Tomorrow, hospice care is often referred to as end-of-life care, as most hospice patients die within a month of enrolling into a hospice program.
Palliative care brings the principles of hospice care to people at an earlier stage of their illness. According to the National Hospice and Palliative Care Organization, palliative care effectively becomes hospice care as a person’s illness progresses and death becomes inevitable.
Palliative Care Body of Knowledge
Registered nurses in hospice and palliative care need knowledge specific to the field, including:
- Understanding end-stage disease processes
- Managing pain and symptoms
- Providing psychological and social care to patients and their families, while remaining spiritually and culturally sensitive
- Educating and advocating for patients
- Understanding loss and grief issues and providing bereavement care
- Practicing as part of an interdisciplinary collaborative team with the patient’s other medical care providers
- Understanding ethical and legal considerations
- Being aware of community resources for patients
According to the Hospice and Palliative Nurses Association, most hospice service providers require at least one year of acute care experience from prospective nursing candidates. Graduate degreed clinical nurse specialists (CNS) and nurse practitioners (NP) also have the option of demonstrating competency through specialty certification in hospice/palliative care.
Advanced Practice Hospice/Palliative Care Education
Many advanced practice nursing programs offer palliative care as a subspecialty, within a particular patient population. Specific MSN options include:
- Adult-Gerontology Primary Care Nurse Practitioner Specializing in Palliative Care
- Adult Nurse Practitioner/Palliative Care Nurse Practitioner
- Acute Care Nurse Practitioner with Hospice and Palliative Care Specialties
- Advanced Practice Adult Oncology/Palliative Care
Other options may be available. For example, some nursing schools lets students create a palliative care subspecialty by adding credits to the Family NP, Adult-Gerontological Acute Care NP, Adult-Gerontological Primary Care NP, or Clinical Nurse Specialist-Adult Health program. Other schools offer both palliative care and pediatric palliative care as distinct clinical specialties in MSN programs designed to qualify both NPs and CNSs.
Post-master’s programs in palliative care are also available for advanced practice nurses who already have an MSN, and some DNP programs offer a palliative care subspecialty.
Advanced Practice Certification
The National Board for Certification of Hospice and Palliative Nurses (NBCHPN) offers specialty certification for all levels of hospice/palliative care nursing.
Both CNSs and NPs can take the Advanced Certified Hospice and Palliative Nurse (ACHPN) exam. In addition to having an active, current RN license in the United States or a comparable license in Canada, candidates must also have post-baccalaureate education through a program that meets one of the following criteria:
- Master’s or higher in nursing from an advanced practice palliative care program that included both classroom training and at least 500 hours of supervised clinical practice in palliative care
- Post-master’s certificate that included supervised clinical practice of at least 500 hours in palliative care
- Master’s, post-master’s or higher degree in nursing from an advanced practice program as a CNS or NP, plus post-master’s practice of at least 500 hours in providing palliative care during the year before taking the certification exam
The exam has 175 questions covering five areas of practice related to the care of adult patients (age 12 and up) and their families:
- Clinical judgment
- Advocacy and ethics & systems thinking
- Professionalism and research
- Collaboration, facilitation of learning, and communication
- Cultural and spiritual competence
Other Hospice Nursing Certifications
Registered Nurses without a graduate degree can take the Certified Hospice and Palliative Nurse (CHPN) exam. NBCHPN recommends at least two years of experience in hospice and palliative nursing practice before attempting this exam. The exam consists of 150 questions covering seven areas of practice related to caring for adult patients and their families:
- Life-limiting conditions in adult patients
- Pain management
- Symptom management
- Care of patient and family
- Interdisciplinary/collaborative practice
- Education and advocacy
- Professional issues
Nurses specializing in pediatric (from perinatal through young adult) hospice and palliative care can take the Certified Hospice and Palliative Pediatric Nurse (CHPPN) exam. NBCHPN recommends at least two years of experience in pediatric nursing practice in hospice and palliative care before attempting this exam. The 150-question exam covers nine areas of pediatric patient care:
- Life-Threatening conditions in children
- Pain management
- Symptom management
- Treatments and Procedures
- Family centered care
- Education and advocacy
- Care at the end of life
- Grief and bereavement
- Professional issues
Other nursing certifications available from the NBCHPN are:
- Certified Hospice and Palliative Licensed Nurse (CHPLN) for licensed practical or vocational nurses
- Certified Hospice and Palliative Nursing Assistant (CHPNA) for nursing assistants
- Certified Hospice and Palliative Care Administrator (CHPCA) for nursing administrators
Certification is valid for four years, and renewal requires a specified number of practice hours and/or points earned through professional development activities.
Associations
The Hospice and Palliative Nurses Association (HPNA) provides networking and support for all nurses working in the field.
The Hospice and Palliative Nurses Foundation (HPNF) has the mission of enhancing nursing excellence to support quality of life for people with serious illnesses.
These two associations, along with the NBCHPN, form the Alliance for Excellence in Hospice and Palliative Nursing, an organization that strives to present a cohesive voice in palliative nursing.
Other organizations of interest:
- The National Hospice and Palliative Care Organization is a membership organization for all hospice and palliative care professionals.
- The Hospice Action Network advocates for legislation that supports hospice care.
- The National Hospice Foundation provides support and resources for professionals and families in providing compassionate care.