A hospice nurse is a registered nurse (or LPN) who cares for people with a terminal illness, focusing on comfort, dignity and quality of life rather than cure. Hospice nurses manage pain and other symptoms, teach families what to expect, coordinate care with the rest of the hospice team and support loved ones before and after a death. Most hospice care happens at home, so hospice nurses often work much like home health nurses, visiting patients wherever they live. Palliative care nurses do similar comfort-focused work for people with serious illness at any stage, even while they are still receiving treatment.
This guide covers what hospice nurses do, hospice vs palliative care, who qualifies for hospice, the four levels of hospice care, the signs that the end of life is near, how to become a hospice nurse, CHPN certification, salary, the history of hospice and how to thank hospice nurses during National Hospice and Palliative Care Month.
In this guide
- What is a hospice nurse?
- What does a hospice nurse do?
- Hospice vs palliative care
- Who qualifies for hospice?
- The four levels of hospice care
- The hospice team
- Signs that the end of life is near
- What is comfort care?
- How to become a hospice nurse
- CHPN and other certifications
- How much do hospice nurses make?
- What is it like to be a hospice nurse?
- A short history of hospice
- Thanking and celebrating hospice nurses
- Frequently asked questions
What is a hospice nurse?
Hospice nurses care for patients who are expected to live about six months or less and who have chosen to focus on comfort instead of treatments aimed at curing their illness. Their patients have conditions like advanced cancer, heart failure, COPD, dementia, kidney disease and ALS.
The hospice nurse's job is to make the time a person has left as comfortable and meaningful as possible, and to support the family through one of the hardest experiences of their lives. Hospice nurses often say they are not helping people die. They are helping people live well until the end.
What does a hospice nurse do?
- Symptom management: treating pain, shortness of breath, nausea, anxiety, restlessness, constipation and other symptoms
- Regular visits: assessing patients at home, in nursing homes, assisted living or hospice facilities
- Medication management: adjusting comfort medications with the hospice physician and teaching families how to give them
- Family education: explaining what is happening, what to expect and how to care for their loved one
- Emotional support: listening, being present and helping families have difficult conversations
- Care coordination: working with the hospice physician, social worker, chaplain, aides and volunteers
- On-call support: answering calls and making visits at any hour, since hospice is available 24/7
- At the time of death: caring for the patient and family, and in many states, pronouncing death
- Documentation: recording visits, symptoms and eligibility information required by Medicare
Many hospice RNs work as hospice case managers, overseeing the plan of care for a group of patients. Hospice LPNs and hospice aides provide many of the routine visits and hands-on personal care.
Hospice vs palliative care
These terms are often confused. Hospice is a type of palliative care, but palliative care is much broader:
| Palliative care | Hospice care | |
|---|---|---|
| Who it is for | Anyone with a serious illness, at any stage | People with a terminal illness and a life expectancy of about six months or less |
| Curative treatment? | Can continue alongside palliative care | Stopped for the terminal illness, with the focus on comfort |
| Where | Hospitals, clinics and sometimes at home | Mostly at home or where the patient lives, plus hospice facilities |
| Goal | Relieve symptoms and stress and improve quality of life | Comfort, dignity and support through the end of life |
Palliative care nurses work on hospital palliative care teams and in outpatient clinics, helping patients with cancer, heart failure and other serious illnesses manage symptoms while they continue treatment. Many hospice nurses move between both.
Who qualifies for hospice?
Under the Medicare hospice benefit, which covers most hospice care in the United States, a patient generally qualifies when:
- A hospice physician and the patient's doctor (if they have one) certify that the patient is terminally ill, with a life expectancy of six months or less if the illness runs its normal course
- The patient chooses comfort care instead of curative treatment for the terminal illness
- The patient signs a statement electing hospice care
Patients can stay on hospice longer than six months if they continue to meet the criteria, and they can leave hospice at any time. Many families say they wish they had started hospice sooner, because it provides so much support.
The four levels of hospice care
Medicare defines four levels of hospice care, and hospice nurses work in all of them:
| Level | What it means |
|---|---|
| Routine home care | The most common level. The hospice team visits the patient wherever they live. |
| Continuous home care | Short-term, mostly nursing care at home during a crisis, such as severe pain or breathing problems. |
| General inpatient care | Short-term care in a hospice facility, hospital or nursing home when symptoms cannot be managed at home. |
| Inpatient respite care | A short stay (up to five days at a time) in a facility so family caregivers can rest. |
The hospice team
Hospice care is delivered by an interdisciplinary team, and the nurse is often the family's main point of contact:
- Hospice physician or medical director and often a hospice nurse practitioner
- Registered nurses and LPNs
- Hospice aides who help with bathing and personal care
- Social workers who help with emotional, practical and financial needs
- Chaplains who offer spiritual support of any faith, or none
- Volunteers who provide companionship and respite
- Bereavement counselors who support families for about a year or more after a death
Signs that the end of life is near
One of the most important things hospice nurses do is gently prepare families for what they may see as death approaches. Every person's experience is different, and not everyone will show every sign. Common changes in the final days and weeks can include:
- More sleep: spending most of the day sleeping and being harder to wake
- Less interest in food and drink: the body naturally needs less as it slows down
- Withdrawal: talking less and turning inward
- Confusion or restlessness: sometimes seeing or talking to people who are not there
- Changes in breathing: irregular breathing, long pauses between breaths or noisy breathing caused by secretions in the throat
- Changes in skin: hands, feet and knees may feel cool and look blotchy or bluish (called mottling)
- Less urine and darker urine
- A burst of energy: some people have a brief period of alertness or appetite shortly before death
Hospice nurses help families understand that many of these changes are a natural part of dying and are not usually painful for the patient, and they adjust comfort measures as needed. If you are caring for someone on hospice, your hospice team is available 24 hours a day, so call them with any questions or worries.
What is comfort care?
Comfort care means focusing on relieving symptoms and improving quality of life rather than trying to cure an illness. In hospice, comfort care can include pain medication, oxygen, mouth care, repositioning, gentle bathing, music, favorite foods and simply being present.
Many hospices also provide a comfort kit (sometimes called an emergency kit) kept in the patient's home. It contains a small supply of medications for sudden symptoms like pain, shortness of breath, anxiety or secretions, so the nurse can guide the family by phone at any hour.
How to become a hospice nurse
- Earn a nursing license. Complete an RN program (ADN or BSN) or an LPN program and pass the NCLEX.
- Get clinical experience. Most hospices prefer at least one to two years of experience in med-surg, oncology, home health, ICU or long-term care, because hospice nurses work independently. (See our med-surg, home health and geriatric nurse guides.)
- Learn end-of-life care. Programs like ELNEC (End-of-Life Nursing Education Consortium) teach pain management, communication and care at the end of life.
- Have a reliable car, since most hospice nurses drive to patients' homes.
- Earn the CHPN once you have enough hospice or palliative experience.
CHPN and other certifications
- CHPN (Certified Hospice and Palliative Nurse): the main certification for hospice and palliative RNs, offered by the Hospice and Palliative Credentialing Center (HPCC). HPCC recommends about 500 hours of hospice and palliative nursing practice in the most recent 12 months, or 1,000 hours in the most recent 24 months, before testing. Check HPCC for current requirements.
- CHPLN: the hospice and palliative certification for LPNs and LVNs
- CHPNA: the certification for hospice and palliative nursing assistants
- ACHPN: the advanced certification for hospice and palliative nurse practitioners and clinical nurse specialists
- CHPPN: for pediatric hospice and palliative nurses
The Hospice and Palliative Nurses Association (HPNA) is the main professional organization for the specialty.
How much do hospice nurses make?
The U.S. Bureau of Labor Statistics does not publish a separate salary for hospice nurses, because it groups them with all registered nurses. The median annual wage for registered nurses was $97,550 in May 2025, according to the BLS. LPNs earn less than RNs, and nurse practitioners earned a BLS median of $132,300.
Hospice nurse pay depends on the role (case manager, visit nurse, on-call or admissions nurse), how pay is structured (salary, hourly or per visit), location, experience, certification and mileage and on-call pay.
What is it like to be a hospice nurse?
Hospice nursing is emotionally deep work. The challenges include grief, caring for families in crisis, long drives and on-call nights. Hospice nurses need strong boundaries and good self-care, and many hospices offer staff support and remembrance rituals.
But hospice nurses also describe their work as one of the greatest privileges in nursing. They help people die peacefully and on their own terms, often at home and surrounded by the people they love. Families frequently remember their hospice nurse for the rest of their lives.
A short history of hospice
- 1967: Dame Cicely Saunders, who trained as a nurse, social worker and physician, opens St. Christopher's Hospice in London, the first modern hospice. She introduced the idea of "total pain," which includes physical, emotional, social and spiritual suffering.
- 1969: Elisabeth Kübler-Ross publishes On Death and Dying, bringing conversations about the end of life into the mainstream.
- 1974: Florence Wald, former dean of the Yale School of Nursing, helps found the Connecticut Hospice, the first hospice in the United States.
- 1982: Congress creates the Medicare hospice benefit, which makes hospice care available to millions of Americans.
- Today: more than a million Medicare patients receive hospice care each year, and palliative care teams are part of most large hospitals.
Thanking and celebrating hospice nurses
November is National Hospice and Palliative Care Month, the main time of year to honor hospice nurses, aides, social workers, chaplains and volunteers. It overlaps with National Home Care Month.
Ways families can say thank you
- Write a card describing the moments that meant the most to you. Hospice nurses treasure these.
- Send a note to the hospice agency naming your nurse, so their leaders know.
- Make a memorial donation to the hospice, or volunteer there later.
- Drop off snacks or coffee at the hospice office for the whole team.
Gifts for hospice nurses
A gentle butterfly design that honors the care hospice nurses give at the end of life. $29.99
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A meaningful thank-you from a grateful family, with a butterfly lifting from a nurse's hand. $15.99
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For visit notes, CHPN studying or journaling after a meaningful day. $17.99
Shop now →For more ideas, read inside a hospice nurse's shift, with gift ideas.
Frequently asked questions
What does a hospice nurse do?
Hospice nurses care for people with a terminal illness, managing pain and other symptoms, teaching families what to expect, coordinating care with the hospice team and supporting loved ones before and after a death.
What is the difference between hospice and palliative care?
Palliative care is comfort-focused care for anyone with a serious illness, at any stage, and it can happen alongside curative treatment. Hospice is palliative care for people with a terminal illness and a life expectancy of about six months or less who have chosen to stop curative treatment for that illness.
Who qualifies for hospice care?
Under Medicare, a patient generally qualifies when a physician certifies a terminal illness with a life expectancy of six months or less if the illness runs its normal course, and the patient chooses comfort care instead of curative treatment.
What are the four levels of hospice care?
The four Medicare levels of hospice care are routine home care, continuous home care, general inpatient care and inpatient respite care.
What is the CHPN certification?
The CHPN (Certified Hospice and Palliative Nurse) is the main certification for hospice and palliative RNs, offered by the Hospice and Palliative Credentialing Center.
How much do hospice nurses make?
BLS does not report hospice nurse pay separately. Registered nurses overall earned a median of $97,550 in May 2025. Pay varies by role, pay structure, location, experience and certification.
Can LPNs work in hospice?
Yes. Hospice LPNs provide many routine visits and symptom checks under the plan of care created by the RN case manager, and they can earn the CHPLN certification.
When is National Hospice and Palliative Care Month?
National Hospice and Palliative Care Month is celebrated every November in the United States.
Exploring other specialties? See our full guide to nurse specialties and the types of nurses.
Honor the hospice nurses in your life
For National Hospice Month, a new CHPN or the nurse who helped your family through a hard goodbye.
Shop the Hospice Collection →Sources
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Registered Nurses
- Centers for Medicare & Medicaid Services, Medicare Hospice Benefits and Hospice Levels of Care
- National Institute on Aging, What Are Palliative Care and Hospice Care? and Providing Care and Comfort at the End of Life
- Hospice and Palliative Credentialing Center (HPCC), CHPN Candidate Handbook
- Hospice and Palliative Nurses Association (HPNA)
- National Alliance for Care at Home, National Hospice and Palliative Care Month
- St. Christopher's Hospice, Dame Cicely Saunders