A day as a Hospice Nurse
Most of your patients won't get better, and the job is making sure the time they have left isn't spent in pain or panic. You drive from house to house, manage symptoms against a plan you help write, and teach families how to do things they never expected to do. This guide follows a home hospice case manager through an ordinary day, including the part where the plan falls apart.
Home hospice, not a hospital floor
Hospice nurses work in a few settings: inpatient hospice units, nursing homes, assisted living, and private homes. The day below is a home hospice case manager, because that's where you'll see a lot of the openings and where the job differs most from bedside nursing. You're on your own in the room. There's no charge nurse down the hall and no rapid response team. You carry a caseload of patients spread across a territory, you see each one on a schedule set by the plan of care, and you're the person the family calls when something changes. That independence is the draw for a lot of nurses and the reason some leave inside a few months.
One weekday on a home hospice caseload
Overnight report and route planning
You open the EMR on your laptop, often WellSky or Homecare Homebase, and read what the on-call nurse logged overnight. One patient's daughter called about agitation in the middle of the night. You move that visit to the top of the list, then text the other families to confirm times. Your route gets rebuilt around whoever is most uncomfortable, not whoever is closest.
The agitation visit
The patient has lung cancer and was restless all night. You assess pain, check for urinary retention, look at bowels, and count what's left in the comfort kit. The daughter gave the lorazepam but was scared to give the morphine. You walk her through the order again, write the dosing on the fridge whiteboard, and call the hospice physician to talk through the plan. Most of this visit is teaching.
Recertification and a quiet decline
Next is a woman with advanced dementia in a memory care facility. She's due for recertification, so your note has to show decline in concrete terms: weight loss, more time in bed, eating less, a new pressure injury on her heel. Vague charting here causes real trouble later in an audit. You measure the wound, update the aide's care plan, and check in with the facility nurse before you leave.
The call that breaks the plan
You're eating in your car when the office calls. A patient you saw two days ago has changed fast: mottled knees, long pauses in his breathing, and his wife says he hasn't woken up since breakfast. Your last two visits get pushed to tomorrow or handed to another nurse. You drive over, confirm he's actively dying, stop the meds he no longer needs, and sit with his wife while she calls her kids. This happens more weeks than it doesn't.
Charting, calls and the death visit
He dies late in the afternoon. Depending on your state and your agency's policy, you may pronounce the death yourself or call the physician to do it. You bathe him with his wife if she wants to help, destroy the leftover controlled meds with a witness, call the funeral home, and notify the social worker and chaplain. Then you chart every visit from the day, which often runs into the evening if you didn't catch up between stops.
Where the hard part actually is
New hospice nurses expect the deaths to be the hardest part. Usually it's the families. You'll meet relatives who haven't spoken in years, a son who wants every treatment and a daughter who wants none, and a spouse who's too exhausted to follow the medication schedule. You can't fix any of that, and you have to keep the patient comfortable anyway. The weekly interdisciplinary team meeting helps, because you get the social worker, chaplain, aide and physician in one room reviewing each patient. The documentation load is the other surprise. Hospice is tightly regulated, and your notes are what prove a patient still qualifies. Nurses who hate charting struggle here more than nurses who struggle with grief.
Ways nurses end up in hospice
From med-surg, oncology or ICU
This is the most common route. Agencies like registered nurses with a solid acute care background because you'll be assessing alone. Oncology and ICU nurses often move over after years of watching patients die badly and wanting to do it differently. Expect a short orientation where you ride along with an experienced case manager before taking your own caseload.
From home health
Home health nurses already know the driving, the visit rhythm and the point-of-care charting. The switch is mostly clinical: learning symptom management, comfort medications, and how to talk about dying without flinching. Many agencies run both home health and hospice, so an internal transfer is often the easiest move.
Straight in as a new graduate
Some inpatient hospice units and larger agencies hire new grads with a structured preceptorship. It's workable, but you'll be learning core assessment skills at the same time as end-of-life care. If you go this way, pick an employer with a real orientation program rather than a quick shadow and a laptop.
Licenses and credentials hospice employers ask for
You'll need an active registered nurse license, which means passing the NCLEX-RN, and requirements vary by state, so check with your state board of nursing. Licensed practical nurses work in hospice too, usually doing visits under an RN case manager. Once you have hospice experience, the CHPN certification is the one postings mention by name and the one worth paying for.
What Hospice Nurse postings ask for
Hiring the most
- Residential Home Health and Hospice62
- Halifax Health46
- VitalCaring Group28
- Trinity Health18
- Prisma Health15
Remote
1% of openings are fully remote.
Questions people ask
Is hospice nursing depressing?
Some days are heavy, and you'll carry certain patients with you for a long time. Most hospice nurses say it's less depressing than hospital work, because they're not fighting a losing battle with every intervention. The goal is comfort, and comfort is usually achievable. Agencies that run regular debriefs and give you time off after a hard stretch make a big difference, so ask about that when you interview.
Do hospice nurses have to take call?
In home hospice, usually yes. Some agencies rotate case managers through evening and weekend call, and others hire dedicated on-call or triage nurses so case managers don't have to. Call means phone triage plus driving out for deaths and crises. How often you're on call varies a lot between employers, and it's one of the first things to pin down before you accept.
How is the pay compared with hospital nursing?
The pay shown on this page is the best starting point. Home hospice often pays per visit or salaried rather than hourly, which changes the math. Mileage reimbursement, on-call pay, and whether you get paid for charting time move your real take-home more than the base rate does, so compare those line by line.
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