The Hospice Nurse (Case Manager RN) provides expert end-of-life nursing care to patients with terminal diagnoses who have elected comfort-focused hospice care, reporting to the Hospice Director of Clinical Services. Hospice nursing inverts the goals of conventional clinical care. Instead of treating disease, you are managing the human experience of dying: controlling pain with precision, anticipating and preventing distressing symptoms, and supporting families through what may be the most overwhelming experience of their lives. Success in this role is measured not by survival but by quality: patients who die comfortably, families who feel held through the process, and bereaved loved ones who receive the support they need afterward. This work draws on the fullest depth of clinical skill and human presence simultaneously.
Conduct hospice admission assessments and develop individualized comfort-focused plans of care in coordination with the interdisciplinary hospice team (IDG).
Manage pain and symptom control using opioid analgesics, anxiolytics, antiemetics, and other comfort medications per physician orders and palliative best practice guidelines.
Recognise and address the physical signs of active dying, adjusting medication protocols to maintain patient comfort during the final days and hours of life.
Provide education to patients and families on what to expect through the dying process, answering difficult questions with compassion, honesty, and clinical expertise.
Coordinate continuous care and general inpatient care levels when symptom burden requires intensified nursing intervention beyond routine visits.
Facilitate goals-of-care conversations to ensure the care plan aligns with the patient's and family's values, preferences, and cultural and spiritual needs.
Perform skilled nursing visits for wound care, catheter management, medication reconciliation, and clinical assessment as clinically indicated.
Collaborate with social work, chaplains, home health aides, and volunteers in weekly IDG meetings, contributing nursing perspective to holistic care planning.
Respond to after-hours on-call nursing needs, providing phone triage and urgent visits for uncontrolled symptoms, family distress, or active death situations.
Conduct pronouncement of death in the home or facility when indicated, supporting families through the immediate post-death period with compassion and calm presence.
Complete CMS-required hospice documentation including nursing visit notes, medication orders, and plan of care updates within required timeframes.
Support bereaved families through the hospice bereavement program by participating in follow-up calls and coordinating with the social work and chaplaincy team.
Active, unrestricted RN license in the state of practice; BSN preferred.
Current BLS certification.
Valid driver's license and reliable personal vehicle with adequate insurance coverage.
Minimum 2-3 years of nursing experience; prior hospice, home health, or palliative care experience strongly preferred.
Demonstrated proficiency in pain assessment and opioid management in a clinical setting.
Comfort and competency facilitating difficult conversations about death, dying, and prognosis with patients and families.
Ability to function independently in unstructured community-based care environments.
Familiarity with CMS Conditions of Participation for hospice and Medicare hospice benefit eligibility requirements.
CHPN (Certified Hospice and Palliative Nurse) credential from HPNA.
Prior experience in community-based or home-based nursing settings.
Training in Motivational Interviewing or advanced communication techniques for end-of-life conversations.
Familiarity with Palliative Performance Scale (PPS) and GDS prognostic tools used in hospice eligibility documentation.
Experience supporting culturally diverse patient populations through death and dying in alignment with varied cultural traditions and beliefs.
Opioid and comfort medication management in terminal illness
Physical signs of active dying recognition and end-of-life care protocol
Wound and symptom management in community settings
CMS hospice documentation and Medicare benefit compliance
Palliative Performance Scale and prognostic assessment tools
IDG care planning documentation and participation
After-hours triage and urgent visit coordination
Sustained therapeutic presence in emotionally heavy patient and family encounters
Honest, compassionate communication about dying and prognosis
Cultural and spiritual humility across diverse end-of-life traditions
Grief processing and personal resilience with repeated patient losses
Collaborative IDG teamwork and mutual support across disciplines
Hospice nurses earn $74,000 to $96,000 annually across most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). On-call pay, mileage reimbursement, and visit rate structures can meaningfully increase total compensation for productive nurses managing larger caseloads. CHPN certification adds 7-12% to base salary at most hospice organizations. Larger for-profit hospice organizations often offer competitive base rates with performance bonuses. Source: U.S. Bureau of Labor Statistics, May 2023; PayScale, 2025.
San Francisco Bay Area, CA ($101,000 - $122,000)
Seattle, WA ($95,000 - $114,000)
New York Metro, NY ($93,000 - $112,000)
Boston, MA ($91,000 - $110,000)
Denver, CO ($88,000 - $106,000)
Hospice nursing positions typically include medical, dental, and vision coverage, 401(k) with employer matching, 3-4 weeks PTO, mileage reimbursement, and a company phone or stipend. CHPN exam reimbursement is standard at most hospice organizations. Employee Assistance Programs (EAPs) with grief counseling access are particularly important in this specialty and should be offered as standard benefit.
Cannot articulate why they specifically want to work in hospice: This is not a role for nurses who want to "try something different." The emotional demands are significant and require genuine motivation. Vague or generic answers here predict short tenure and compassion fatigue.
Shows discomfort discussing opioid use in terminal illness: Adequate pain management at end of life requires confidence with opioid titration. Nurses who hesitate around this due to misplaced addiction concerns may undertreat patient pain, which is a serious quality failure in hospice care.
Has no framework for supporting family members through anticipatory grief: Families are a core part of the hospice patient unit. Nurses who focus exclusively on the patient without accounting for family dynamics will miss a substantial portion of their clinical and compassionate responsibility.
Cannot describe how they process repeated patient losses personally: Compassion fatigue and secondary traumatic stress are occupational hazards in hospice nursing. Candidates without personal resilience strategies are unlikely to sustain long-term performance in this role.
No experience with or openness to on-call nursing coverage: After-hours coverage is a standard hospice nursing responsibility. Candidates who cannot or will not participate in on-call rotations limit operational scheduling flexibility and team equity.
Q: What does a hospice nurse do?
A hospice nurse provides end-of-life nursing care focused on comfort, symptom control, and quality of life for terminally ill patients. They manage pain and distressing symptoms, support families through the dying process, participate in interdisciplinary team care planning, and provide after-hours on-call coverage in community settings.
Q: What qualifications do you need to be a hospice nurse?
You need an active RN license, BLS certification, a valid driver's license, and at least 2-3 years of nursing experience. Prior hospice, home health, or palliative care experience is strongly preferred. The CHPN credential from HPNA is the recognized specialty certification and significantly strengthens a candidate's qualifications for senior roles.
Q: How much does a hospice nurse make?
Hospice nurses earn $74,000 to $96,000 annually, consistent with the national RN median of $86,070 (BLS, May 2023). CHPN certification adds 7-12% to base compensation. On-call pay and per-visit structures can meaningfully increase total earnings for nurses managing productive caseloads in high-demand markets.
Q: What skills are required for a hospice nurse?
Hospice nurses need expert opioid and comfort medication management, recognition of active dying signs, end-of-life care protocols, and CMS hospice documentation compliance. Equally essential are therapeutic presence in emotionally heavy encounters, honest communication about death and prognosis, cultural and spiritual humility, and personal resilience with repeated patient losses.
Q: What is the career path for a hospice nurse?
Hospice nurses advance to case manager lead, clinical supervisor, or palliative care team roles. With CHPN certification and experience, paths include Hospice Director of Clinical Services, Palliative Care Coordinator, and Education Specialist. Some pursue APRN licensure in palliative care or gerontology nurse practitioner programs.
Q: What are the biggest challenges facing hospice nurses today?
Caseloads are increasing as hospice enrollment grows faster than the available hospice nurse workforce. Compassion fatigue and moral distress are prominent given the repeated nature of patient loss. For-profit hospice growth has in some cases created productivity pressure that can conflict with the relational, unhurried care model that defines quality hospice nursing.