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The hospice movement has evolved in the United States over the past 25 years.  The focus of hospice care is on comprehensive physical, psychosocial, emotional, and spiritual care to terminally ill persons and their families.  Hospice providers promote quality of life by protecting patients from burdensome interventions and providing care at home, whenever possibly, instead of the hospital. Hospice nurses provide care primarily under the guidelines of the Medicare Benefit Act of 1983, a federal program that allows patients to die in their homes with their families and friends at their side. 

 Palliative care, the more recent area of specialization, is defined by the Last Acts Task Force (1999) as the “comprehensive management of the physical, psychological, social, spiritual, and existential needs of patients, particularly those with incurable, progressive illness. The goal of palliative care is to help them achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity, while remaining sensitive to personal, cultural and religious values, believes and practices”.

The care that both hospice and palliative care nurses provide is essentially the same as demonstrated by the Hospice and Palliative Nurses Role Delineation Study. However, hospice and palliative care nurses differ in their preparation and practice settings.


Hospice and palliative care nurses work in collaboration with other health providers (such as physicians, social workers, or chaplains) within the context of an interdisciplinary team.  Composed of highly qualified, specially trained professionals and volunteers, the team blends their strengths together to anticipate and meet the needs of the patient and family facing terminal illness and bereavement.

Hospice and palliative nurses distinguish themselves from their colleagues in other nursing specialty practices by their unwavering focus on end-of-life care. Hospice and palliative care includes 24-hour nursing availability, management of pain and other symptoms, and family support. By providing expert management of pain and other symptoms combined with compassionate listening and counseling skills, hospice and palliative nurse promote the highest quality of life for the patient and family.

Regardless of the setting, hospice and palliative nurses strive to achieve an understanding of specific end-of-life issues from the perspective of each patient and his or her family.  To accomplish this, nurses collaborate in a cultural assessment of the patient and family and provide culturally sensitive care.

Hospice and palliative nursing is not only practiced at the bedside. Nurses, consistent with their individual educational preparation, experience and roles, promote the highest standards of end-of-lie care through community and professional education, participation in demonstration grants, and in end-of-life research. As society’s needs change and awareness of the issues surrounding the end of life increases, nurses are called to advocate for the terminally ill and their families through public policy forums, including the legislative process. 


Although the majority of hospice and palliative care nurses are “generalists” some elect to sub-specialize (for example, in oncology, pediatrics, or geriatrics) and pursue advanced practice credentialing.  Both the hospice and palliative care nurse have a similar knowledge base. Certification for nurses practicing in hospice and palliative care as a Certified Hospice and Palliative Nurse (CHPN) has been available since 1999, following the initial development of the Certified Nurse Hospice (CRNH) in 1994. The certification process reflects a competency basis for the evaluation of an individual’s practice and is not an advanced certification.  

Practice Settings:   

Hospice nurses typically practice in the homes of terminally ill persons and their family caregivers; however, some also work in in-patient hospice units.  Hospice nurses also visit patients who are enrolled in hospice and living in a variety of long-term care settings (e.g., nursing homes, foster care, assisted-living). On average, hospice patients usually die within a month of enrolling in the hospice program.  Palliative care nurses typically practice in non-home settings including hospitals, nursing homes, and rehabilitation units and they treat patients with longer prognoses.                


There is a distinct body of knowledge with direct application to the practice of hospice and palliative care nursing. This includes: pain and symptom management; end-stage disease processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations; communication skills; and awareness of community resources. 


Hospice and palliative nurses are registered nurses prepared at the associate- degree, baccalaureate-degree, and/or master’s-degree level (there are currently two master’s degree programs that focus on hospice/palliative care – New York University (New York, NY) and Ursuline College (Pepper Pike, OH).  A small percentage of hospice and palliative nurses hold a doctoral degree.  

Salary Range:

Hospice and palliative care nurses salaries are comparable to those of other registered nurses.  If the individual holds an advanced practice degree, his or her salary is comparable to that of nurse practitioners. 


            Hospice and Palliative Nurses Association (HPNA)
One Penn Center West Suite 229
            Pittsburgh, PA 15276-0100
            Fax: 412-787-9305
            Web site: 


Journal of Hospice and Palliative Nursing