How to Become a Hospice Nurse (Steps, Duties & Salary 2025)

Hospice nurses care for terminally ill patients, managing symptoms to keep them comfortable at the end of life and supporting their families through it. The work isn't curative, but it demands the same clinical rigor as any other specialty plus the emotional resilience to watch your patients die. If that tradeoff appeals to you, here's how the path works.

Career Snapshot

Where you'll work: Hospitals, long-term care facilities, and patients' homes.

What you'll do: Manage symptoms and provide comfort for terminally ill patients, and support their families.

Minimum degree: ADN or BSN. Many employers prefer or require a BSN.

Good fit for: Nurses who want meaningful work at the end of patients' lives and can compartmentalize the emotional weight that comes with it.

Job perks: More autonomy than most nursing roles. Hospice nurses often make their own decisions and manage their own cases.

Median annual salary: $93,600 (RN, BLS)

Steps to Become a Hospice Nurse

Look for programs with end-of-life coursework. Most nursing programs cover end-of-life care, but some offer electives that go deeper. When you compare programs, check accreditation (required for financial aid and the NCLEX), NCLEX pass rates, support services, and whether an online option fits your schedule. Every nursing program requires in-person clinical and lab work regardless of format.

Choose ADN or BSN. Hospice nursing requires at least an ADN, which takes two years and gets you working sooner for less money. A BSN takes four years, goes deeper, and prepares you for management roles later. Many employers prefer the BSN.

Apply and complete prerequisites. Both degrees require a high school diploma or GED. Some programs also want ACT or SAT scores and a minimum GPA. You'll likely complete prerequisites in English, biology, chemistry, and math before starting nursing courses.

Finish coursework and clinicals. Both degrees cover microbiology, anatomy, pharmacology, sociology, and psychology. A BSN adds nursing theory and management, leadership, and public health. Clinical training happens in simulation labs, hospitals, or community clinics. Most BSN programs require 700 to 800 clinical hours.

Pass the NCLEX-RN. This computer-based exam from the National Council of State Boards of Nursing covers patient safety and infection control, care management, risk reduction, and pharmacology. Questions adapt to your answers, so you may see as few as 75 or as many as 265.

Meet your state's licensing requirements. Every state requires the NCLEX-RN. Many also require a background check, fingerprints, or references. The NCSBN maintains a database of state requirements.

Gain clinical experience. Few nurses go straight from school into hospice. Get one to two years of experience first, ideally in a related area.

"I have a long background in critical care, including almost a decade in the intensive care unit, and more years in case management where I worked with geriatric patients and those with dementia," says Ryan H. Catan, RN, CM-DN, a nurse care coordinator at Hospice of the Chesapeake in Pasadena, Maryland. "Those are the kinds of patients we tend to have."

Jon Fitzke, RN, RNCM, a case manager at Willamette Valley Hospice in Salem, Oregon, worked with ventilator-assisted ALS patients and in a burn unit before moving to hospice. "I learned a lot about compassion from these jobs," he says.

Consider certification. Certification is optional but can help you stand out, open advancement, and raise your pay. Two are available for RNs:

• Certified Hospice and Palliative Nurse (CHPN), from the Hospice and Palliative Credentialing Center, for experienced hospice nurses. Requires 500 clinical hospice hours in the previous 12 months or 1,000 in the previous 24 months.
• Certified Hospice and Palliative Pediatric Nurse (CHPPN), same body, for experienced pediatric hospice nurses, with the same hour requirements in pediatric hospice care.

Both exams are online, three hours, and 150 questions covering assessment and planning, pain and symptom management, advocacy, education, and practice issues. The pediatric exam adds child and family-centered care. The credentialing center recommends about six months of prep. Recertification is required every four years and includes continued clinical hours, professional development, and a situational judgment exercise.

Advance your training. An MSN can move you into management and administration. Catan and Fitzke both note that if leadership doesn't interest you, certification and continuing education can get you the job you want without a graduate degree.

A Day in the Life

Catan starts by reviewing overnight emails and calls from physicians' offices and patients reporting symptoms. He handles many by phone or email, but some require a visit. He spends most of the day driving between patients, about 40 minutes each, four to six a day. Between visits he updates charts, orders supplies, coordinates with providers and families, and triages calls. "Communication is a cornerstone of hospice work," he says. He recommends psychology coursework on fear and grief: "You will use information about anticipatory grief, family dynamics, and personality disorders throughout a career in nursing."

How Long It Takes

Timeline depends on your degree. An ADN takes two years, a BSN four. Add one to two years of general experience and roughly six months for certification, and most nurses reach hospice work in four to six years.

Where You'll Work

Hospice and palliative departments in hospitals, long-term care facilities, and assisted living and memory care centers. Hospice agencies assign nurses to patients in various facilities. Many hospice nurses also see patients at home, often after they've chosen to leave the hospital for their final days. Some work for insurance companies reviewing hospice billing and services.

Pros and Cons

Meaningful work. Fitzke says hospice nursing "fills me up more than it depletes me" and taught him "it is never too late to develop meaningful relationships." Catan gets validation from patients, families, and colleagues: "I get to work with my heroes every day."

Emotionally draining. Fitzke takes care of himself after a patient dies. His organization provides grief counselors and encourages paid leave.

Difficult interactions. Hospice nurses enter patients' homes and have to accept people and circumstances they can't control.

Hospice vs. Palliative Care

These are distinct specialties. Hospice care is for patients approaching the end of life, generally with up to six months to live, and begins after treatment has stopped. Palliative care eases pain and discomfort for patients coping with an illness, disease, or treatment, such as cancer patients managing symptoms during active treatment.

Salary and Outlook

RN jobs are projected to grow 5% from 2024 to 2034, according to the U.S. Bureau of Labor Statistics, with stronger demand in homes and residential care as older adults prefer to be cared for outside hospitals. The median annual RN salary is $93,600. The BLS doesn't break out hospice specifically, and actual pay varies with education, experience, location, workplace, and certification. Catan notes an experienced hospice nurse can earn more than they would on a hospital med-surg unit.

Professional Resources

• The Hospice and Palliative Nurses Association offers continuing education, a podcast, certification, and conferences.
• The Journal of Hospice and Palliative Nursing covers current research and clinical insights.
• The American Nurses Association offers continuing education, conferences, and a career center.