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Role standards

Nursing

Hospice nurse

What a hospice registered nurse must be able to do alone at the bedside and on the phone: get pain and breathlessness under control, keep the controlled drugs in the home safe, record the decline honestly, and tell a family the truth about a death that is coming. Drawn from the HPCC Certified Hospice and Palliative Nurse examination content outline and the Medicare Hospice Conditions of Participation.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
3
Sources
3
Version
1

Built from Hospice and Palliative Credentialing Center, Centers for Medicare and Medicaid Services, Electronic Code of Federal Regulations, Journal of Palliative Medicine, National Coalition for Hospice and Palliative Care. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent hospice nurse does on day one, dimension by dimension.

Clinical skills

  • Assesses pain and other distressing symptoms at the end of life, gives what is ordered in adequate doses without delay, reviews the effect, and gets the regimen changed when it is not working.
  • Assesses a patient with a life-limiting illness for comfort, reversible causes of distress, the trajectory of decline and the signs that death is near.

Workflow and tools

  • Documents each visit and each death accurately and promptly so the record shows symptom control, decline, teaching and communication, and supports eligibility only with what was observed.
  • Builds and revises an individualised hospice plan of care with the patient, family and interdisciplinary group, and changes the level of care or setting when symptoms or support require it.

Patient communication

  • Talks honestly with patients and families about dying, prognosis and fears, responds to emotion, and stays in the conversation without false reassurance or false certainty.
  • Finds out what matters most to the patient at the end of life and translates it into choices about care, including resuscitation and the place of death.

Compliance and safety

  • Keeps controlled drugs in the home secure, counted and documented, teaches the family to store and give them safely, recognises and reports signs of diversion, and disposes of them only under the hospice's written policy and the law.
  • Reconciles medications at admission and when the plan changes, and reviews each against the patient's comfort goals so that drugs that no longer help are raised for stopping.

Role knowledge

  • Works as a member of the hospice interdisciplinary group, brings the patient's needs to the right discipline, and coordinates care so the plan is one plan.
  • Recognises ethical conflicts at the end of life - requests to hasten death, disputes about treatment, doubt about capacity or consent - and takes them to the team, the physician or the ethics process rather than resolving them alone.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Leaves a dying patient in severe uncontrolled pain or breathlessness without giving the ordered breakthrough medication and without contacting the hospice practitioner for a change, including because of a belief that opioids will cause addiction or hasten death.

    Uncontrolled suffering at the end of life cannot be undone for the patient or the family, and an ordered dose withheld from fear is a failure of the care hospice exists to give.

  • Removes, keeps or uses a patient's controlled drugs, disposes of them outside the hospice's written policy or without documentation, or knowingly leaves a count discrepancy or suspected diversion unreported.

    Diverted opioids reach people they can kill, leave the patient without their medication, and taking a controlled drug from the home is a crime and professional misconduct.

  • Documents a visit, assessment finding or decline that did not happen, including describing decline that was not observed to keep a patient eligible, or alters a time of death, pronouncement or disposal record.

    The next nurse acts on a false record, and false documentation to support hospice eligibility is a false claim to Medicare under federal law.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not prescribe, or give a dose, frequency or drug beyond the order, however distressed the patient.Gives what is ordered and calls the on-call hospice physician or nurse practitioner at once with the symptom, the doses used and a specific request.
  • Does not administer or supply medication intended to end a patient's life, and does not start palliative sedation on their own judgement.Responds to the request with compassion, treats the suffering, and brings it to the physician, the team and, where the law allows medical aid in dying, the hospice's own policy and the patient's attending physician.
  • Does not pronounce death where state law or hospice policy does not permit a registered nurse to do so.Follows the state's pronouncement rules, contacts the physician or the authority required, and supports the family meanwhile.
  • Does not remove a patient's controlled drugs from the home or take them back to the office.Disposes of them in the home under the hospice's written policy, state law and federal disposal rules, and documents it.
  • Outside the United States, eligibility, controlled drug disposal and pronouncement rules differ; this standard's regulatory detail is US Medicare and federal drug law.Applies the same principles - orders, secure handling, honest records, team decisions - under the local regulator's rules.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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