Hospice Nurse Building Nationwide Model for End-of-Life Clinician Training

As hospices contend with industry-wide staff shortages, Susan Lysaght Hurley, director of research at Massachusetts-based hospice provider Care Dimensions, is working to transform her organization’s nurse residency program into a national model. 

The number of hospice and palliative care clinicians will drop precipitously during the next two decades, largely due to retirements and staff leaving the field due to burnout, recent research has found. Among U.S. physicians, 40% are 56 or older and incoming palliative care and hospice specialists will not be enough to replenish the ranks. By 2045, only one physician will be available for every 808 patients, according to the same study.

Hospice and palliative care providers also experience shortages in non-physician disciplines, including chaplains, nurses, and social workers. As far back as 2008, the U.S. Centers for Medicare & Medicaid Service (CMS) began allowing hospice providers to use contracted nursing staff because not enough nurses were available to fill permanent positions.


“There’s a national nursing shortage that we’ve all known about for a while, and as the specialty of hospice and palliative care has grown that’s obviously going to have an impact,” Hurley told Hospice News. “We need to have support for nurses in particular at the direct-care level who will want to move into this field, to be able to provide them with good training, even for those who are really interested right out of their nursing school preparation.”

Hurley was recently selected by the Cambia Health Foundation’s Sojourns Scholar Leadership Program, which is designed to identify, cultivate and advance the next generation of palliative care leaders. Cambia Health Foundation is the nonprofit arm of Portland, Ore.-based Cambia Health Solutions, an enterprise that includes more than 20 companies with the mission to improve the economic sustainability of the health care system.

Each Sojourns Scholar receives a $180,000 during a two-year period to design and implement new palliative care solutions. Hurley’s project, “Addressing the Palliative Nursing Workforce Gap: A Hospice Nurse Residency Program” is designed to expand Care Dimensions’ nurse residency program, which trains nurses who are new to hospice and palliative care, though they may be experienced in other clinical settings. 

Participants in Care Dimensions’ nurse residency program learn hospice and palliative care principles through field work as well as didactic training. (Photo courtesy of Care Dimensions)

The residency program combines classroom training with mentored, hands-on experience in the field. Founded in 2015, the program provides six months of training to new nursing graduates, as well as a three-month program for experienced nurses. 

Through Hurley’s Sojourn project, a team will develop national standards for hospice nurse residency programs, contained in a forthcoming toolkit, that other hospices can adopt or adapt to suit the needs of their nurses. Hurley’s team will also work directly with three hospice providers to implement a pilot residency program in their agencies.

“We’re finding that we need to think about nurses not only in that generalist role, but also in a specialist role,” Hurley said. “Nurse residency has been around for a while in other specialty areas of nursing. However, the vast majority of them are in acute care settings. Bringing specialization to the community level is paramount in order to really think about the quality of care going forward.” 

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