Hospices Develop Nurse Residencies to Stem Labor Pressures

As hospice providers contend with industry-wide nursing shortages, some are taking matters into their own hands with in-house residency programs.

A lack of hospice-specific clinical training is a significant recruitment barrier. Few nursing students receive exposure to hospice or palliative care during their education, and most do not feel prepared to provide end-of-life care to patients and families, a 2018 study found.

So some hospices have decided to offer that education themselves. This can not only better prepare new hires to work in the field, but it can also help attract prospective employees in the first place, according to Dr. Stephanie Patel, CEO of the Massachusetts-based hospice provider Care Dimensions.


“People are looking for a lot more mentorship and time to learn the field. People aren’t just going to jump right into hospice with no experience,” Patel told Hospice News. “They’re asking a lot more questions about orientation and onboarding. That is part of the reason we started our residency a few years ago.”

Care Dimensions launched its residency in 2015 using a $249,000 Massachusetts Healthcare Workforce Transformation Fund Training Grant.

The residency offers training to six nurses annually in two tracks, including one for new graduates. The second track is designed for nurses who are experienced working in other clinical settings, but are new to hospice and palliative care.


Most nurses train in hospitals, and some can be reluctant to move into hospice. This is often due in part to misconceptions about the service and what it entails, according to Patel.

“Our hope was that if we created this residency, we could build a pipeline of nurses who had exceptional training and could then go on and train further nurses,” Patel said. “It would open up the opportunity, and show how rewarding it could be to be a hospice nurse and how it differs from other fields.”

Care Dimensions is not alone in adopting this approach.

New York City-based Calvary Hospital also offers a nurse residency. Calvary is the only acute care hospital in the United States that is primarily focused on hospice and palliative care.

The program includes didactic instruction designed to culminate with participating nurses receiving certification in palliative care and hospice, as well as a preceptorship component that takes place in both the inpatient setting and patient homes.

Calvary also used a communication platform to observe nurse residents during home visits and provide feedback.

“It’s highly competitive for attracting those nurses to work in different hospice organizations,” Dr. Christopher Comfort, chief operating officer for Calvary, told Hospice News. “So our idea was to begin the process that would allow us to hire nurses that may have been involved in the field for a long period of time, but also allowed us to attract nurses who were new graduates and those who had worked in different areas that were now interested in hospice and palliative care.”

A similar residency exists at UnityPoint Health, an integrated health system with sites in Iowa, Illinois and Wisconsin. The nonprofit offers hospice and other community-based services through its UnityPoint at Home segment, which serves both metropolitan and rural communities.

UnityPoint’s program is accredited by the American Nurses Credentialing Center. The residency focuses on helping newly licensed nurses transition into the workforce in addition to setting-specific clinical training in hospice and home health care, according to Katrina Agnew, vice president of hospice for UnityPoint Health.

“We’ve been really successful with recruiting nurses to our program,” Agnew told Hospice News. “I’ve witnessed a couple that have matriculated from being in the nursing residency program to RN case manager or a clinical supervisor, a really positive career track for them.”

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