I’ve had a very busy summer consulting with hospices all across the US. In talking with administrators about their biggest worries, I heard one alarm sounded everywhere I went: Hospice is in the grip of a critical nursing shortage. Certainly, in some areas the problem is greater than in others, but make no mistake; recruiting the ideal experienced, compassionate, smart, flexible and dedicated hospice nurse (or social worker, for that matter) is more challenging by the day. As a board member of the University of Florida College of Nursing’s Alumni Council, I can tell you that the school cannot afford to admit more than 120 new undergraduates/year. The University of Delaware College of Nursing admits 136. Numbers like these will not begin to meet the burgeoning needs of the Baby Boomer generation as they age.

And it’s not just that new nurses aren’t entering the field at the rate we need them to; we’re losing those we have, nurses who are leaving the profession because they’re unhappy with the workload – and with the disrespectful ways in which they’re treated.

According to this survey of nurses conducted by RN Network, 27% feel overworked. But 32% of nurses feel disrespected by their administrators – and 50% of them are considering leaving the field because of it. Many report having suffered harassment or bullying on the job:

  • 45 percent of nurses have been verbally harassed or bullied by other nurses
  • 41 percent have been verbally harassed or bullied by managers or administrators
  • 38 percent have been verbally harassed or bullied by physicians

Not surprisingly, 52% of those reporting harassment are considering leaving the field. I’ve written in the past about bad bosses, and about nurses who “eat their young”; if your supervising staff or your management lack the skills needed to support your nurses in their work, you’d better consider getting them some training in management skills. Yes, lives depend on nurses’ good judgment and decision-making – but we were all newbies once, and a good manager can correct an employee without belittling, bullying or otherwise discouraging her. If yours can’t, fix it.

There’s no time for hand wringing: We must act now to find ways to:

  • retain the great staff we have
  • foster new staff into the work
  • providing better orientation and preparation for nurses going into their first hospice jobs
  • offer more flexible schedules when possible
  • use non-RN's in areas that do not require that liscense (aides, LPN's, volunteers, death doulas, and fully engage the social workers and clergy so the care is truely interdisciplinary
  • employ technology in helpful ways and determine where technology hinders the provision of care
  • LISTEN...listen...listen to your staff and support them as the amazing people they are who look in the face of death day in and out and still come back to work

Large hospital systems are creating “Nursing Residency” programs, hiring new graduates and taking them through a one-year Residency program where they get regular training, support, and lower case loads. And it’s working; retention figures for nurses who go through these programs average above 90%. Larger hospices might consider offering that level of support when hiring new nursing graduates who have life maturity about death.

As both a nurse and an administrator, I have seen and understand the macro as well as the micro view of what happens when staff are pushed to their limits, without backup, without support or encouragement - and the results are not pretty. We need to begin a giant conversation about how to provide care to dying people in this new environment, now!

I can help! Click here so we can start a conversation!!

Do your staff feel this way?!


So impressed with this inspirational story coming out of Gilchrist Hospice of Baltimore. Talk about a powerful mission…changing the world!

“When Don Hohne visited the Arusha region of Tanzania in 2012, he saw a man with an enlarged abdomen, swollen with fluid to the point that it looked like he was nine months pregnant. Seeing the man’s pain and discomfort, Hohne’s group inquired with a local palliative care staff member if the fluid could be removed.

He recalled the staff member saying, “Yeah, it’s possible that we could do that. It could be problematic getting him to the hospital, and then he doesn’t have any money, so he has no way of covering any of the costs.”

Hohne’s four-person group from Gilchrist, a Maryland nonprofit providing hospice and palliative care in partnership with Nkoaranga Lutheran Hospital where that staff member worked, decided to fund a hospital trip for the man, whose name was Thomas. So he was loaded onto a motorcycle and bumped down rugged roads to the Lutheran hospital, which is housed in a series of one-story buildings connected by covered walkways.”

Don Hohne, one of the Gilchrist visitors who went to Nkoaranga, posing for a photo with local children.

What inspires your volunteers? HopeWest Hospice is great at garnering recognition for their hard-working volunteers, as in this terrific feature story:

GRAND JUNCTION, Colo. - HopeWest has a variety of programs that help people with both end of life care and grief support. Many local volunteers donate their time to the organization, because HopeWest has touched their own lives.

At Charmed By Heirlooms on Main Street, the volunteers turn what could have been trash, into treasure. The handmade items they create are largely inspired by their imagination, and are sold with the proceeds benefiting HopeWest.

Creativity at it's finest at Charmed By Heirlooms thanks to HopeWest


Pause, and enjoy morning at the RiverCove Retreat Center

The Watershed Group
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