Hospice nurses are experts at supporting patients and their families during the transition from curative care to end-of-life care. They partner with families to ensure their loved ones’ wishes are honored. Hospice nurses must help patients establish, and periodically re-establish goals of care as their condition improves or declines. This chapter discusses the role of the hospice nurse in establishing and reaffirming patient’s end-of-life wishes. Additionally, it reviews the nurse’s role in communicating changes in the patient’s condition. The chapter ends with a discussion of how to identify and intervene appropriately, along with other members of the hospice team, during times of family conflict. This information provides a strong foundation for hospice nurses establishing goals of care with patients and families and ensuring agreement regarding the plan of care.