Few nurses receive formal training on end-of-life care, and many would like more expertise in this area. “Within our practice, and within our years of teaching undergraduate students, we continually noted knowledge deficits of individuals caring for patients with poor prognosis and/or actively dying,” says Shelly Orr, PhD, RN, CNE, research operations program director for Virginia Commonwealth University (VCU) Health System.

Orr and colleagues studied the benefits of targeted education on principles of end-of-life care, with two workshops provided to 19 nursing students and 24 practicing nurses.1 Using the End-of-Life Nursing Education Consortium (ELNEC) Knowledge Assessment Test, Orr and colleagues found the initiative was beneficial and feasible.

“The goal of ELNEC is to get training on end-of-life care principles, and then teach the principles to others to spread the knowledge,” Orr explains.

Two workshops were provided. The first was in person, but because of COVID-19 restrictions, the group was forced to offer the second workshop remotely.

“We were surprised to find there were not differences in learning between the face-to-face and virtual learners,” Orr reports.

Communication with patients and their families tends to be the No. 1 issue for which nurses indicate they are unprepared. Most undergraduate nursing programs provide little to no formal training regarding palliative care principles, including communication.

“Mostly, nurses feel unprepared when put in a situation that warrants a difficult conversation with patients and/or their family about a patient’s declining status,” Orr laments.

It is difficult for nurses to remain hopeful and honest when caring for someone at the end of life. “Caring for the family of a dying patient can be just as important, yet demanding, as caring for the dying patient,” Orr notes.

Families need physical, psychological, and spiritual care, too, that nurses must be adept in providing. “Formal training and experiential learning are needed,” Orr stresses. Nursing education programs need to value end-of-life and palliative care as a part of their formal curriculum, according to Orr. “Everyone dies,” she says. “Shouldn’t all nurses be prepared to deliver the best end-of-life care based on sound evidence-based principles?”


  1. Orr S, Falk M, Elswick RK. Facing the inevitable: Preparing nurses to deliver end-of-life care. J Hosp Palliat Nurs 2021; Jun 22. doi: 10.1097/NJH.0000000000000780. [Online ahead of print].