Are nurses becoming more influential in palliative care? A personal perspective from Romania


To mark this world first, the European Association for Palliative Care (EAPC) is publishing a special series of 12 monthly posts to honour the work of nurses who work in palliative care and draw attention to several issues that are linked to this crucial workforce. Today, we are delighted to welcome as our guest writer, Dr Nicoleta Mitrea, APRN, PhD, Director of Nursing Education and Development at HOSPICE Casa Sperantei and Senior Lecturer at University of Transilvania, Brasov, Romania, who shares a very personal perspective based on recent experiences. 

Dr Nicoleta Mitrea.

Are nurses becoming more influential in palliative care?  With 20 years’ experience as a palliative care nurse, and now as a nurse educator, hereare my thoughts on this question from a very personal perspective based on recent experiences.

When looking at the profession from the globally accepted theoretical perspective, nursing is the best profession one can choose to practise, if you’re driven to strive for values like compassion, caring, loving, giving oneself to the service of others.

When looking at the nursing profession as a part of palliative care, which promotes values such as: holistic, patient-centrered care, families as the unit of care, teamwork, quality of life and death, then nursing is really the profession to choose and be engaged in. Palliative care is not about cure, it aims to alleviate symptoms, and at its heart is nursing care. Ultimately, the professional values of nursing converge so smoothly with the concept and values of palliative care.

Nursing in general can be viewed as a controversial/divergent profession in the way it is developed, organised and carried out worldwide (WHO, 2020). Statistics suggest that globally nurses are confronted with the same disease challenges; it therefore seems logical that nursing should be grounded into the same pillars of education at different levels, competency requirements, career opportunities for development and clinical practice. This however, is not the case and so, how can nursing in general be influential if globally it is not a unique, united force?

There are diverse levels of the development of palliative care services in European countries (EAPC, 2019), together with the diversity of existing and non-existing programmes of education in palliative nursing across European countries (EAPC, 2020).

In a world in which knowledge/education is power, I dare to suggest that now is the time to start and unite visions for development of the nursing profession in general, and palliative nursing education and practice in particular.

So am I qualified to speak as an expert?  I started to work in Palliative Care 20 years ago, when nursing in Romania was based on a high school level diploma. I was 26 years old at the time. Driven by the values mentioned above, the common characteristics of nurses, the opportunity to work with professionals like Associate Professor Daniela Mosoiu, and having mentors like Dr Betty Ferrell and Pam Malloy (End-of-Life Nursing Education Consortium– ELNEC international), I took my education to a higher level. From nursing technical college (three years), to nursing university (four years – Bachelor level), to a Master’s in Palliative Care (two years), and finally doctoral studies (five years), I became the first nurse in Romania with this level of education in the palliative care field, and the tenth nurse in the country with this level of education.

Nicoleta with members of her team at HOSPICE Casa Sperantei. L-R: Dorina Oprea, Melinda Demeter, Nicoleta Mitrea, Cristina Hiris, Hajni Nagy.

With an extraordinary nursing team effort that lasted for eight years, in 2017 we changed the legislation in Romania and palliative care was included among the list of nursing specialty programmes. Although I am recognised as a leader in palliative nursing in Europe and internationally, in Romania this is not the case where the competencies acquired over so many years now shake the regular, socially accepted dynamics of work. 1-2

So, are we as palliative care nurse specialists influential? In my part of the world, our influence is insignificant and does not compare with the amount of effort and time that we as palliative care nurse specialists must invest in order to determine change.

As globally nursing is often evaluated through the lowest performance in the chain, I believe that it is in everyone’s interest to align palliative nursing education, practice and policies worldwide. And only then can we say that we’ve become truly influential.

The need for team work is a must, so I would suggest that we work together on common policies on both: educational programmes and nursing competencies. We need to (re)-embrace core values and principles that are the foundation of leadership practices, of change-driven missions, of transforming visions into realities.

Celebrate the International Year of the Nurse and Midwife 2020 on the EAPC blog #nurses2020 #midwives2020. View the series here and join us again in October when Ms Rose Kiwanuka from Uganda is our guest writer. 


World Health Organization (WHO), ‘State of the World’s 2020 Nursing Report’ (2020).
Arias-Casais N, Garralda E, Rhee JY, Lima L de, Pons JJ, Clark D, Hasselaar J, Ling J, Mosoiu D, Centeno C. EAPC Atlas of Palliative Care in Europe 2019. Vilvoorde: EAPC Press; 2019.
Pereira SM, Hernandez-Marrero P, Pasman HR, Capelas ML, Larkin P, Francke AL. ‘Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports’, Palliative Medicine 2020, First published online September 11, 2020.

  1. Mitrea, Mosoiu, Ancuta, Malloy, Rogozea.‘Developing, Promoting and Sustaining PC Across Central Eastern Europe -Educating Nurses to Be Leaders Is a Critical First Step’Journal of Hospice &Palliative Nursing 2019; (21) 6: 510-517.
  2. Mitrea, N, Moşoiu, D, Ancuţa, C, Malloy, P, Rogozea, L. ‘The impact of the ELNEC Training Program on the clinical practice of Eastern European Nurses working in Specialized PC service’.  Journal of Hospice & Palliative Nursing 2017; (19) 5:424-434.

More about the author
Nicoleta Mitrea APRN, PhD, is Director of Nursing Education and Development at HOSPICE Casa Sperantei and Senior Lecturer at University of Transilvania, Brasov, Romania. She is also an ELNEC international trainer, a trainer in the European Palliative Care Academy (EUPCA) programme and a member of the EAPC social media team. Read more about her publications here.

Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the second six months of 2020.


This entry was posted in 2020 Most-viewed posts, ADVOCACY & POLICY, International Year of Nurse & Midwife 2020, Nursing. Bookmark the permalink.

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