Leaders, advocates and voices for change: a message about future nurse leaders.

For our Palliative Care and Public Health blog series, Philip Larkin and Sonja McIlfatrick reflect on palliative care nursing ‘facts of life’, nurse education and call for a reorientation of the way in which nurses see their role.


It is hard to envisage the world of palliative care without nurses. Nurses are the largest work force in palliative care, providing palliative care in varied settings and contexts. Their contribution to the evolution and legacy of palliative care is evident; a practice of treatment and compassionate care to address physical, psycho-social and spiritual need across the trajectory of living and dying.

A significant marker of the role of the palliative care nurse across many countries has been the shift to University based models of nurse education, where the focus is not only on competence in clinical practice but enhanced capacity for critical leadership and autonomous roles. Although the recently published EAPC report on nursing preparation for palliative care practice showed wide variation in palliative nursing education and training, it  also highlighted that clear guidelines and recommendations can influence decision-makers to see the value and importance of nurses for the delivery of high-quality and cost-effective care.

What does this mean for public health palliative care?  A careful reading of the components of the World Health Assembly (WHA) resolution 67.19  speak to the fundamental language of nursing; well-being, dignity and comfort, all of which frame good nursing practice. The resolution focuses on quality of life and the alleviation of suffering which nurses have a unique capacity to address through proximity to patients and caregivers on a 24-hour basis. However, the need for governments to ensure that undergraduate training programmes prepare all healthcare workers for the delivery of palliative care within the context of universal health coverage must also include nurses. The WHA resolution calls for a reorientation of health services and nurses have a key role to play in this.

However, we have to accept some ‘facts of life’ regarding palliative care. Current public health messages call for a generalist approach to palliative care, so what does that mean for how we educate future generations of nurses as the largest workforce in the discipline? Should the future focus of palliative care nurse education be towards the wider education of the many and the refocusing of the specialist education of the few towards roles of consultancy and clinical leadership? Secondly, what role can nurses play in challenging the social and political inadequacies which influence real choice and desire for palliative care by patients and families? Even in countries where there is relative economic stability and access to care, disadvantaged and vulnerable citizens regularly fail to get what they need because a) they are blocked by the system b) they believe they won’t be heard c) others (usually ‘expert’ clinicians) think they know better! Sadly, palliative nursing (as well as patient and caregiver voices) remains underrepresented and unheard at policy tables.

What we need now is a reorientation of the way in which nurses see their role in palliative care – as leaders, as advocates, as voices for change and reason and a repository of knowledge to support people to be part of the decisions made, not as the recipient of someone else’s benevolent care. If we truly support a public health approach to palliative care, then nurses need to be prepared to engage with communities as partners, not practitioners.  The forthcoming Public Health Palliative Care International Congress calls for a change in the democratisation of the care of the dying and grieving. This asks us to reflect on our public health palliative care actions as nurses to ensure that the next generation of palliative care nurses are well-prepared in how they can respond to informed communities as partners to help enable the optimisation of what palliative care can be.

Links and resources

  • Find out more about the EAPC Reference Group on Public Health and Palliative Care.
  • Read more about Public Health and Palliative Care on the EAPC blog.
  • The End-Of-Life Care research group is hosting the 7th international Public Health Palliative Care International conference ‘Democratizing caring, dying and grieving: participation, action, understanding and evaluation’. Bruges, Belgium, 20 – 23 September 2022. Find out more here.
  • The End-Of-Life Care research group Public Health & Palliative Care Research Summer School is taking place on 14 to 17 September 2022, in Ghent, Belgium.

About the authors

Phil Larkin is the Kristian Gerhard Jebsen Chair of Palliative Care Nursing, Department of Palliative and Supportive Care, University Hospital of Lausanne and the Institute of Higher Education and Healthcare, University of Lausanne. He has worked in Palliative Care for over 30 years and is past President of the EAPC (2015-2019).  ORCID: 0000-0001-8424-3920.

Sonja Mcilfatrick is Professor of Nursing and Palliative Care and Head of School of Nursing and Paramedic Science, Ulster University, Northern Ireland. Sonja is a current member of the EAPC Board of Directors and has worked in palliative care for over 20 years. ORCID: 0000-0002-1010-4300. Twitter @SMcilfatrick.


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This entry was posted in EAPC Task Forces/Reference Groups, public health palliative care and tagged . Bookmark the permalink.

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