Using Simulation to Build a Stronger End-of-Life Nursing Workforce

Preparing and retaining nurses for end-of-life care is no longer just a clinical priority; it is a strategic imperative for every hospice and palliative organization. Nurses at the bedside of dying patients carry an enormous emotional, ethical, and technical load: they manage complex symptoms, navigate intense family dynamics, and hold space for grief, fear, and uncertainty shift after shift. Without intentional preparation, ongoing support, and clear pathways for growth, even the most committed clinicians can burn out or leave the field altogether. Building a strong end-of-life nursing workforce means investing in high-quality education (including simulation and communication training), creating emotionally safe teams and supervision structures, and designing roles and schedules that are sustainable over time. When organizations do this well, they don’t just “fill positions.” Instead, they cultivate confident, resilient nurses who can stay, grow, and deliver consistently excellent care to patients and families at the most critical moments.

This study looked at whether Simulated Clinical Immersion (SCI) – high-fidelity, scenario-based simulation with structured debriefing – better prepares nursing students to care for older adults at the end of life than traditional lectures. In a quasi-experimental pre/post study of 128 fourth-year nursing students, all students first received the same didactic content on palliative and EOL care (symptom management, ethics, communication). Then, half completed SCI using a realistic scenario of a critically ill older adult needing symptom control and a goals-of-care discussion with family. The other half continued with lecture-only teaching. Knowledge, clinical self-efficacy, and perceived simulation effectiveness were measured before and after. The SCI group had dramatic gains in EOL knowledge and self-efficacy, as well as in perceived preparedness, while the lecture group showed essentially no change.

The authors conclude that immersive simulation is far superior to lecture-only teaching for building the knowledge, confidence, and readiness needed for high-quality EOL care. SCI allowed students to practice difficult conversations, symptom assessment, and ethical decision-making in a psychologically safe environment, then process the experience through structured debriefing – an approach grounded in experiential learning theory. The gains were especially strong in communication and psychosocial support domains, which are central to hospice work, and the effect sizes were large, suggesting a genuinely meaningful educational impact rather than just small test-score differences.

The paper argues that high-fidelity simulation and expert debriefing should be considered essential, not optional, elements of nursing curricula focused on palliative and EOL care for older adults.

Takeaways for Hospice Agencies

For hospice and end-of-life organizations, several takeaways follow. First, you can expect nurses who have gone through this kind of simulation to arrive more confident and ready to handle complex family meetings and symptom crises. Where that training is missing, agencies may need to build similar simulation and debriefing into orientation and ongoing education.

Second, leaders might ask: Do we provide our own “clinical immersion” for new staff – safe practice with EOL scenarios, followed by structured debriefs – or do we throw people straight into real crises and hope they learn on the fly? Many hospice agencies are so short-staffed that new clinicians are sent into the field almost immediately. But investing more time in onboarding and training can make a real difference – for patients, for staff, and for the agency itself. Giving new hires deeper preparation, especially around end-of-life care and difficult conversations, is essential. For those who are new to hospice, this additional support can build confidence, improve quality of care, and ultimately strengthen staff retention.

Third, this study points toward partnership opportunities with nursing schools: co-design hospice-specific simulations (home deaths, challenging family dynamics, cultural/religious needs), offer your nurses as guest facilitators, and create student rotations tied to these simulations. At the nursing-school level, embedding mandatory end-of-life simulations throughout the program can

• Normalize and de-stigmatize end-of-life care, making more graduates willing to choose hospice or palliative roles
• Shorten onboarding time because new hires arrive with core skills already practiced
• Reduce burnout and turnover by giving nurses emotional tools and confidence before they face real deaths

Over time, that combination – more students exposed early, plus a smoother transition into practice – can help expand the pool of nurses who are both available and truly prepared to work in hospice and other end-of-life settings.

Link to article

The impact of simulated clinical immersion on nursing students’ preparedness for end-of-life care in older adults