Reply To: End of Life Care issues and staffing

  • Linda Ritter

    February 10, 2021 at 12:45 pm

    ​We worked really hard 8 years ago to establish EOL standards of care on our Hematology/Oncology/Stem Cell Unit. We started with a survey of the nurses to understand and establish baseline education level and found that we were all over the board. so then we started educating the nurses using ELNEC (End-of-Live Nursing Education) Materials to raise our knowledge base by hosting a 2 day Pediatric Palliative Care and End-of-Life Conference. We spoke with our managers about the practice (then) of staffing End-of-Life patients as a forth in a 3:1 pt:nurse ratio. We felt that this time, like birth, was one of the most important times in this families lives and to honor the child we wanted to intensify our nursing care. Our managers listened and we now staff our patients for End-of-Life as 2:1 or even 1:1. We encourage nurses to be aware and accept the assignment if they are able and to speak up if they have difficulty with this. We have “expert nurses” on our staff who know how to manage symptoms including pain, dyspnea, secretions, and have worked to establish standard orders sets for the physicians. Our nurses know to help with legacy building/making memories with drawings, hand prints, and photos and they work together with our Child Life Specialist, our Social Workers, our Chaplains, and our Physicians to help the patient and family along this journey that will form their memories of this time. This work is ongoing because we have new nurses coming on all the time, so we have a committee that communicates with the staff on current events and helps to debrief. It’s a work in progress but most importantly, we as nurses came up with the idea to raise our standards and to speak up  and step up to provide the care that is needed to the patient and the family during this time. Hope this helps!


    Linda Ritter, RN, CPON
    Pediatric Oncology RN Coordinator
    Lucile Packard Children’s Hospital, Palo Alto California
    Original Message:
    Sent: 02-10-2021 10:47 AM
    From: Laura Bermudez
    Subject: End of Life Care issues and staffing

    Hello everyone,

    I would like to know a couple of things.  How do you manage your end of life care?  What Nurse patient ratios do you observe? Spiritual care?  Family support?

    Thank you for any feedback,
    Laura B. Ramos

    Laura Bermudez, RN
    Winters, CA
    United States