Mobilising nursing power: An urgent call to realise universal access to palliative care

Introduction

The global burden of serious health-related suffering is projected to increase by nearly 90% by 2060, highlighting the urgent need to expand equitable access to palliative care as a fundamental component of universal health coverage. ¹ Nurses, who comprise more than half of the global health workforce, are central to achieving this goal. To meet the growing global needs, health systems must strategically invest in nursing at all levels—spanning education, clinical practice, leadership, and research—empowering nurses to shape and deliver high-quality, sustainable, and compassionate palliative care worldwide.

Recognising that high-quality palliative care depends on strong interdisciplinary collaboration, this editorial centres specifically on nursing. We highlight the critical role of nurses in expanding equitable access and call for increased investment in nursing leadership, education, research, and advanced practice. We further propose a research agenda to build evidence for nurse-led models, demonstrate their impact on equity and system resilience, and guide policy reforms that embed palliative care within universal health coverage and global health priorities.

Mobilising nursing for a changing world

Nursing expertise is central to addressing the complex challenges reshaping global health. The core competencies of the profession, including early identification of needs, clinical knowledge, advanced communication, relational continuity, advocacy, and system-based practice, are precisely those required to redefine the boundaries of palliative care for contemporary populations. With demographic changes, including longer life expectancy, rising multimorbidity, and extended periods of serious illness, nurses are essential to redesigning care models that move beyond reactive, end-of-life responses toward proactive, needs-based approaches across the life course. ² Embedded within communities and across diverse clinical settings, nurses recognise subtle changes, anticipate deterioration, and cultivate the relationships necessary for person-centred, anticipatory care. ³ However, the capacity of the nursing workforce to meet these demands varies considerably, shaped by differences in confidence, preparation, and system support. Many nurses are insufficiently equipped to lead conversations about prognosis, goals of care, or dying, often due to limited training, inadequate mentorship, and workplace cultures that marginalise palliative care.^4,5 In settings dominated by task-oriented models, some may not view care of the dying as integral to their role. ⁴ These issues often indicate systemic gaps in education and investment in the profession.

Nursing expertise, when adequately supported, is particularly critical in chronic disease management, where trajectories are unpredictable and distress manifests across physical, psychosocial, and spiritual domains. These complexities require a professional skill set that integrates clinical expertise with the relational and contextual judgement needed to understand people’s experiences and needs. Nurses enact this integration through clinical expertise, facilitation of communication and shared decision-making, and sustained therapeutic engagement. ⁶ Importantly, nurses function as coordinating agents within fragmented health systems, bridging services, smoothing transitions, and aligning multidisciplinary inputs to ensure that care remains coherent, continuous, and responsive to changing needs. ⁷ By integrating clinical expertise with nuanced awareness of person’s social, cultural, and emotional contexts, nurses can enhance both individual quality of life and the effectiveness of health system performance.

Nursing’s ethical foundations further position the profession at the forefront of confronting structural inequities in palliative care. Through culturally safe practice, transformative education, evidence-based provision of care, and engagement in advocacy and policy, nurses address the effects of poverty, discrimination, and the ongoing legacies of colonialism that shape access to care. ⁸ As the largest and most trusted group of health professionals, and with their proximity to lived experience, nurses are in a powerful position to translate principles of justice and equity into tangible action, and dismantle structural discrimination in palliative care. ⁹ This includes challenging institutional biases, safeguarding marginalised populations, and promoting environments in which dignity and autonomy are protected. ¹⁰ This is particularly relevant in current global crises. From pandemics and conflicts to climate-related disasters and forced migration, nurses have consistently demonstrated extraordinary resilience, sustaining care in contexts marked by disruption, scarcity, and uncertainty.^11–13 These contributions, although often under-recognised, are foundational to effective palliative care response in crisis settings.

A global call to empower nurses in palliative care

Achieving universal access to palliative care will remain unattainable without a concerted global effort to empower and prepare nurses at all levels of practice, particularly those in advanced clinical, scholarly, and leadership roles. Nurses already deliver much of the world’s frontline palliative care; yet many lack the specialised preparation, authority, and institutional support required to practise to their full potential. To translate palliative principles into equitable, system-wide practice, investment in nursing education, workforce development, leadership, and research capacity must become a global priority.

There is an urgent need to prepare advanced practice nurses who can lead service development, mentor colleagues, and advocate for policy change. Advanced practice nurses possess the clinical depth and strategic insight necessary to coordinate complex care, influence organisational decision-making, and strengthen health systems. ¹⁴ Evidence demonstrates that advanced practice nurses improve care quality, enhance patient outcomes, and reduce healthcare costs, reinforcing their central role in building resilient, sustainable health systems. ¹⁵ Their expertise is therefore essential for integrating palliative care into chronic disease management, community health, primary care, and other areas where suffering is often unrecognised or untreated.

Nurses also play a critical role in education and knowledge generation, both of which are fundamental to advancing palliative care globally. As educators, nurses shape the competencies, values, and clinical judgement of future practitioners, ensuring that palliative care principles are disseminated across the wider health workforce. Their pedagogical leadership is especially important in resource-limited settings where formal palliative care training opportunities remain scarce. As researchers, nurses contribute to the evidence base that underpins high-quality palliative care: designing studies, leading implementation research, evaluating models of delivery, and generating culturally relevant knowledge that addresses gaps overlooked by mainstream scholarship. ¹⁶ Strengthening nursing research capacity enhances the field’s methodological diversity, supports innovation, and ensures that clinical practice, policy, and education are informed by robust, contextually grounded evidence.

This need is particularly acute in low-resource settings, where over 80% of the global burden of serious health-related suffering occurs. ¹ In many such settings, nurses are the principal or only providers of care, yet often lack the professional recognition, educational pathways, or infrastructural support necessary to fulfil their roles. Equipping nurses with advanced clinical, educational, and research skills can substantially expand access to palliative care, improve care quality, ensure continuity in resource-constrained systems, and strengthen advocacy for service development. ⁵ Governments and health ministries must therefore invest in nursing education pathways, protected roles for advanced practice nursing, and policy frameworks that recognise, utilise, and remunerate nursing expertise.

Empowerment must also extend beyond clinical practice, education, and research. Embedding nursing leadership within interdisciplinary collaboration, governance, advocacy, and international partnerships promotes shared learning, fosters innovation, and builds sustainable capacity across borders. Global campaigns continue to call for greater investment in nursing workforce development, stronger representation of nurses in policy-making arenas, and the recruitment of more nurses into leadership and research roles. ¹⁷ Strengthening nursing’s voice in decision-making not only enhances the quality and reach of health services but also ensures that palliative care is integrated across the disease trajectory and at all levels of health systems.

Setting a research agenda

Growing global demand for palliative care highlights the urgency of a research agenda that both strengthens nursing-led scholarship and advances understanding of nursing’s contribution to palliative care delivery. This requires two complementary strands of inquiry. First, nurses must be equipped and supported to design, lead, and evaluate research that informs evidence-based practice, service development, and policy formulation. Second, a parallel programme of research is needed to examine how nursing roles, competencies, and care models shape access, quality, and equity across diverse health systems and populations. Together, these priorities ensure that future policy, education, and workforce planning reflect the full scope and impact of nursing while advancing global commitments to equitable palliative care.

Palliative care nursing research can be broadly organised into three domains:

To accelerate and coordinate palliative care nursing research globally, we recommend the establishment of a consortium led by investigators from diverse contexts with regional hubs. Such a consortium could support researchers through defining core competencies, training programmes and mentorship, while guiding regional and international collaborative studies. It could also foster the generation of contextually relevant evidence and shared strategies across regions with similar cultural contexts. Moreover, by encouraging pragmatic and action research, the consortium could respond promptly to emerging needs and serve as a reliable platform for sharing cross-culturally validated measurement scales, service packages, and training protocols.

Conclusion

As global health systems face rising serious health-related suffering, growing demand for palliative care, and widening inequities, incremental change is no longer enough. Preparing nurses as advanced practitioners, leaders, researchers, educators, and change agents is essential to addressing persistent inequities in access to palliative care, and to achieving the health-related Sustainable Development Goals. ¹⁸ Strategic investment in nursing will strengthen palliative care systems, accelerate progress toward universal health coverage, and advance a global health agenda rooted in equity and social justice.