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education, palliative care, safety net/public hospitals



  1. Virani, Rose MHA, RNC, OCN, FPCN
  2. Malloy, Pamela MN, RN, OCN
  3. Dahlin, Connie MSN, ANP-BC, ACHPN, FPCN, FAAN
  4. Coyne, Patrick MSN, ACHPN, ACNS-BC, FAAN, FPCN


As the numbers of medically uninsured rise, more and more Americans are depending on public/safety net (P/SN) hospitals-hospitals responsible for the care of the uninsured and underinsured. The Center to Advance Palliative Care has found that far fewer P/SN hospitals report palliative care services, compared with similarly sized not-for-profit hospitals. While the development of dedicated palliative care services is an important way to enhance palliative care in P/SN hospitals, P/SN providers may need to develop alternative strategies in these underresourced settings. The purpose of this article was to describe the implementation and evaluation of the End-of-Life Nursing Education Consortium for Public Hospitals (ELNEC-PH), a comprehensive, statewide initiative to enhance palliative care education and leadership in 16 (out of 17) California P/SN hospitals. Funded by a grant from the California HealthCare Foundation, the 2-year (2011-2013) ELNEC-PH nursing project was designed to provide education and mentoring to public hospital nurses and to promote collaboration between participants and their hospital-based palliative care programs. The ELNEC-PH project consisted of 5 main activities: ELNEC education, mentoring, online palliative care education, an annual grantee meeting, and a workshop. At 18 months after course, participants reported that the program significantly increased their effectiveness and ability to teach palliative care content to their colleagues (P = .028). There was a significant increase in the number of educational programs for all modules offered across all 16 hospitals (P < .05). Lessons learned included developing a team, aligning the palliative care program with the goals and mission of the organization, and identifying key stakeholders and their needs. The ELNEC-PH project has been an invaluable educational effort that has attempted to address the growing need for palliative care education in California P/SN hospitals, which can be a model for other P/SN hospitals nationally.