What you’ll learn in this article…
- ELNEC has prepared over 56000 trainers across 150 countries.
- Map ELNEC modules to AACN CARES competencies before building your syllabus.
- MUSC hosts an ELNEC Train-the-Trainer summit August 20 to 21, 2026.
The End-of-Life Nursing Education Consortium (ELNEC) is a standardized palliative care curriculum for nursing education, and in 26 years it has trained more than 56,000 educators who have since taught over 1.8 million clinicians across 150 countries.1 That reach now includes more than 1,200 undergraduate and 450 graduate nursing programs in the United States alone.
Those numbers reflect a shift already underway in accreditation expectations: palliative care is a required competency domain under AACN's CARES framework, not an elective module reserved for hospice-track students or a unit tacked onto the end of a med-surg course.
For nursing program directors mapping curriculum against competency standards, the practical question is no longer whether to teach palliative care, but how to sequence it, staff it, and place students clinically without overloading an already dense plan of study.
Why Palliative Care Education Is a Curriculum Priority
For years, palliative care was often treated as a hospice elective or a late-semester end-of-life add-on. In a competency-driven curriculum, it is better understood as a foundational skill every pre-licensure graduate must carry into general practice, because every new nurse will meet patients with serious illness, not only those on hospice.
The Competency Framework Has Shifted
The AACN's 2021 Essentials moved nursing education toward competency-based preparation and added a clear requirement: baccalaureate students must demonstrate competency in hospice, palliative, and supportive care. The AACN's CARES framework, published in 2020, spells out 17 competencies students should reach by graduation. ELNEC has updated its materials to reflect these expectations for both entry-to-practice and advanced-level nursing students. This is not a specialty extra reserved for palliative teams; the standards define it as baseline safe nursing practice.
Illness Burden Makes This a General-Practice Skill
The case for universal training is demographic. In the United States, 60 percent of adults live with at least one chronic illness, and 42 percent have multiple chronic conditions. An aging population and rising chronic disease prevalence mean serious illness conversations, symptom management, and goals-of-care planning now occur across primary care, hospital, community, and long-term care settings. Pre-licensure programs cannot assume another provider will handle these discussions, and waiting until a nurse specializes in hospice misses most of the need.
Competency Protects Students and Patients
Nurses who lack structured palliative communication skills often report feeling unprepared during difficult conversations, which can contribute to moral distress. Building core skills in symptom assessment, cultural considerations, and family communication helps new graduates engage earlier and with more confidence. For patients, early palliative communication is associated with better symptom control, clearer care planning, and less avoidable suffering. For nurses, structured skills reduce moral distress and increase confidence in initiating hard conversations.
The Curricular Gap Is Still Real
Despite the standards, implementation remains uneven. Between 2021 and 2023, only 135 of 996 U.S. baccalaureate nursing programs reported offering standardized primary palliative care education. That gap means many graduates enter practice without a shared baseline for leading serious-illness conversations. This matters because AACN expectations assume every program has a reliable pathway for teaching these skills. Integrating ELNEC into required coursework is one concrete way to close it.
ELNEC's Global Reach in Five Numbers
The End-of-Life Nursing Education Consortium has grown into the largest palliative care education initiative in nursing. As ELNEC enters its 26th year, its partnership with the Medical University of South Carolina College of Nursing, City of Hope, and the American Association of Colleges of Nursing signals a new chapter of expanded reach. Here is where the program stands today.
What ELNEC Is and How Its Train-The-Trainer Model Works
Palliative care has moved from an optional specialty elective to a foundational expectation across the nursing education curriculum, and the End-of-Life Nursing Education Consortium (ELNEC) offers nurse educators a structured way to build that capacity. ELNEC is administered by City of Hope and developed in collaboration with the American Association of Colleges of Nursing (AACN).1 In its 26th year, ELNEC has prepared more than 56,000 trainers, who have educated over 1.8 million clinicians across all 50 states and in 150 countries.1 The MUSC partnership specifically increases access for nurse educators in the southeastern United States, placing the training model closer to programs that may have had to travel farther in the past.3
The Train-the-Trainer Cascade
ELNEC uses a train-the-trainer model in which nurse educators and clinicians complete an ELNEC course, then return to their own programs and practice settings to teach the content to other faculty, students, and staff. The intended audience spans undergraduate and graduate nursing faculty, continuing education providers, staff development educators, and specialty nurses in fields such as pediatrics, oncology, critical care, and geriatrics. Eligibility varies by hosting site. One pediatric session, for example, requires registered nurses with existing education in hospice and palliative nursing, while other courses are open to a broader range of nurses.4
August 2026 Train-the-Trainer Summit at MUSC
The current MUSC, City of Hope, and AACN partnership brings an in-person summit to Charleston, South Carolina. The two-day event runs August 20 and 21, 2026, with sessions starting at 7:00 AM on August 20. It offers content in APRN Adult, Communication, Core/Critical Care, and Pediatric tracks. Registration closed August 9, 2026, so interested faculty should note the deadline for future offerings.2
Continuing education credit totals 12 or more hours, approved by the California Board of Registered Nursing through City of Hope National Medical Center/Beckman Research Institute. Participants who complete the summit receive continuing education documentation and are positioned to train others using ELNEC materials at their home institutions.2
Fees and Faculty Discounts
Pricing varies by track and registration period. Most tracks range from $575 to $775, with early bird rates at $575 to $675 and late rates at $675 to $775. The APRN Adult track has pricing at $675 to $775 depending on timing. Schools of nursing faculty receive a $100 discount using the code SONFACULTY, and groups of three or more colleagues from the same institution can email ELNEC for a $50 per-person discount. These discounts lower the cost for faculty building palliative care capacity through nursing program development.2
Palliative care is no longer an elective specialty topic, it is a core competency every nursing graduate must demonstrate before entering practice.
ELNEC Curricula Compared: Undergraduate, Graduate, Core, and Specialty Tracks
ELNEC offers multiple curriculum tracks so you can match the right content to your learners, whether you teach in a prelicensure BSN program or prepare APRNs for advanced palliative care roles. The undergraduate and graduate curricula align with the AACN CARES and G-CARES competency frameworks respectively, while the Core, Geriatric, and Pediatric tracks extend foundational content to faculty development and population-specific practice. Below is a side-by-side look at the key features of each track to help you decide where to start.
| Feature | Undergraduate / New Graduate | Graduate | Core | Pediatric Palliative Care | Geriatric |
|---|---|---|---|---|---|
| Primary Audience | Prelicensure students, RN-to-BSN students, and nurses in residency or orientation programs | Master's and DNP students | Undergraduate nursing faculty, CE providers, and staff development educators | Nurses providing palliative care to pediatric populations | Nurses caring for older adults in home, community, assisted living, skilled nursing, hospice, and ambulatory settings |
| Number of Modules | 6 interactive modules | 6 interactive modules | 8 modules | Module count varies by delivery platform (available through Hospice Education Network and Cure4Kids) | Module count varies by delivery platform (available through Hospice Education Network) |
| Estimated Hours per Module | 1 to 2 hours each | Approximately 1 hour each | Varies by facilitator pacing | Varies by facilitator pacing | Varies by facilitator pacing |
| Delivery Format | Online interactive curriculum with case studies, testimonials, and vignettes via ELNEC Academy | Online interactive curriculum with cases and video demonstrations featuring APRNs via ELNEC Academy | Online learning through Hospice Education Network | Online learning through Hospice Education Network; also downloadable via Cure4Kids (available in English) | Online learning through Hospice Education Network |
| Key Content Focus | Introduction to palliative care nursing, communication, pain management, symptom management, loss and grief and bereavement, final hours of life | Advance care planning conversations, pain and symptom management, leadership in primary palliative care | Introduction to palliative nursing, pain, symptom management, ethical issues, cultural and spiritual considerations, communication, loss and grief and bereavement, final hours | Core palliative content adapted for pediatric populations and developmental considerations | Core palliative content adapted for age-related conditions in home and community settings |
| Competency Alignment | Aligns with AACN CARES competencies for primary palliative care | Aligns with AACN G-CARES competencies for advanced practice palliative care | Provides the foundational framework from which undergraduate and specialty modules are derived | Population-specific adaptation of Core competencies | Population-specific adaptation of Core competencies |
| Access and Train-the-Trainer Requirement | Available through ELNEC Academy online; CE availability determined by the academy course offering | Available through ELNEC Academy online; faculty are encouraged to attend a national ELNEC Train-the-Trainer course to receive APRN-specific teaching materials | Designed for faculty who complete a Train-the-Trainer course, which provides full teaching materials and presentation resources | Available through Hospice Education Network and Cure4Kids; Train-the-Trainer attendance recommended for full instructional toolkit | Available through Hospice Education Network; Train-the-Trainer attendance recommended for full instructional toolkit |
Mapping ELNEC Modules to CARES and G-CARES Competencies
The table below maps each ELNEC Undergraduate/New Graduate module and two key ELNEC Graduate modules to their primary AACN CARES and G-CARES competency domains. Competency domain titles and performance language are drawn from the official AACN CARES, G-CARES, and ELNEC alignment documents; consult those sources for the complete competency statements. Where a module addresses multiple domains, the primary alignment is listed here. Assessment ideas are tied directly to the competency language so you can build rubrics that document student attainment.
| ELNEC Module | CARES Competency Domain | G-CARES Alignment | Suggested Assessment |
|---|---|---|---|
| Module 1: Introduction to Primary Palliative Care (Undergraduate/New Graduate) | Primary palliative care for all nurses | "Articulate the value of palliative care as a basic human right at a local, national, and global level." | Written mapping exercise or competency recognition quiz in which students identify G-CARES competencies in primary palliative care appropriate to their scope of practice. |
| Module 2: Pain and Symptom Management in Serious Illness (Undergraduate/New Graduate) | Management of pain and other symptoms | "Promote delivery of care that supports holistic assessment and management of pain and symptoms common in serious illness at the full scope of practice." | Case-based symptom management OSCE or high-fidelity simulation with a checklist aligned to CARES and G-CARES pain and symptom management competencies. |
| Module 3: Communication in Serious Illness and End of Life (Undergraduate/New Graduate) | Communication with patients, families, and the health care team about serious illness and end-of-life care | "Demonstrate communication expertise in primary palliative care skills, in particular sharing difficult news, discussing advance care planning and completing advance directives, in facilitating/leading family and interprofessional team meetings, and transitioning to hospice care when appropriate." | Standardized patient encounter focused on a serious illness conversation and goals-of-care discussion, scored with a rubric mapped to CARES communication competencies and G-CARES communication performance language. |
| Module 4: Ethical, Legal, and Cultural Aspects of Palliative and End-of-Life Care (Undergraduate/New Graduate) | Ethical, legal, and cultural aspects of care for persons with serious illness and at the end of life | "Demonstrate leadership guided by principles of ethics, social justice, equity, and moral courage in the advancement of quality palliative care." Also: "Collaborate with healthcare team members to coordinate culturally sensitive, patient-centered, and family-focused palliative care across care settings." | Ethics case analysis and written care plan demonstrating application of CARES competencies related to ethical, legal, and cultural decision-making for persons with serious illness. |
| Module 5: Care for Patients and Families at the Time of Dying and After Death (Undergraduate/New Graduate) | Care of patients and families at the time of dying and after death | "Advocate for environments of care that uphold the dignity of the patient and family during the dying process and after death through culturally sensitive and compassionate end-of-life care." | Reflective narrative or care plan documenting nursing actions to support dignity, cultural sensitivity, and compassionate care at the time of dying and after death, linked to CARES and G-CARES end-of-life competencies. |
| Module 6: Self-Care, Grief, Loss, and Bereavement (Undergraduate/New Graduate) | Grief, loss, bereavement, and self-care for nurses and teams caring for persons with serious illness and their families | "Contribute to an environment that fosters well-being for self, patients, families, and team members to cope with suffering, grief, loss, and bereavement." | Structured self-care plan paired with a team-based debrief reflection assignment demonstrating application of CARES and G-CARES competencies related to grief, loss, bereavement, and professional resilience. |
| Graduate Module 1: Advanced Practice Leadership in Primary Palliative Care | Leadership for quality palliative care across settings (CARES and G-CARES alignment domain) | "Demonstrate leadership guided by principles of ethics, social justice, equity, and moral courage in the advancement of quality palliative care." Also: "Engage in strategic partnerships with interprofessional colleagues and community stakeholders to influence policies and quality improvement activities related to primary palliative care." | Graduate-level project analyzing patient, family, community, or system challenges and opportunities as an APN leader in serious illness care, mapped to G-CARES leadership competencies. |
| Graduate Module 2: Advanced Symptom Management and Consultation | Holistic assessment and management of pain and symptoms common in serious illness (CARES and G-CARES alignment domain) | "Promote delivery of care that supports holistic assessment and management of pain and symptoms common in serious illness at the full scope of practice." Also: "Consult with specialty services for complex palliative care issues that exceed one's functional area of practice and educational preparation." | Graduate-level OSCE or complex case consultation write-up demonstrating advanced symptom management and appropriate consultation, aligned with G-CARES domain statements. |
Strategies for Integrating ELNEC Into Your Nursing Curriculum
Successful ELNEC integration hinges on matching your delivery model to your program's structure, sequencing modules strategically across semesters, and aligning content with AACN CARES competencies from the start.
Three Integration Models to Consider
Most nursing programs choose one of three approaches when adopting ELNEC content:
- Threaded/embedded modules: The six one-hour ELNEC modules1 are woven into existing courses across the curriculum. This is the most common model, used by traditional BSN, ABSN, and RN-to-BSN programs alike. A Midwestern university2, for example, threads all six modules into concept-based courses, pairing each with discussion boards, case studies, and NCLEX-style quizzes.
- Dedicated palliative care course: Some programs create a standalone one- to three-credit course3 built around ELNEC content. This approach concentrates contact hours and allows deeper exploration of topics like pain management and communication, though it requires curriculum committee approval and may compete for credit space.
- Capstone and simulation integration: Faculty embed ELNEC modules into final-semester experiences, pairing content with high-fidelity simulations of end-of-life scenarios. This model reinforces earlier learning and gives students a safe space to practice difficult conversations before clinical placements.
Semester-Level Sequencing Examples
For ADN programs, consider introducing the Introduction and Communication modules in your first-year fundamentals course, then adding Pain Management and Symptom Management during second-year medical-surgical rotations. Loss, Grief, and Bereavement and Final Hours of Life fit naturally into capstone or complex care courses.
BSN programs have more flexibility. A four-year sequence might place foundational modules in sophomore-level health assessment, intermediate content in junior-year adult health courses, and culminating modules in senior capstone alongside simulation experiences. RN-to-BSN programs typically embed modules within required online courses, using online nursing education best practices and spreading them across multiple semesters so working nurses can manage the workload.
Mapping Contact Hours and CARES Competencies
The six ELNEC Undergraduate modules total at least six online contact hours1, but most programs add faculty-led activities like written assignments, discussion, and simulation to deepen learning. AACN provides crosswalk documents that map each module to specific CARES competencies4, making syllabus alignment straightforward. When building your course outlines, reference these crosswalks to document how your program meets accreditation requirements for nursing education alignment.
Faculty Development as the Entry Point
Before you can teach ELNEC content effectively, you need trained faculty. The MUSC Train-the-Trainer summit scheduled for August 2026 in Charleston offers continuing education credits and certification for educators ready to cascade palliative care competencies across their programs. Attending a train-the-trainer course is the practical first step toward sustainable curriculum integration.
Three ELNEC Integration Pathways for ADN and BSN Programs
There is no single right way to bring ELNEC content into a nursing program. The best approach depends on your curriculum structure, credit-hour flexibility, and clinical partnership network. Below are three proven pathways, each mapped to a realistic semester sequence so you can adapt the one that fits your program's design.
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Designing Palliative Care Clinical Placements and Simulation Experiences
Palliative care clinical learning must be deliberate, sequenced, and interprofessional, not an afterthought squeezed into an acute care rotation.
High-Yield Clinical Sites
Priority placements include inpatient palliative care consult services, hospice, home health, long-term care with active palliative programming, and pediatric palliative care.1 Inpatient consults let students observe complex symptom management and goals-of-care conversations in real time. Hospice and home health normalize end-of-life support for patients and families. Long-term care and pediatric settings show how palliative needs shift across the care trajectory and across developmental stages. Home-care cases often require students to manage symptoms across distance and coordinate with family caregivers, which builds a level of clinical judgment in nursing that a single inpatient shift cannot replicate. Before assigning a site, conduct a clinical placement evaluation for nursing students and confirm that the caseload and learner level match.2 A novice undergraduate may gain more from a structured hospice orientation and a limited number of observed visits than from an unpredictable inpatient consult service.
Supervision and Preceptor Models
Use an expert preceptor or mentor who can provide protected orientation and observational time before direct care.3 Debriefing should happen throughout the placement, not only at the end, and should include symptom assessment, communication choices, ethical tension, emotional response, and team effectiveness, helping establish psychological safety in nursing education.4 Set clear expectations for each visit and offer self-care guidance for both students and educators, because palliative placements routinely surface grief. Peer-assisted learning can also work well when senior students help orient juniors to hospice or home care routines.
High-Fidelity Simulation Scenarios That Reinforce the Placement
- Imminent dying with escalating dyspnea and pain.5 Objective: assess a rapidly changing patient, communicate with family, and escalate appropriately. Roles: student nurse, preceptor, family member, provider. Debriefing prompts: What assessment cues did you notice first? What would you say differently? How did the experience affect you?
- Goals-of-care family meeting. Objective: practice advance care planning communication and shared decision-making. Roles: nursing student, medicine, social work, chaplaincy, pharmacy, family member. Debriefing prompts: How did each discipline shape the plan? What ethical tensions emerged? Which team behaviors helped or hindered the conversation?
Interprofessional Learning
Case conferences and team meetings are the most practical interprofessional activities.1 When live participation is not possible, run a mock team meeting with chaplaincy, social work, pharmacy, medicine, and nursing roles. Guest panels with hospice nurses, chaplains, and child-life specialists can also prepare students for emotionally demanding placements.
Faculty Development, Program Evaluation, and Next Steps
Faculty development in palliative care is the ongoing work of preparing nursing instructors to use innovative teaching strategies in nursing education for end-of-life content with confidence, current evidence, and consistent competency standards. It supports nurse educator career advancement and has two moving parts: getting faculty formally trained through ELNEC Train-the-Trainer and measuring whether that training actually changes what students know, feel, and do at the bedside.
Becoming a Certified ELNEC Trainer
The pathway is straightforward. Faculty attend an ELNEC Train-the-Trainer course, either at a hosted summit (such as the two-day event at MUSC in Charleston on August 20 and 21, 2026) or through AACN-affiliated regional offerings. Completion earns continuing education credits and confers trainer status, which authorizes the faculty member to teach ELNEC modules to students, staff nurses, and other faculty using the official curriculum materials. That cascade model is how ELNEC has scaled to more than 56,000 trainers worldwide, and it is the mechanism that lets a single champion seed palliative care content across an entire program.
Evaluation Tools That Actually Work
You cannot defend curricular change without data. Programs integrating ELNEC typically use a layered evaluation approach:
- Knowledge: The Palliative Care Quiz for Nursing (PCQN) is the most widely reported instrument, with published pre/post gains from 8.45 to 10.2 points immediately after training, holding at 9.03 at follow-up.1
- Attitudes and confidence: Domain-specific surveys have shown statistically significant confidence gains (p = 0.003 in one undergraduate cohort), with the largest confidence increase in education and smaller gains in communication, an area worth targeting for reinforcement.2
- Skills: Competency checklists and simulation rubrics, including the Primary Palliative Nursing Care Competency Assessment Tool, let you score observable behaviors during OSCEs or clinical debriefs.2
- Practice change: Longitudinal studies of practicing nurses report 86.9% self-reported practice improvement, 73.9% improved communication, and 75.3% increased motivation post-training.1
A 2026 systematic review synthesizing 28 studies found baccalaureate programs covering 95.3% of ELNEC core content, most often through clinical conference debriefing and lecture.34 A new graduate nurse residency study showed significant improvement on 7 of 8 measured items.5
Four Next Steps
1. Identify a faculty champion, ideally someone with clinical palliative or hospice experience, and fund their Train-the-Trainer attendance. 2. Audit your current curriculum against the ELNEC module list to find gaps (pain, communication, and grief are common weak spots). 3. Register the champion for the MUSC summit or the next AACN-hosted trainer course. 4. Pilot one module, ideally communication or symptom management, in a single course next semester, collect PCQN pre/post data, and use the results to build the case for full integration.
What Nursing Faculty Earn Nationally
Nursing faculty salaries reflect a meaningful investment in education over clinical practice alone.
