Date of Award

January 2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Darlene Hanson

Second Advisor

Tracy Evanson


Introduction: Self-efficacy is defined as confidence in one’s competence; the ability to successfully accomplish tasks and achieve favorable outcomes (Bandura, 1997). Many nurses today say they feel their undergraduate education was inadequate for them to feel competent to provide palliative and EOL patient care. (Chiplaskey, 2016; Scherlin & Quinn, 2016; Zheng et al., 2018).). Inadequate EOL preparation also results in nurses experiencing distress, death anxiety, burnout, feeling overwhelmed and leaving practice within just a few years (Friedman et al., 2011; Gaw, 2012; Kovner et al., 2006; Parry, 2008; Silverstein, 2017, November 28; Suzuki et al., 2008; Wilson & Kirshbaum, 2013). This is particularly troubling in light of the global nursing shortage; studies indicate that 17.5%-48% of new nurses leave their first job within one year and 33.5% of new nurses will leave within the first two years. Further, 37% of new nurses had at least considered changing jobs (Androus, 2021; Kovner, et al., 2007; Kovner, et al., 2014; Labrague & McEnroe-Petitte, 2018). Little is known about what factors affect new nurses’ self-efficacy to provide palliative end-of-life (EOL) care, particularly in rural hospital settings. The purpose of this exploratory correlational doctoral study was to identify demographic, educational, and experiential factors which may be associated with new nurses’ self-efficacy to provide quality palliative patient care at EOL.Methods: A survey was developed and sent via email to new nurses, those licensed within the past three years within the upper Midwest United States. The survey included demographic questions, the Palliative Care Self-efficacy Scale (Phillips et al., 2011) and the Rosenberg (1965) Self-esteem Scale. Results of the survey were analyzed using descriptive statistics, Pearson correlation, ANOVA and simple multiple linear regression. Eight factors were included in the final linear regression model. Bandura’s Self-efficacy Theory (SET) was the framework for this study. SET states that mastery experiences, vicarious experiences, verbal persuasion, and emotional and physiological states all contribute to self-efficacy. Results: The sample included 221 completed surveys. Mean self-efficacy score was 36.7(+8.4) out of a possible 48 points. Participants were primarily White females, aged 20-29 and holding Bachelor of Science degrees. Five factors were found to be significantly associated with new nurses’ self-efficacy to provide palliative EOL care (p < .05). Self-efficacy and experiencing the death of a family member were both positively associated (ß = .181 ;p = .008 and ß = ..185; p = .031 respectively). Factors negatively associated with new nurse self-efficacy were the number of deaths experienced; 1-5 death experiences (ß = -.310; p = .016), 6-10 death experiences (ß =-.248; p = .038), and 10 or more deaths (ß = -.358; p = .010). This is in complete opposition to the SET concept of mastery experience. Conclusions: Nurses need support, especially new nurses as they transition into practice. The current literature indicates that even experienced nurses are lacking self-efficacy to provide EOL patient care. It is important that nurse managers evaluate all nurses for their feelings of self-efficacy prior to assigning them a dying patient and develop policies that require debriefing following the death, especially for new nurses just transitioning into practice. Recommendations for education are to follow new national guidelines and continue to prepare nursing students to care for patients at end-of-life care, evaluating them for self-efficacy prior to them graduating. Further research should be conducted with a larger, more diverse sample and focus on factors found to be non-significant in this study, such as nurse residency programs, yet supported by the nursing literature. Qualitative or mixed methods designs may provide an answer as to why new nurses felt less self-efficacious despite multiple experience with caring for a patient at EOL. Special consideration should be given to continuing to investigate rural settings.