Background: As the population is ageing, and with the rising incidence of type 2 diabetes, the demographics of people on dialysis therapy are changing, with an older population living with multiple co-morbidities. As such, the meaning of haemodialysis (HD) has shifted from a short-term therapy for those awaiting a kidney transplant to a palliative therapy that focuses on quality of life.

Methods: A narrative inquiry focused on nurses' experiences of caring for adult persons on HD approaching end of life. Registered and enrolled nurses working in HD inpatient and outpatient units at one tertiary level hospital service in Southeast Queensland constituted the sample.

Results: Fifty-five of a possible 130 nurses (40% response) completed narratives. Just over half of the nurses had 10 or more years of nephrology nursing experience. Nurses experienced moral discomfort when challenges associated with: (1) poorly implemented end-of-life care; (2) contested decisions to start or stop HD; and (3) limited opportunities to settle disagreements within the service context.

Conclusions: Nephrology nursing practice has not kept up with changing patient demographics, leaving nurses unprepared for the emotional and moral decisions to be made in everyday practice. It is timely to make explicit the palliative intent of HD therapy for persons with multiple co-morbidities, providing a space for advance care planning, open and supported discussions about quality of life, and transparent shared decision making when patients are considering to cease therapy.