End of life care is an important aspect of acute stroke nursing because stroke mortality rates remain high, despite advances in care. There is a national drive to improve the quality of end of life care in all clinical areas, including for stroke patients. Patients who have had a stroke should not be excluded from acute stroke care at the end of life. Stroke care should incorporate multidisciplinary working, anticipatory care planning and prescribing, and effective communication with patients and families. The use of end of life care pathways is widely recommended as best practice. Palliative care specialists may provide support where patients’ needs are complex, while decisions to withhold cardiopulmonary resuscitation should be avoided immediately following stroke. Spiritual care extends beyond religious care and is the responsibility of the multidisciplinary team. Although more research is required about stroke care at the end of life, providing high-quality, patient-centred services for patients who have had a stroke and their families during this time is achievable.