Aim: This paper examines how clinical nurse specialists assessed their competences in relief of symptoms, and explores factors affecting good care routines in palliative care. Methods: A prospective survey among 235 former post-bachelor (response rate 50.6 %) students at two university colleges in Norway. Results: Correlations between the measured concepts showed a medium to high correlation between all the five competences. Use of care routines correlated with all the other factors. The ability to identify lack of care showed significant correlation with one concept: time available for nursing. The results from the regression analysis supported a model with good care routines as dependent variable (F=22.59, df=91, P<0.001). The independent variables in the model explained almost 57% of the variance in using care routines. Competences dealing with mouth problems, nausea, anxiety and the use of the Edmonton symptom assessment system (ESAS) had a positive effect on care routines. On the other hand, the ability to identify lack of care had a significant negative effect on the use of care routines. Conclusion: The importance of systematic assessment of the palliative patient's care needs and symptom management are emphasized, and use of the ESAS, and good care routines was affected by post-bachelor competences.