Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises

William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN; Tamryn F. Gray, PhD, RN; Kimberly Chow, RN, ANP-BC, ACHPN; Patricia M. Davidson, PhD, RN, FAAN; J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN; Viola Karanja, BSN, RN; Judy Khanyola, MSc, RCHN; Julius D. N. Kpoeh, ASN, RN; Joseph Lusaka, BSc HM, DCM, PA; Samuel T. Matula, PhD, RN, PCNS-BC; Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN; Patricia J. Moreland, PhD, CPNP, FAAN; Shila Pandey, MSN, AGPCNP-BC, ACHPN; Amisha Parekh de Campos, PhD, MPH, CHPN; Salimah H. Meghani, PhD, MBE, RN, FAAN


Journal of Hospice and Palliative Nursing. 2020;22(4):260-269. 

In This Article

Increased Need for Palliative Nursing During COVID-19

COVID-19 is a global pandemic, first identified in Wuhan, China.[1–3] Widespread transmission of COVID-19 is translating into large numbers of people needing medical care simultaneously.[4] As of May 5, more than 3.8 million people globally had been confirmed COVID-19 positive and over 267 000 had subsequently died.[5]

With the daily number of confirmed COVID-19 cases rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and the dire need for greater numbers of medical professionals to adequately address the crisis.[6,7] At the same time, health systems are striving to increase capacity to meet public health demands,[8] fairly distribute sparse resources,[9] address the complex ethical challenges posed by the pandemic,[10] and support health care workers to lower viral exposure and maintain the health of their families.[11,12] In fact, there have been few health events in modern times that have caught health care professionals as unprepared to effectively tackle the clinical needs of patients and communities as COVID-19.

The COVID-19 pandemic has intensified the strain on seriously ill patients and their families, amplifying suffering through increased functional decline; grief, bereavement, and death; stresses and anxieties; and economic and social instability. Alleviation of that suffering—in all its forms—is a key part of the palliative nurse workforce response.[13] Patients and their families will undoubtedly face symptoms, emotional distress, and complex decision-making in the face of uncertainty and limited options, and no one is more prepared to address these needs than palliative care clinicians.[4] Although the palliative care professional community is readily adapting strategies to provide high-quality services to those in both acute and community-based settings,[14,15] there remains an opportunity to provide specific recommendations for leveraging the role of palliative nurses during this unprecedented health crisis.

Considering the Broader Global Nursing Workforce

The pandemic has placed immense pressures on the entire global nursing workforce. A recent Wall Street Journal commentary[16] stated nurses are "marinat[ing] in risk as they spend more time than anyone else tending to patients." Increased nurse-to-patient face time is concerning when greater exposure to COVID-19–positive patients puts nurses at greater risk, particularly for older clinicians (>55 years)[17] and given the widespread deficits of personal protective equipment. Nurses are the frontline agents tending to the suffering of the patient: psychologically, emotionally, spiritually, socially, and physically. Palliative nurses are confronted with the challenge of providing compassionate, relationship-based care in the context of a viral pandemic characterized by rapid decompensation and symptom exacerbation, embedded in a culture of social distancing.

There are roughly 28 million nurses working globally, constituting approximately 59% of the health sector and delivering up to 90% of care services.[18] While all nurses should be included in the practice-based, scientific, and scholarly dialogues surrounding safe COVID-19 mitigation strategies, palliative nurses are uniquely trained in goals-of-care communication, clinical ethical considerations, symptom management, and end-of-life care and are more likely to be consulted as experts on these pertinent issues during the evolving crisis. Thus, palliative nurses are at disproportionate risk of moral distress, moral injury, and poor well-being given these responsibilities and skill sets.