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

Palliative Nurse Well-being During COVID-19

The strain on palliative nurses during COVID-19 is extraordinarily high; hence, it is vital to consider what will keep our workforce sustained and healthy. Like other health care workers, palliative nurses are likely to experience a period of cumulative loss that will be more intense and traumatic than in the past. There should be strategic action to ensure palliative nurse well-being and safety throughout the duration of the COVID-19 crisis given these considerations, especially when considering nurses' substantial vulnerability to burnout.[50]

In a survey of 2109 palliative care specialists, nurses had 1.61 (95% confidence interval, 1.26–2.05) higher odds of reporting burnout compared to physicians, and those who reported burnout had 1.40 (95% confidence interval, 1.09–1.80; P = .0075) times the odds of leaving the field early.[51] Palliative nurses should be encouraged to discuss difficult cases with team members, seek therapeutic support through personal or professional pathways, and acknowledge both the individual trauma of working with seriously ill patients experiencing COVID-19, as well as the collective trauma of responding to a health emergency. Many palliative nurses will also likely experience loss of their loved ones and undergo significant shifts to personal, family, and home life. The presence of existential guilt and/or survivor's remorse among palliative nurses should be acknowledged as a likely major effect of this pandemic and the associated isolation occurring in private and public life.[52]

Prior to the COVID-19 pandemic, the National Academy of Medicine had acknowledged the significant burnout experienced by clinicians across health systems and developed a consensus-based systems approach to professional well-being.[53] The National Academy of Medicine's recommendations for clinician well-being during the COVID-19 pandemic[54] include meeting basic needs (eg, food, sleep, exercise, etc); taking breaks whenever possible; keeping connected with colleagues to assist in stress, fear, and anxiety management; respecting differences in how people cope and manage the COVID-19 experience; staying updated with reliable sources of information and minimizing overexposure to media; performing ongoing self-reflection and self-assessments of one's own mental health and emotional needs; seeking support from peers, managers, and professional help as needed; and honoring both one's own service and the service of colleagues during this very challenging time.

During the COVID-19 pandemic, it is essential that nurses become familiar with, utilize, and share all available resources. Table 2 provides complementary resources for palliative nurses and other health care workers from organizations invested in clinician well-being, ongoing competency development and education, access to emergent research, and connectivity to the larger nursing and health workforce during COVID-19.