Hospice Nurses Hard at Work during COVID-19 Pandemic

[TeriRNHospice, ADN, RN]

There has been a lot of talk about the amazing, dedicating, and hard-working ER and ICU nursing teams during the COVID-19 health crisis in the United States. Through the media, we are hearing the stories of the ER and ICU nurses working long, sometimes double, shifts to provide care and compassion to all of those unfortunately affected by COVID-19, and the beautiful touching stories of holding patients hands when their family can not be at their side. We are hearing the stories of the risks involved in their health due to the limited PPE available, and the gut-wrenching stories of nurses emotionally supporting waiting family members. We, fellow nurses across the nation and even the world, are hearing and listening about these nurses, and we must say that we are all proud to be a member of the nursing world at this time.

However, we can't forget another group of nurses that are suddenly finding themselves working harder than ever - our Hospice Nurses.

Hospice Nurses are having a sudden increase in visits to patients, having to manage end-of-life symptoms, and are providing support and education to families of hospice patients. Hospice nurses are also getting busier with new admissions onto hospice services which is increasing their census.

Hospice Agencies across the nation are suddenly seeing a rise in Hospice admissions and Hospice deaths since the start of the COVID-19 pandemic. First, the new admissions include patients with a weakened immune system or advanced cancer that have found themselves suddenly positive with COVID-19. These patients are electing NOT to go to the hospital, not to seek treatment, and are wishing to maintain their comfort at their home. And, there is also another group of hospice patients keeping the hospice nurses busier than usual: Those hospice patients that were on hospice services before the introduction of this new virus into our world, are declining and dying at an alarming increased rate, particularly those living at facilities.

The new hospice patients that are being admitted onto hospice services that are testing positive for COVID-19 are electing comfort measures only (either they are making that decision independently or the Activated Power of Attorney is making that decision on their behalf). Hospice nurses have been busy helping to provide comfort and symptom management for these patients in their homes through pharmacological interventions or nonpharmacological interventions. Symptom management medications used in end-of-life have greatly increased, and pharmacies throughout the nation are reporting low supplies of these medications, including oral Morphine concentrate. Unfortunately, many of these COVID-19 hospice patients are living in facilities where there are NO VISITOR policies. These facilities are also limiting hospice team members such as Home Health Aides, Hospice Social Workers, and Hospice Chaplains - all critical members of the hospice team. Without these team members providing visits, this leaves the Hospice Nurse as the sole provider of care for end-of-life. Hospice Nurses are suddenly finding themselves in the role of nurse, social worker, chaplain, and aide.

The other hospice patients that have an increase in needs have been those hospice patients that were on hospice services before the COVID-19 pandemic, that are not showing signs or symptoms of this virus, but that are living in a facility where there are limits on visitors. Hospice nurses are seeing a decline in the condition in these patients because, we hospice nurses believe, the lack of social interactions is affecting their overall health. These facility patients are unable to participate in the planned, organized activities in facilities (as they have been cancelled), they are eating alone in their rooms, they are not getting regular visits from families or loved ones or volunteers, and they are not being stimulated mentally regularly. We are seeing facility patients becoming lonely, withdrawn, sleeping more, spending more time sitting or lying down, increase in sores, and having a decrease in appetite/intake. There has been an increase in hospice deaths over the past 6-weeks in facilities, not from COVID-19 but instead from generalized decline in condition. Thus, an increase in hospice nursing visits to facility-based patients to provide end of life symptom management and pronouncement of deaths.

Now, as of lately, there has been an increase in hospice admissions at facilities. Not patients who are positive COVID-19, but patients who are declining in overall health and we believe it is from the lack of social interactions. We have had more and more families contact our hospice agency requesting information about hospice services, qualifications guidelines, and many family members concerned about the declining condition of their loved one who is living in a facility.

Hospice nurses are working hard during this time of COVID-19. They are working to ensure that patients are comfortable, addressing symptom management issues, helping to make sure that the patients are safe, and they are advocating to help patients understand their choices and then receive their end of life decisions.

It's a wild time to be a nurse during this pandemic, especially with all the risks involved with providing nursing care. But, Thank Goodness for Nurses - THANK GOODNESS FOR ALL THE NURSES OUT THERE WORKING RIGHT NOW. Where would these patients be if it weren't for the caring, compassionate, dedicated nurses who are with them right now, helping them, caring for them, fighting for them, and advocating for them? Although the media is focusing on the ICU and ER nurses during this pandemic, there are other nurses that are out there too working just as hard, including the Hospice Nurses.

Thank you ICU Nurses, ER nurses in the forefront and middle of this pandemic. Thank you Hospice Nurses on the back end of this pandemic. There is good in all of this - The Nurses.