A palliative care leader, who has supported hundreds of clinicians throughout the pandemic, offers healthy tips for channeling our feelings to move the field forward.

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While COVID-19 has focused a light on the heroic nature of what health care workers are doing—especially bedside nurses—it hasn’t changed the underlying challenges that have been part of the health care system for years. It’s not surprising that anger and frustration are now bubbling.

We’re all tired. We’re all anxious. Some of us may even be feeling pretty desperate or constantly overwhelmed. We know that every hospital is short-handed, because people are either on leave or have exited the field all together. So, we need to channel all of these emotions somewhere before frustrations about the unvaccinated, or lack of adequate staffing, or our broken health care system boil over.

"You’re not wrong for feeling this way. We can’t change what’s happened, but we can lean into these emotions in a positive way to make meaningful change."

You’re not wrong for feeling this way. We can’t change what’s happened, but we can lean into these emotions in a positive way to make meaningful change.

We define palliative care as being an extra layer of support. But COVID-19 has helped ensure we’ve become part of the initial layer. Palliative care is now seen as essential to meeting the needs of patients and families in a way that's meaningful and that can truly impact their quality of life.

"[The pandemic] has exposed enough of the problems in health care to begin breaking down the barriers and creating new avenues for us to make change."

The pandemic has ripped the band-aid off the existing inequities in care delivery and the inefficiencies of the health care system. It has exposed enough of the problems in health care to begin breaking down the barriers and creating new avenues for us to make change. Outside forces have never really been able to change health care, so this revolution will need to come from within.

For palliative care providers, it's a huge opportunity to lead that revolution. Which is to say, we’re already shorthanded; those of us who are left can’t imagine going back to the status quo: a broken, financially-strapped model of health care, that's dependent on episodic care of the healthy to fund the whole thing. We need to find a way where caring for the seriously ill is sustainable.

Nurses have the strongest case to make for transformation of how care is delivered because they have been on the front lines of the pandemic. However, everyone—physicians, social workers, PAs, RTs—have a part to play. We’re all burned out. We can make our collective voices from these individual disciplines be so loud that they can’t be ignored.

Applying Lessons Learned

Changing some of the real problems at the core of health care is going to take a long time, but simple gains can be made coming out of this, if we channel our emotions effectively. That will start us down the road of transformation. For example, we can apply the many lessons learned about strategic and crisis planning to be better prepared next time. Just-in-time planning left us vulnerable to the pandemic and should not be something we return to.

Specific to palliative care, we have opportunities we can act on now:

  • Strengthen relationships. We have better relationships with emergency rooms and ICU than we ever had before. While we were always in those settings, we became more essential to the fabric of how they operate now.
  • Embrace telehealth. Telehealth is likely here to stay and we have to look at how much that can increase. We should be championing telehealth to engage more patients and advocating for broadband access for people everywhere, so we can provide high quality care to them no matter where they live.
  • Get involved with DEI activities in your organization. Advocate for those patients that the pandemic exposed as marginalized, vulnerable.
  • Seize leadership opportunities. We are losing leadership in palliative care as older leaders retire or leave medicine altogether. Opportunities exist for younger, more diverse leadership voices. And our palliative care voices now sit at the table with health system leaders. Take advantage of CAPC’s leadership resources and training, and to hone those skills.

These are not burn-the-existing-system-to-the-ground and build-it-back-up new ideas. However, they're really good steps forward that are already happening. As we continue down that road and we see things actually getting a little bit better, we'll gain some momentum, and can focus on other issues, like payment reform or revenue diversification.

Be Ready

We must be ready to act. Despite, or maybe because of, these tremendously powerful emotions, now is the time to think about how you will communicate with your leadership when we come out of this.

"Palliative care has been a key player during the pandemic. How can you use this to position yourself for what comes next?"

Think about how to seize this opportunity. Palliative care has been a key player during the pandemic. How can you use this to position yourself for what comes next? One of the challenges we’ve had in palliative care is leveraging our visibility without overextending. We have to be ready to have those conversations.

The real change I have seen for palliative care is that we went from a group that had to be creative and find a reason to get in front of medical leadership, to becoming a lot more popular and being invited more often to talk to those same leaders on issues important to the health care system.

"The charge I put to palliative care leaders is this: be ready, because when leadership comes to you, you must be able to articulate your value."

The charge I put to palliative care leaders is this: be ready, because when leadership comes to you, you must be able to articulate your value.

Be ready to communicate the effectiveness you’ve brought during the pandemic. Be able to bullet point that out and say “yes, our volumes went up this amount.” Be ready with testimonials from patients with families. That’s always powerful. Be ready to present data you collected; the percent increase in consults from the ED, or whatever it may be.

You have to do your homework to find out what matters to medical leadership. You want to bring those statistics with you, because now we have an opportunity to get those meetings and to position ourselves as a vital part of the fabric, rather than sort of this “nice to have” that we used to be.

We have a unique opportunity to channel our feelings—the frustration, anger, exhaustion, despair, burnout—whatever we all individually and collectively feel, to be powerful advocates for change. We have a chance to step up and become leaders in this effort. Let’s make a real effort to turn what we’ve experienced over the last 18 months into something good, for us, and for the patients we serve.

"We have a unique opportunity to channel our feelings [...] to be powerful advocates for change."