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Emily Izzo, U of U Health.
We’re in This Together: Making Tough Decisions Easier
The realities of COVID-19 have impacted visitor policies, creating challenges for patients and moral distress for staff. Jennifer Jones, nurse manager, has developed several approaches for leaders and staff to work through the tough decisions the updated visitor policy is forcing.

was called to oncology nursing because of the patients. Taking care of cancer patients allows me to see patients at their most vulnerable. A cancer patient is taking a crash course in what is truly valuable in life as they are confronted with their own mortality. As we take care of them, we get to see them as they really are. They share their vulnerabilities with us. Their relentless strength and courage remind me of the important things in life. 

The impact of COVID-19 on our oncology patients and staff has been substantial. While we can’t take safety for granted, reducing the risk of exposure has come at a price. Most of our patients can’t rely on virtual care and have to visit the hospital frequently. Separating them from their family during these stressful situations is hard for both patients and staff. 

Catch 22: COVID-19 visitor policy 

Many of our patients are nearing the end of their journey and struggling with end-of-life decisions. They rely on support from their families, but our updated visitor policy limits the amount of time they can spend with loved ones. While we recognize that these restrictions are intended to protect patients and workers alike, we often feel like we’re robbing patients of their remaining time with their family. 

The case that impacted me the most was a middle-aged woman who was admitted to our unit. Over two weeks, her condition deteriorated, and her mental status went from normal and alert to confused and agitated. 

The visitor policy prohibited her three teenagers from seeing her, even as her condition deteriorated and she transitioned to comfort care (end of life). The trauma her family endured was debilitating. We struggled to balance two extreme needs: protecting our patients and health care workers from exposure and giving her much-needed love and support from her family. After discussing the situation with the health care team and my director, we were able to make an exception and allowed the children to visit their mom, but we were left wondering if we’d made the right decision. 

Situations like this reflect the murky waters workers are navigating daily. To guarantee safety, we have to deprive our patients of one of their greatest joys: their loved ones. In the absence of familial support, nurses are shouldering the extra responsibilities of caregivers, a burden they aren’t prepared to bear. 

This isn’t the kind of nursing I want to provide. Quality care to me means creating a safe space for patients and their families. Now we’re being asked to make hard choices. 

Making tough decisions easier

Balancing the needs of patients and families, the safety of all patients and staff, and the emotional needs of staff is an impossible task and causes moral distress. In order to make tough decisions easier, I have learned to include staff in decisions, to seek support from leaders, and to take care of myself.

Empower staff to help make the decisions

The burden of these decisions weighs heavily. To lighten the burden, I’ve learned the value of including my employees in the decision process. Their insight is invaluable as they are closest to the patients. Even on days when I’m swamped with requests, I want my staff to know I value their opinions and part of the decision making process. This open dialogue allows both myself and staff to feel less alone in these difficult situations.

Seek support from leaders

When circumstances are unclear, I reach out to my director and say, "I'm not sure what to do in this situation. Can we talk about this?" He validates that these are difficult decisions and provides input and support. This helps me not feel alone in making tough decisions.   

Take care of yourself 

These distressing decisions take a toll on our wellbeing. I’ve learned to utilize different strategies to relieve stress.  

  • Therapy: Talking with someone who isn’t directly involved with the situation helps me maintain clarity. 
  • The Resiliency Center: This hub of personal wellness has provided me and my employees with resources and health services that combat daily stressors.  
  • Write about it: Acknowledging my fears and emotions on paper helps me work through negative thoughts. 
  • Don’t personalize it: When my dad was diagnosed with cancer this summer, and I wasn’t able to go to his appointments, the visitor policy became a personal obstacle. I’ve learned to set boundaries, so I don’t conflate my own experiences with my work. 

Let your values guide you

Whenever someone asks me to make an exception, I turn to our core values. We value keeping patients, staff, and visitors safe. We also want our patients to have the support of their loved ones. To prioritize both of these values, we have to get creative, like keeping people safe by using an iPad, or setting up a Zoom call, instead of in-person visits. 

Bright spots

Back in March, guidelines were strict because we didn’t fully understand COVID-19. Now, as we continue to accumulate knowledge, we have more leeway. 

One of our patients was a mother who hadn’t been allowed to see her young children in four and a half weeks. She wasn’t doing well, so we were able to make an exception and bring her kids in for a visit. Their reunion triggered renewed determination, and our patient began to recover.  

Another patient, a young woman, was struggling by herself with a new diagnosis. We had to place a new trach and PEG tube. Even though hospital policy stipulated that she couldn’t have visitors, we were able to let her mom come learn how to care for her daughter once she was discharged. It was emotional for all of us, and we knew we’d done the right thing. 

You’re not alone

We hear this time and again, but remember: you’re not alone. Sometimes in health care we get siloed. I’m sharing my story because I want to connect with others who are experiencing this unparalleled frustration. Whether we’re connected by our suffering or success, we’re experiencing these emotions together. 

I want to hear about your tough decisions and those moments that brought you joy—please share them in the comments if you feel comfortable.


Jennifer Jones

Manager, Nursing, Huntsman Cancer Institute, University of Utah Health

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