We live in a culture where most people rigorously avoid talking about death, much less witnessing it firsthand. Over the course of a lifetime, the average person may be present at the bedside of one or two very close family members in their last moments. Depending on how long a person lives and the size of their social circle, they may attend a few dozen funerals.
In contrast, nurses are faced with death and all the emotional turmoil that comes with it over and over at work. Whether you serve in a hospice setting, OR, ED or ICU, there is no escaping these events. Even if you aren’t physically present at the side of your patient when he passes, hearing that he didn’t make it is still difficult.
It’s Okay to Grieve
Every nurse has her own way of coping when a patient dies—and some deaths hit harder than others. Seeing the grief of the patient’s family members, you may think that in comparison to the loss they are feeling, you have no real right to be so sad. After all, you barely knew the patient. But the truth is that every life that touches ours has an impact. Humans find meaning through connection with others, and grief at its core is about experiencing a loss of connection.
Coping in Healthy Ways
Respect your natural tendency to grieve and give yourself some space to do it—the sooner the better. This may mean seeking support and understanding from other nurses immediately after the patient’s death, taking a break (or turning down an extra shift when you are feeling emotionally vulnerable) or attending a formal or informal debriefing to discuss the event with colleagues.
The last option may be particularly helpful if you are haunted by feelings that you might have done more to prevent the patient’s death. Often, other nurses and doctors on the case are feeling the same doubts and guilt. Having a safe space to talk through these issues without judgment is important since stifling your feelings can lead to anxiety, depression and burnout over the long term. Remember that most people would never even consider entering a field where making a single mistake has the potential to be fatal. It takes a lot of courage to face that risk every day, and it’s natural to second guess yourself after a particularly harrowing case.
Depending on how close you became to the patient’s family, you may want to keep in touch with them in the days after the patient’s death. You might send written condolences, bring food to them or attend the funeral. If this doesn’t feel appropriate in a given circumstance, spend time on nurturing or soothing activities for yourself instead. All of these acts can help your healing process by giving you something positive and proactive to focus on.
It’s Okay to Take Death in Stride
There are times when a patient’s death leaves you feeling only equanimity or a sense of calm inevitability. This doesn’t mean you are emotionally numb or that there is anything wrong with you. Sometimes, it simply means you are learning to accept death as the natural part of life that it is (this is often easiest when an older patient dies without extensive suffering). You may have discovered or created grieving rituals over the years that ease the emotional burden. Having a well-developed spiritual or philosophical framework within which to experience and respond to death can also be beneficial by providing a “big picture” perspective.
One thing holds true for most nurses: We aren’t trained to cope with loss in nursing school. Instead, we learn most about healthy grieving strategies on the job from other nurses who have years of experience dealing with deathz
How do you feel when you lose a patient? What immediate steps do you take to let these emotions out? What do you do over the long term to keep from being overwhelmed by grief? Please share your advice in the comments section.
this week 2 clinic patients missed appointments because they had recently died
i callled with simple appt reminder and spoke with bereaved sister in one case and bereaved mom in another
i am very sad right now and am appreciating theses comments kindess, wisdom, perspectives and pearls
i appreciate each writer so very much ♥️
Long term care (LTC) nursing is different from acute care; often more like hospice care. While working in LTC over several years I experienced the passing of a couple dozen of the people I took care of EVERY year. It was somewhere around 100 in all over 4 years. These people were living in LTC partly because they were not going to get better from their disease(s). From the very first one that passed I was surprised at how easily I accepted death without significant emotional upheaval. I eventually realized that for most I had been able to see their death coming for days or weeks and had done pre-grieving. That made the difference. Among all those patients there were 2 that created an emotional grief response afterward. I cared about them, certainly, but I also cared about many others too. I think I experienced their death differently because in those two it came as a surprise to me; no pre-grieving.
Another thing that helped – as spoken of in the article – was seeing death for them as the ‘next step’ in their life. I would try to prolong their life as much as possible (within the instruction of their care plan, their POLST, and my nursing ability) but the eventual outcome was known from the start. For some it was weeks, others had months, and for others it was years. Knowing that from the start, though, changes things.
I did develop some rituals for ‘saying goodbye’. For all who passed I would try to enter the room and verbally say goodbye to the person’s body. If appropriate and especially for residents I felt close to and had cared for extensively, I would eagerly volunteer to give them ‘final cares’ of cleaning etc. It was a way to show respect for the person, say good bye, and take care of them one last time. Finally I made a point of taking their name off the sign by the door.
ER nurse, here. When I lose a patient, I say a prayer and ask God to help them on their journey. Then, after I prepare the body for the family to say their goodbyes, I tell them that their loved one was not alone when they died and that I prayed for them. I offer to call our chaplain or their spiritual leader, should they want. I do my best to take care of whatever I need on my end (funeral home, transfer to morgue, etc) without taking them away from their time to grieve. Lastly, I make sure that they know that I’m available for whatever needs they have and to take as much time as they need to be with their loved one. Death is hard. Sometimes I cry with them and give lots of hugs. Sometimes, people people just want to leave and don’t want touchie-feelie. The best I can do is gauge what the family/friends need and try to give it to them to the best of my ability.
Some patient’s deaths are easier to deal with than
Than others. The truth is, however, that
Nurses are given little if any time to process
It all A nurse gets forms to complete is told
To call the funeral home, help to prepare
The body sign for its release. then, all too
Often as soon as the room is clean, that
Nurse gets the next admission. on so many
Levels, that is so difficult. we are human
Too and that will trully try one’s strength.
Couldn’t be more true. Well said!
One of the things that has helped me for many years, not just in nursing but in life, it simply understanding that we are made of human flesh, human flesh gets diseases, has defective genes, gets injured beyond repair. There is no great scheme going on, no great motives or life lessons in each event. Some times it is just simply that what happened is not something that is compatible with life. That may sound cold to some. I am certainly not dismissing the sadness, we all need to feel and grieve, just saying it is easier to move thru when you know it is just part of being here, made of flesh. I guess it helps too if you have a spiritual belief, as I believe we never really “end”, we just become the inner essence minus the flesh. I came to all this way of thinking after losing my 7 year old grandson, I was a bit mad at God, thinking why, then I realized, he had cancer, a cancer that was not curable, that made it impossible for him to live. Sometimes it just “is”.