How Nurses Cope with Death

Thank you for this EXCELLENT article!What a great inside look of those poignant moments that nurses experience at the end of a patient's life. No matter the age, it is always something we must deal with, however the loss of a young life can be overwhelming.Thanks to all who shared their coping mechanisms.

This is a difficult subject that you handled with grace and dignity.As nurses we are often witness to some very tragic moments and we all cope with this differently. The commonality is that we come back to work tomorrow. Thanks

This is one of the saddest part of what we do as nurses. We interact with patients with the insight that death is always a possibility. On a past post, I commented about establishing a boundary for yourself and I also added that this is hard to do because we are human beings with emotion and bonds that are felt when severed. I do not think we should not empathize with patients but we should allow ourselves to grieve (i.e. talking to family members, reflect quietly by yourself or with others, etc). I have worked in the ER of a Combat Support Hospital in Iraq and even the hardiest soldiers I've worked with still needed that hug at the end of a shift. Thank you for sharing other people's experiences and ways to cope with death.

I have shed tears with family members because sometimes I can't help that, and I have shed tears while caring for a couple of patients while deployed whose family members were just as bad off, when I knew they wouldn't make it. But as in the original post, I have built walls to make it through until later, because it just isn't about me. And yes, we have to keep going for the rest of the shift and come back again! We are stronger than we realize.

I worked geriatrics for a couple years and losing patients was hard but the sudden illness and death of a co-worker has been the hardest for me to cope with. It has been over a couple months and I am still grieving, quietly and mostly late at night when all are asleep. Thank you for the article it has helped me.

As a PICU nurse for mre than 17 years, I've witnessed my share of children's deaths. It never gets any easier but I think I've become better at managing my own feelings. I have close friends who are also nurses who truly get me when I talk to them about it all. They feel the same level of anger that I do when something senseless and preventable happens. They know my behaviour and know when I'm not coping well. They make sure I'm okay. I also find solace in physical endeavors like digging up my whole garden and replanting it in order to work through things. Or walking for miles in the cold to see if there are geese on the lake - and to clear my head. Hobbies have saved many minds.Our unit just had 7 deaths in 7 days and we're all feeling a little shell-shocked. We only had 26 deaths for all of 2014, so this has really been a rough time. We have a large population of new grads who may be experiencing death for the first time and I worry about them. I hope they know that there will always be someone they can talk to and someone who will support them without trying to fix them. They need only look around.

I so appreciated this article! I left ED nursing in 2012 after 27 years, and now am orienting as a hospice nurse. Next month I join the peds hospice side. In all my years of ED nursing I felt like the ED nurses that posted in the article, that if I internalized the grief and pain I saw, that made it about me and not about caring for and supporting patients and families. Now I find that on the hospice side, you really are closer to the family dynamic and grieve with them for their loss, not so much for the passing of the patient. I'm busy watching the hospice teams support each other and seeing how they work with the families. The peds team meetings are full of tears and support; I am grateful for the peds nurses in the article sharing their experience. Thanks!

#1) Understand yourself and your beliefs about death and dying. If your not comfortable with the subject, explore it!#2) NEVER tell the family members that you understand what they are going through...unless you have actually experienced the same thing!#3) Just BE there. No need for your opinions or very much verbalization. Just knowing that someone cares enough to listen and tend to the "little" things is a great help.#4) If you are asked to pray with the family...DO IT, even if you are not the "praying type".#5) Leave it at the door when you head home. This is the hardest one I think and is not meant in a callous way. You have to protect your heart so you are able to share it with the next family that needs you!

Things have not leveled off on our unit. We've had 3 more deaths since I last posted. Even the very experienced of us are feeling it. Some of our losses have been high-profile which adds to the distress. Our new director of critical care nursing made the effort to acknowledge our struggles and to praise us for our dedication and professionalism. She mentioned moral distress, the first time anyone from upper management has done so, for which I give her points. Our administration bought us lunch yesterday in an effort to recognize how difficult these last two weeks have been. I wish I could say we're due for a reprieve but I know we're not.

Well, working in a Pediatric Ventilator sub-acute facility for the past 19 years I can honestly say that it has to do with acceptance. My very first pediatric death I took to heart. I took it very hard for many reasons other than it was my first. It was a home care client of mine. 'Johnny' (not his real name) was born with his heart, part of his aorta and some of his lungs outside of his chest cavity. He wasn't supposed to survive. His stay in the NICU was long but at 14 months, he was finally coming home. Trach, vent, O2..everything needed for this little guy... including 24 hour nursing. 'Johnny' had his ups and downs and ins and outs of the hospital as with all medically fragile children but he thrived. He learned to crawl and stand and enjoyed his life even though he was not very mobile because of the equipment. (There were no real portable ventilators at that time). One day 'Johnny' got sick. It looked like we were heading for pneumonia. We caught this early. So ABTs, increased nebs etc (you know the drill i'm sure). 7 days of prednisolone. i come from the days where every one was ALWAYS titrated down from Prednisone. 'Johnny' had been on it for 5 days and was getting better. That day, i was called and the agency begged me to work. I had been working another case and had last saw 'Johnny' on the previous weekend. the agency informed me that 'Dad' was finally going back to work after being home with 'Johnny' for the past 2 years. Mom had a good job and dad (who was great) stayed home. Dad finally felt comfortable enough to leave for work while 'Johnny' was cared for by the nurses. I said that I would work, but I wanted another day off sometime that week because after all that day was my birthday. I was working almost 7 days a week and sometimes double shifts. I wanted to take my birthday off but since 'Johnny' was one of my favorite cases, I went. Mom was already at work, and off Dad went. The cutie and I (and the 2 big dobermans) were by ourselves. I sat down and went over the notes and got comfortable with what was going on. My eye spotted the Prednisone, 'Johnny' was not titrated from it. It was literally just stopped 2 days prior. it bothered me and when his primary nurse called in I gave her a heads up. She stated, "oh they don't do that anymore for kids that are on for such a short time." She had years of experience on me so I was like, ok. Not one hour into the shift, my sweet 'Johnny' was watching TV and sitting nicely playing with toys. His body arched backward and he turned blue. His vent started alarming so I thought that he had a trach plug. I tried suctioning and to my horror, I could not get the catheter past a certain point. It certainly did not feel like ANY plug I've ever encountered. I went for the emergency trach. With one hand hitting the button on the speaker phone for 911 and the other removing and trying to replace the old trach with a new one. Nope not going in. There was something blocking it. Ok....step down trach...(smaller diameter).... I'm talking to the 911 dispatcher and working like mad at the same time. He's turning bluer by the moment. I'm yelling....what is the ETA...I need someone now...."they should be at the door in a couple of minutes. The step down trach, nope. I grabbed the supply drawer with one of his rubber urine catheters in it lubed it up tried it....nope. I lubed up a suction catheter to try to get that in at least...anything with a darn lumen, nope... nothing. All this time 'Johnny" is arching his back and having a seizure which he has no history of. The Paramedics were there. Ran down his history, and what had occurred. i will NEVER accept an order to just stop ANYONE's Prednisone ever again. This child died from intractable edema of his airways. His airways were so edematous, that it didn't matter what I put in his upper airway, nothing was going to get through. His PE was thorough. His seizure activity was so intense that his tracheal muscle was in sustained contraction which was bad enough. I was devastated. i wanted to not only leave pediatrics, i wanted nothing to do with nursing. i vowed that this was my first and it would be my last pediatric death. Mom and Dad were very thankful for all that I did. They said they were just thankful that they were able to have him as long as they did. They said that they would be so disappointed if I left nursing or pediatrics. They made me want to try again. I'm glad I did. I can be nothing else. Nurse defines me. It's been my life for so long. People ask me how do I handle it. If not me, then who? i don't do it for money (it helps but there is plenty of other jobs to do for money), i do it because I care. And that day I cared that I was the last face that 'Johnny' saw and that he knew he was with someone that loved him.

Death is inevitable, just as are taxes are, said Benjamin Franklin. Yet we as nurses deal with this reality as no one else does. Often Doctors, and other healthcare providers don't deal with the mechanics, and the emotions involved with holding the hand of a dying person whose family may not even be there.I cried with one young patient who died squeezing my hand when his Hodgkin's Disease finally choked him to death weeks after he refused a trach. His Mom bolted from the bedside, unable to see him die. Then His Dad ripped his own hand from his dying son's grip and ran to be with his wife, who was falling apart. Only I was still there watching him choke to death. I grabbed his now empty hand and growled we were all still here with him. He clutched my hand with a real death grip. Then just relaxed as he gave up the ghost. I reassured his parents. Left the room to confront his siblings at the door. Then I found the most private place I could on the ward. In the med room I cried like a baby. I am still tearing up now some 39 years later. Death will almost always be a part of who we are as nurses. Fortunately life is the better part of what we do. Even my time in Obstetrics had its touch of death. There is no easy way of dealing with it. Places particularly touched by death, Burn Units, Oncology, ICU, ER, Hospice, and other areas I might not even be aware of, are often listed with only brief tours of duty compared with other areas of nursing like Primary Care etc.I read somewhere that the Burn Units in particular often see a turn over of nursing personnel in as little as 6 months. The truth being if YOU can't deal with it "get out." Why? Because "burn out" is a serious thing, both physically and emotionally. Getting away from it before you burn out is a healthy thing. Stress has some incredible consequences, including your health and your relationships.Nursing is a jewel of a profession, but your life and your loves are even more important in the scheme of things then your profession. When you are doing something you like or even love you are a truly a happy individual. If you are not happy, move on. One great thing about Nursing is it has so many niches. Trust me, you will find your place.I did Emergency Medical Services and the ER for over 20 years. It was what has made me as happy as I feel about my life. I am not rich, but I am rich in experience I would never give up or take away. As nurses we are often immersed in a co-dependent personality that makes us even seek out this profession. We need to help people to be who we want to be as an adult person. It will probably never make us rich as Finance or Business, but can you imagine yourself in a suit, or God forbid, a tie, day in, and day out.Be what you want to be, but be happy in what you do. Death is a part of life. Someone has to deal with it on a frequent basis. If you can't, no matter, there are other areas where you can be who you want to be as a nurse. However, if you can deal with it, and accept it, know that those who loose a loved one will be so glad you are there to be with them, and you will know so much more about who YOU are as a person and nurse.

I have found that I was probably the most mentally healthy when i went into Pediatrics. Even though the sub-acute area was not hospice, there was more than a fair share of death and dying. One thing that I have learned about children is that if you are consistent in your love and care they are less afraid of anything. They are resilient. It really helps when a team is actually on the same level. That no one is afraid to express themselves and grieve. It should be mandatory to have a good cry at least once a week