Dealing with Death as a Nurse

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Nursing can yield many personal rewards, satisfaction and joy. It can also be the source of many challenges and frustrations. Nurses are vital healthcare professionals and see countless patients through horrendous injuries and severe illnesses that could easily take their lives. Unfortunately, they may experience the death of a patient in any routine workday, and the impact can be extreme. Overcoming the loss of a patient is never easy. Continue reading for guidance and resources for dealing with death as a nurse, including advice from several nurses with firsthand experience. 

The Odds of Experiencing a Death

The U.S. Census Bureau indicates that, statistically, there’s one death every 13 seconds around the country. The Kennedy Institute of Ethics adds that this equates to five deaths every minute, or 297 each hour and more than 7,000 daily. While every death may not impact a nurse when it occurs, odds are that most nurses will care for at least one patient who doesn’t pull through at some point in their career.

Nurses working in critical care units, emergency rooms, cardiology, oncology or geriatrics may experience more deaths than peers in other fields. However, the diverse array of leading causes of death outlined by the Centers for Disease Control and Prevention (CDC) in 2020 indicates that nurses from any field could face losing a patient. The CDC listed the following as the leading causes of death that year:

• Heart disease
• Cancer
• COVID-19
• Accidents
• Stroke
• Respiratory disease
• Alzheimer’s disease
• Diabetes
• Influenza
• Kidney conditions

Per the CDC, the infant mortality rate is 5.42 deaths per 1,000 births. In 2020 alone, 3,529 children aged 1 to 4 and 5,623 youngsters between 5 and 14 died. Causes of death varied, including accidents, homicide, cancer, congenital conditions and, in the upper-age bracket, suicide. These infant and child mortality figures indicate that nurses in pediatric, OB/GYN, labor and delivery, neonatal intensive care and similar nursing fields could experience patient deaths.

Hospital-based nurses aren’t the only ones experiencing death. CDC data indicates that the number of hospital deaths is declining, with a gradual increase in the number of people dying at home and in nursing homes, hospices or other long-term care facilities. Therefore, home healthcare nurses and those working in residential care settings are more likely to experience death than in the past.

Death as Part of Nursing

A minority of nurses make it through their nursing career and never experience a patient’s death, but most nurses will have patients pass away. According to an Evidence-Based Nursing journal article, most nurses experience job-related death for the first time during, or even before, their first year of practice.

Although it’s an anticipated part of the profession, a patient’s death often profoundly impacts nurses.

Susan Gentile, an Adult Nurse Practitioner and primary care provider who administers urgent care at ChoicePoint, said, “I would be lying if I said that losing a patient or seeing them die in front of you ever gets better with time. It doesn’t. And I think it’s only natural to feel sad when someone you took care of leaves you.”

Experiencing death as a nurse can take several forms. The most obvious form is physically being with a patient when they pass away, but nurses may arrive for a shift, find the empty bed of a patient they’ve been caring for and learn of their passing that way. Similarly, clinic nurses may notice the absence of a long-term patient, investigate and discover they’ve died.

Nurses often feel the after-effects of death, even if they weren’t present at the time of the patient’s passing. These effects can also be felt when breaking the sad news to a patient’s loved ones.

Nicholas McGowan, MSN, RN, CCRN, is a critical care nurse with 12 years of experience in cardiovascular, surgical intensive care and neurological trauma nursing. He also hosts an online course at Critical Care Academy, where he helps nurses achieve critical care (CCRN) certification. He offered his advice on handling death notifications to loved ones.

“For grieving families grappling with death or loss, it’s important to allow them permission to grieve. When they’re told, ‘everything happens for a reason,’ this denies them their right to feel sad or as if the loss was supposed to happen for some mysterious reason, and they should just accept that. Instead, what I tell those looking for meaning is that ‘some things in life weren’t meant to be fixed. They were meant to be carried.’”

The 7 Stages of Grief for Nursing Professionals

Nurses spend an enormous amount of time studying to enter their professions, but no amount of studying can properly prepare you for the death of a patient. The meaningful connections formed between nurses and their patients make an unexpected, or even an expected, passing even harder to bear. Gentile explained that grieving is natural when a nurse loses a patient.

Kristy Anne, a nurse and behavioral scientist experienced in palliative care, founder of Project In-Between and author of 30 Day Self-Care Solution for Nurses, added, “The grief and death cycle is an ever-evolving part of our human experience.”

Everybody experiences grief differently, but most go through common stages of grief and the grieving process. In her book, On Death and Dying, Elisabeth Kübler-Ross, an eminent Swiss-American psychiatrist and researcher of dying people, details five stages of grief:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

An extra two stages, shock and testing, were later added for a total of seven stages. In essence, grief theories typically detail a progression through feelings of denial, anger, sorrow and eventual acceptance after a significant loss. These stages of grief can also apply to nurses who experience a patient’s death.

Stage 1: Shock

Nurses may feel shocked immediately following the death of a patient, particularly if the death was unexpected. During this stage, it’s typical for nurses to experience disbelief or feel numb and detached as an emotional buffer to prevent becoming overwhelmed.

Stage 2: Denial

Following shock, nurses may experience the denial stage of grief. They may try to bury their feelings. 

However, per Janelle Willis, MSN, APRN, CNE, a clinical instructor and certified nurse educator at the University of Nevada, Las Vegas, “It’s okay to grieve, and nurses should give themselves time to grieve. Appropriate grief is even okay in front of the patient and family, and often humanizes the experience and shows care and compassion.”

Willis speaks from experience, having seen patient death during her nursing practice and through her work educating students on coping with death as a nurse. Her experiences with death led to her introducing the Precious Prints program to Southern Nevada hospitals. This program provides a locket personalized with the fingerprint of a child patient who died to their family to honor the child’s memory.

Stage 3: Anger

Once denial wanes, nurses may feel angry. They may direct their anger inward or at colleagues, the universe, the patient’s relatives or the actual patient. Others may struggle to express their anger in healthy ways or repress it because it’s a scary emotion. But anger is an essential part of the grieving process and must be addressed to move forward.

Stage 4: Bargaining

The bargaining stage of grief for nurses can involve questioning events and outcomes, pondering other possibilities and replaying situations in their heads. Feeling guilt and dwelling on the past are expected during this stage.

Stage 5: Depression

Depression can hit nurses hard, particularly if they previously suppressed feelings of grief. Although depression is a natural part of the process, some nurses may seek a mental health professional to help them through it.

Nena Hart, MSN, RN, is a certified hospice and palliative nurse, a hospice nurse consultant and the owner of Hart Healthcare Solutions. She has over 18 years of experience with compassionate support of the chronically ill and dying.

Hart said it’s typical for nurses to compartmentalize to avoid feeling emotions that could prevent them from carrying out their work to a high standard. She added that she was taught early on in hospice that it doesn’t have to be that way.

Stage 6: Testing

The testing stage of grief in nursing typically includes attempts to seek help and move forward after a patient’s death. It may include talking to a trusted friend or colleague, joining a support group or using other coping mechanisms to reach a “new normal.”

Stage 7: Acceptance

Upon reaching the acceptance stage, nurses accept reality and continue with their work and life. Acceptance is especially important as it puts nurses in a better place to continue helping others. 

“As nurses come to terms with their own thoughts and feelings of death, they will be in a more comfortable, confident state to help others,” advised Willis. “Discover your own healthy coping strategies that allow you to continue your work of caring for patients with empathy and skill. Recognize that death is inevitable, even if it is untimely or tragic. Allow yourself time to grieve and let go of sorrow through prayer, meditation or relaxation.”

Tips for Dealing with a Patient’s Death

While experiencing death will always be unpleasant, nurses can implement strategies and take positive actions to help them deal better with losses of life. Here are eight tips that might help you find new ways to come to terms with a patient’s death.

Focus on the Family

When a patient is dying, many family members turn to their loved ones’ nursing team for comfort and support. At that time, helping others may also help a nurse cope with death.

“Helping families through the process of a loved one dying is an honor,” said Willis. “The majority of people in our society are uncomfortable with dying; they’re hesitant to be with family members or friends during this time because they don’t know what to say or do or what to expect. The family often craves someone who can be comfortable, confident and compassionate during this time. This is the nurse’s role.”

Allow Yourself to Feel

Bottling up emotions is unhealthy in the long term. It’s essential to let yourself process your feelings.

“Don’t repress the emotions,” warned Gentile. “The more you try and not grieve, the more everything will seem difficult. If you just lost a patient, take a little break, grieve, say a prayer for them and return back to your work. Your feelings do matter.”

Remember You’re Not Alone

When faced with a patient’s death, it’s vital to remember that you’re not alone. Many nurses experience death on the job and can often identify and empathize with how you’re feeling. Willes agreed that discussing your feelings with colleagues who understand your situation can be a valuable support during distressing times.

Don’t isolate yourself following a death at work or during feelings of depression. Even though they haven’t had the same experiences as you and your fellow nurses, family and friends can still provide much-needed support when you’re feeling low.

Gentile advised to “seek the comfort of family and friends. After a hard day of work, go and hang out with your friends and family. Let them know what you went through today, and if they try to cheer you up, be grateful.”

Acknowledge the Death

Stage seven of the grieving process is acceptance of a patient’s death. To help you to reach this point, take time to talk about the death and the patient with permission or without divulging any private information about the patient. Acknowledgment can be especially healing in cases of traumatic death or if you work in a unit that doesn’t directly deal with the end-of-life process.

“Acknowledge and accept the inevitable,” advised Gentile. “As a nurse, you need to understand that there will be patients under your care that may never walk out of the hospital. Death is an inevitable part of this life, and you should accept it.”

Practice Self-Care

Self-care regimens are always important for nurses, especially after a harrowing event. Find activities that help bring pleasure and provide stress relief, even if only momentarily. 

Hart recommended, “Make time to prioritize self-care and give yourself downtime. Don’t be tempted to use business, working more and distraction to keep you from feeling.”

For some people, self-care involves art, music or reading. Others feel better spending time outdoors, taking a mini vacation, indulging in retail therapy, spending time with pets or performing other activities that nurture their mind, body and soul. It’s also essential to get adequate rest, nutrition and physical exercise.

Connect with a Higher Purpose

Some nurses may feel more at ease after practicing meditation and mindfulness. Nurses with strong spiritual beliefs may obtain comfort from attending worship or speaking with a spiritual leader. Gentile said thinking of a deceased patient in a better place can help. 

Danielle Miller, BSN, RN and CEO of Stars and Stripes Consulting, said, “I was told by a physician before I became a nurse that when a patient codes, they’re dead. If you bring them back, it’s a miracle. I’ve never looked at a code the same way since.”

Reflect on the Positives

Helping patients and their loved ones through sickness, injury and death is an honor, as stated by many nurses. Try to take comfort that your presence helped ease suffering. Indeed, a research article in the Canadian Medical Association Journal indicated that nurses who attend to dying patients usually find great meaning in their work.

Miller shared something a patient’s family member told her after their loved one passed that gave her comfort. She recounted they said, “The nurses who are there when your family member passes are with you forever. I’ll always remember them for the wonderful people they are, even if they couldn’t save my loved one.”

Use Support Resources

Healthcare employers typically offer support services for staff members. Counseling or therapy can be especially beneficial for nurses experiencing grief. Hart stressed the importance of asking for help whenever needed.

“Accept the resources from your team and organization for coping and self-care,” she said. “Utilize EAP (Employee Assistance Programs) and chaplains if you have them. They’re there for you, too. Debrief with other nurses and your IDT team when it’s available. Ask for help when you’re struggling.”

Have you personally experienced the death of a patient as a nurse or other healthcare provider and found effective ways to deal with it that you’d like to share with others? Please leave your comments below and help fellow nurses and medical workers learn new ways to work through the grieving process.

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