Originally posted by BSNfromMCN
A big hug to you Ted. I am feeling the same grief today. I experienced my first death last night. I have another year of school left and am currently in my second week of an externship. My first "real" nursing experience outside of clinicals. A gentleman I cared for the past 3 nights went unexpectedly in his sleep. I pretended to be able to continue working while my insides were collapsing. I hid in the bathroom to cry about a dozen times and avoided eye contact at all costs. 15 hours later, I'm still weepy. I've been teased by classmates of being too soft hearted to be a nurse and now I'm wondering myself. How do you find that balance between compassion and competency? Am I of any benefit to patients and families if I am emotional? Does it ever get any easier? I know that I did my best for my patient but I still feel so guilty for not being able to fix everything. The doc was even shocked, and I don't think anyone knew what else we could've done. I am haunted by the fact that I reassured his daughter to go home and get some rest. That we'd take good care of him. 3 hours later she got the call. It just seems so horribly cruel and unfair. I knew that this experience would come sooner or later, I just wish I knew how to deal with it. Thanks for sharing and expressing what is also on my mind today.
BSNfromMCN:
Warm thoughts and a heart-felt (((HUG))) your way on the loss of your patient. Your first patient. . . that you cared for for three days, no less.
Are you a new nurse? Coping with a death of a patient coupled with the emotional and "feelings of confidence"
swings of being a new nurse seems like a lot to manage to me! Heck, coping with a death of a patient coupled with a very busy shift involving the responsibility of providing care for a lot of patients is a HUGE load even for the "seasoned" nurse!!!!
Which ever the case it is for you, now's the time do exactly what you're doing now. Reach out for support to talk, vent and reason. Do it through correspondence like you're doing via a bulletin board, or through some kind of counceling (spiritual counceling if you're active in a religion), or through some kind of supportive staff meeting, or through some kind of memorial service. . . . . . .
Don't forget to take care of YOURSELF!
I ask myself, where does burn-out come from anyway??? Well, there's a number of reasons, actually. Many reasons that's non-related to this thread that can and should be dealt with through other threads. But, with regards to experiencing frequent deaths of patients, a nurse can very well find him or herself ripe for the burn-out.
Someone responded to this thread who work on a cancer unit. I used to work for a cancer unit too. I've seen a lot of death there! Our hospital used to have a quartally non-denominational memorial service for those who've died on our heme/onc unit. This support service was not only beneficial for the family of the loved ones they lost, but for the nurses and other healthcare professionals as well. I used to play piano for these memorial support services. It was a very healing time for me in many ways.
Balance between compassion and competency? I see no relationship on how one effects the other. To me, they're "apples and oranges" for the "fruit salad" of a well-rounded nurse. (Does that make sense?
) As stated before, one needs to take care of him/her self in order to remain compassionate and not become ripe for the burn-out. With regards to competency. . . quite frankly, I believe it's every nurse's responsibility to maintain some kind of on-going educational process in order to maintain competency.
But there maybe something more I can share which might help you keep the responsibilities of nursing in perspective with one's life.
Like I said, I used to work on a heme/onc floor. Saw a lot of death. Young people, older people, people with families and children, people starting out in new relationships and jobs and other areas of life. I cared for these individuals. . . many times. . . for weeks on end. For months, sometimes!!! Got to know them PRETTY WELL!!! And became emotionally attached.
There was a time, fairly early on in my nursing career, when I was well ripe for the burn out because of the deaths I've experienced! Heck. . . I gave many of these patients chemo therapy which, MANY TIMES, knowing that this treatment could be and was a contributing factor to their deaths!!!! (Although!!! I balance that one with the realization that it was their very deliberate decision to undergo these sometimes harsh chemo and radiation therapy treatments! To me, it was their way of FIGHTING and FIGHTING HARD!!!)
I was ripening for burn out, alright!
There was a relatively new RN on our floor. She was a very seasoned LPN who worked hospice as a career prior to becoming a hem/onc nurse. She was scattered brained! Very unorganized! Very knowledgable! Very competent! Very compassionate! Very giving! And VERY UN-BURNT OUT!!!!!
I thought the world of her! (Though I hated following her. She used to work the evening shift. . . . way to messy and always finishing her charting 'till last, which got in the way of me starting my night shift sometimes.) She was . . . is . . . . the model patient advocate! A mentor of sorts for me.
I approached her one night when I was feeling very burnt out. A young patient . . . another one. . . had just died. I was ******! We all worked so hard to try to save his life. HE WORKED HARD to try to save HIS life! It was to be expected that he die, actually. He had AML; had tons of chemotherapy; was septic. . . a very, very sad and familiar story.
Yet this "scatter-brained", compassionate, very competent nurse was. . . continuing on. . . . moving one foot in front of the other. . . doing her work. . . smiling, even! Always, always attuned to the patients' needs! And always, always working hard to meet those needs to the best of her abilities!
I approached her, one sad day after a patient's death, and asked her, "How do you do it?" "How do you maintain your composure?" How do you not be burnt out after all of 'THIS'??" (And I pointed to all of the sick heme/onc patients in their reverse isolation rooms who. . . more than likely. . . . were not going to make it! Their chances of living were next to nill!)
And what she said was simple and very profound. "Ted," she said, "I give them the best darned eight hours of my professional life and then I go home and forget. I leave work at work."
It actually took me a while for that simple gem to sink in!
But I hold on to that simple philosphy to this day. Yes! There are times when I do bring home some of my work. . . like I did the other day! But it is the norm for me to give the patients the best darned nine hours (actually) of my professional life. Go home. and live life with my family.
The down side. . . at least for me. . . is that I truly forget patients' names! I really do. I suck at remembering names! And I think this is partly because I make a HUGE effort to leave work at work! The hospital is out of my mind the moment I get into my car and put my foot on the gas pedal.
Am I of any benefit to patients and families if I am emotional?
That's a good question. I've cried with families a few times. I guess I was emotional, if you call that emotional. We all worked hard to help someone live. I became friends to the patient and their family. I was sad and I cried. . . with the family. . . when "THAT" patient died.
There is this concept of "Professioanal Detachment". I agree with it. But this does not mean that there are times when I . . . to a certain degree. . . become emotionally involved with a patient.
Remember, we are humans who emote!
There's a balance there between "Professional Detachment" and forming friendships with patients. I dare say, lean towards the side of "Professional Detachment". But not to the point of being emotionally void and totally empty of empathy.
Again, I cared for patients on this heme/onc floor for weeks on end. Then they would go home and come back again in a month for me to take care of them for another few weeks. It is hard NOT to form friendships and emotional ties with this type of hospitalization. Still, I need to "keep things in perspective". I need to know when to stand back and be the objective third party sometimes. This is very important in providing effective care at times! And if I can't, I find a nurse who can!
Another point to remember. Keep home life at home! This will help keep objectivity and help from getting so emotional as to not to be able to provide the support a patient or family may need.
Again, as stated before, as healthcare professionals, I truly believe we need to take care of our own selves. . . the physical, the emotional and the spiritual.
Does it ever get any easier?
No.
And yes.
And no.
And yes.
It depends. There's always something that will challange us. There's always something new that can be learned. Sometimes we're receptive to challanges and change. Sometimes we're not.
Remember, we're human. Wonderfully, gloriously human. With ups and downs who meet challanges sometimes and . . . sometimes we shy away from them, or need extra support to meet them.
I know that I did my best for my patient but I still feel so guilty for not being able to fix everything.
To me, seems like you did do your best.
Feeling guilt for not being able to fix everything?
Remember this. We're humans!!!
We're not gods!
Ted
Would you like to comment?
Re: A patient died today. . . .
