Advice needed - withdrawing life support & how to deal

[just_peachy83]

Hey everyone!

I am a new grad RN and I'm working in a 25-bed MICU at a university hospital system. I LOVE my job and am done with orientation next month - WOOHOO! :) I am nervous but excited at the same time - I work with a very supportive, helpful staff.

I wanted to ask for some advice, though, because these past few weeks I have come across my first real bump in the road as a new nurse, and I'm just kinda struggling with it. The past few weeks on my unit we have seen many very young patients, like my age or younger, die. Most have been withdrawal of life support situations, but it's been hard on everyone. I took care of a couple of these patients, and it's still on my mind. Does anyone else feel this way? Is this normal? I worked in an open heart SICU as a tech before graduation and witnessed several codes and many deaths there. It's not like this is new, but being the nurse resposible for a dying patient IS new and very emotional for me. Sometimes I worry about my family now, and worry that they will die a traumatic death like some of these patients. I am feeling much better this week and I did fine two nights ago when one of my DNR patients with pulmonary fibrosis was dying...I was okay afterward, too. I love what I do and my preceptor says I am doing fine. I don't want to change areas, but I didn't think I would be hit this hard. Any advice on how to deal with this more effectively?? I would really appreciate any words of wisdom. :)

Thanks everyone.

[blueheaven]

With 29 years in, most everyone has expressed what I would say. Sometimes it is easier for me than others, and I have stood at the bedside and cried with the family. Lovemygamecocks...I am so glad that the nurses caring for your grandfather were as compassionate as they were to you.

"In the week before all of this, this nurse told us to ignore the scheduled visiting times. We stayed hours at a time and never a word was said."

Good for her! At my facility, there is a lot of grumbling among my coworkers when I do this but to them in all due respect. :) That is my patient, on my shift and I do what I would want done for my family member.

[weezledawg]

I believe that some of us are just built for these types of positions (ER, ICU, Hospice) and that we are naturally drawn to deal with end-of-life issues. I know that there are many worse conditions than death and my job is to support a patient, should they die, throughout that process with the utmost dignity, respect and compassion. This means adequate pain relief and support of the living who inevitably are left to grieve. I take heart in knowing that sometimes the ultimate healing I can provide was given not through "saving" that patient, but through facilitating a proper end.

[Sabby_NC]

Exactly--I agree when we stop feeling sad/bad at the suffering or death of our patients, we need to go do something else, at least for a while.

As a hospice nurse, I was confronted right away, not with removing of artificial supports, but with the end of one life and the changing of all the others around that life. I saw amazing transitions, and I realized that part of my strength lies in having made peace (mostly) with my own mortality and having developed a settled and comfortable belief about what happens, for me, next.

When it is helpful, I share a little (or some) of that with my clients and their families. When it is not, I just stand still and strong, and give them what I have that they can use. At the end, I can feel very good--I limited or eliminated suffering. I comforted. I made someone's day better. I gave something from deep inside myself that will be carried by someone else and passed along who knows how many times.

And I recall the advice of Carl Whitaker, a family therapist early in the development of that field, who, when asked about avoiding burnout, said, among other things, hold a baby, be good to yourself, seek out the support and ear of others, and lend your own.

And I hug my sister and my dogs a lot.

Good for you to be in this work, and even more good for you that you are thinking and feeling as you are. What a wonderful addition you are to our profession.

Hi Chris,

That was a beautiful post. Thank you for those words.

It is people like you that make our job as Hospice Nurses so rewarding.

[SICU Queen]

It does get easier, but only because you learn to deal with it better. Each nurse has her/his own way of coping. Of course it's always sad to see a life end, especially if the patient is young. I definitely have shed my share of tears!

One thing that's helped me over the years is to do my best to make sure the patient has a GOOD death: as pain free as possible, and surrounded by family, or at least, not alone. I've also realized that there are certain things I want for myself when it's my time, and I've made sure that those wishes and requests are in writing.

Death is a part of life and it deserves as much attention and caring as any other part. Use your experiences to bolster your knowledge, and next time you are caring for a dying patient, think of the ways you can make it better, for both patient and family, then DO IT.

[deeDawntee, RN]

You are a human being and being a nurse means getting involved in the human experience, that is the way it should be. It is OK to have all the feelings that you will experience. Being a nurse does force one to look at death and dying and to come to terms with it for yourself.

You WILL develop coping strategies and an ability to detach which is necessary, I believe, for you to be an effective nurse. After awhile, not everyone's death will tear you up anymore and that is the way it should be. You have to put some boundaries around your own internal peace of mind and not let your job strip that away from you. You can still offer support and care, certainly, but you will learn to protect your own emotional well-being. We all will take our turns at grieving the losses in our own lives, it truly is not necessary for you to grieve the whole world's.

Thanks for your compassion and for your caring! :icon_hug:

[nursejill155]

I find it hard when death occurs in my unit no matter what they age. Everyone is someones sister, mother, father, brother or friend. I feel that it is good to cry but try to keep control, don't sob uncontrollably! But I think crying is normal when you see a grieving family and caring for that pt. you gave them a piece of yourself. I have absolutely no advice to allow this to be easier because it is not an easy part of life. Just take care of yourself and your feelings and work through it.