Dealing With Death in the PICU

How do we as nurses survive to fight another day? Where do we draw our strength from to offer to the families of our patients? How do we not burnout and spiral into depression over the senseless tragedies and "unfair" death of a patient?


Dealing With Death in the PICU

It has been a particularly harsh summer for me and the nurses I work with. I have had seven of my patients pass away, either on my shift when I was their nurse, or on a different shift. I have advocated for my patient to grieving parents who were left with the decision to withdraw care or to prolong the suffering.

I handed a 2 month old child to his mother to cradle in her arms when support was withdrawn - he was beaten by his father because he would not take his bottle. I battled for the life of a teenage girl who overdosed on Rifampin - not to kill herself - but to see if her abusive mother even cared about her. We lost the battle.

I straightened the hair of another young teenage girl, who got a freak brain abscess after contracting an ear infection, before withdrawing life support. Her mom painted her nails. There are more, of course. Our unit has faced its share of darkness over the past few months. With every death, I have shed tears along with the family - it is never easy to lose a life - but the life of a particularly devastating.

How do we as nurses survive to fight another day? Where do we draw our strength from to offer to the families of our patients? How do we not burnout and spiral into depression over the senseless tragedies and "unfair" death of a patient?

I have been pondering these questions all summer as I hop out of bed when my alarm blasts the darkness. I am not sure I have an answer, but I am always grateful for my job and the lives I touch. When I get to work, I look at my coworkers and wonder about how they cope. This is what I see when I use my "observation powers".

I see nurses who are sure of their skills, detailed in their patient assessments, critical of every medicine given and drip rate hanging from the iv, dedicated to their patient(s), honed in on minute changes that may show patient deterioration, advocates of patient needs, and compassionate in their care. Every beat on the monitor is appraised, lab levels are considered, critical thinking is applied. Every skill the nurse has is steadfast to fighting for the best outcome of their patient, and sometimes the nurse will win, and sometimes lose.

As a whole, the nurses will support each other. We lean on each other, fight side by side, rushing to the battle call. When we do not win, we cry, we hug, we talk. For the families, we allow ourselves to shed a few tears but we remain the comforter to our families - we will not allow them to feel the need to comfort us - for we are the professional and we are there to serve them in their darkest hours. Yet, they can see we care and we are not made of stone. They can see that their loved one was important to us.

After work, we may gather for dinner and a few drinks, or we may cry on our way home and head straight for a hot bath. Some of us deal with the stress by working out, diving into the love and laughter of our own families, or reading a great book.

Whatever it is we do to make it through a death, we make sure that the death of a patient does not consume us. If it does, we will not make it to fight another day.

Julie Reyes, DNP, RN

44 Articles   260 Posts

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kiszi, RN

1 Article; 604 Posts

Has 9 years experience.

Thank you for this article and for the amazing difference you make in your precious patients' and parents' lives! I am grateful for all of the pediatric nurses out there who fill the need that many would find too difficult. :HUGS:

tokmom, BSN, RN

4,568 Posts

Specializes in Certified Med/Surg tele, and other stuff. Has 30 years experience.

I did my BSN capstone on burnout and compassion fatigue and one Native American proverb I stumbled across summed it up nicely:

"In traditional Native American teaching, it is said that each time you heal someone, you give away a piece of yourself until, at some point, you will require healing."

It's good you and your co-workers replenish yourself and fill your glass and pamper yourselves. I think sometimes we forget to do just that that. We take care of patients only to go home and take care of family and somewhere we may take a moment for ourselves. It's obviously not enough time considering burnout and compassion fatigue are so rampant in this profession.


4 Posts

You and other nurses in PICU are doing amazing jobs. As nurses, we feel deeply happy after saving a life of our clients but emotionally distress after we lost a life. Even though, we will still have that emotional feeling after a lost, we need to be grateful for all lives we touch and save so that we will be at our best and will be able to help others to feel the same and know that we are doing our best for them.

God bless you, Julie.

Maybe having a spiritual view helps. That is, I believe there are many things in this life that we simply are not meant to understand. I have learned to put my questions aside and trust that God is in charge and the world is unfolding as He sees fit. I wasn't always able to be satisfied with this answer, but it helps me now to make sense of the seemingly unexplained.

Has 33 years experience.

Maybe the same characteristic that encouraged us to become nurses also presents itself when we are in the thick of life and death. That part of us that is persistent, obstinate, compassionate, and forgiving. Sometimes we feel that we have given all that we possibly could, but tomorrow we will give more and there is always a tomorrow. Bless all of us for doing the best we can in the environments that we work in. They may not be ideal environments, but they do have the patients that keep us coming back and sustain us. Yes, our patients sustain us, it is not always us sustaining them. There is a part of us that needs to nurture others and that is why we are nurses.

Specializes in PeriOp, ICU, PICU, NICU. Has 20 years experience.

I worked in a busy PICU and loved it; however, it took it's toll on me. I decided to take a much needed break and venture outside the hospital setting. So far so good, but I miss it and don't. It's a weird feeling.

A Jaqueline

83 Posts

Thank you for this encouraging article, you are doing a great job.

Has 33 years experience.

" Whatever it is we do to make it through a death, we make sure that the death of a patient does not consume us. If it does, we will not make it to fight another day."

The nurse has to care of her own mental health. When we can no longer bear that burden.. it's time to move on.... and that's okay.

Julie Reyes, DNP, RN

44 Articles; 260 Posts

Specializes in pediatrics, occupational health. Has 6 years experience.

So many great and insightful comments. I think nurses have a passion for people that cannot be seen in any other profession. In my opinion, nurses are some of the most amazing people in the world, and that is why we need to take care of ourselves - so that we don't get burned out.

When I was a 9-1-1 paramedic, I had every bad call imaginable. So much so that I still see the faces of people I tried so hard to save. I am sure that I have some form of PTSD. I never was able to really talk about the experiences I had, and at the time, I didn't have much faith in God. I didn't just burn out, I exploded like a bomb. It has been over 10 years since I stepped foot in a truck, and I will never be able to do it again. I want to make sure that I never have this type of experience as a nurse.

NutmeggeRN, BSN

8 Articles; 4,597 Posts

Specializes in kids. Has 40 years experience.

I think it is very important that you recognize your stress and are able to write about out support from your EAP or whatever works and is therapeutic for you.

You need to be good to yourself if you are going to continue to be good for others.

{{gentle hugs}}


5 Posts

Beautiful. Thank you for fighting for our loved ones