How much death do you see/ have you seen on the job?
I know this varies depending on your area of practice... For example, a Nurse working in an MDs office vs. Acute Care/Trauma. Nevertheless, I am just curious as to how many Nurses on this forum have witnessed/experienced death on the job in their careers, how it affects them, what keeps them going? A professor I had in nursing school admitted that she had never experienced the death of a patient in her entire career; and that she purposefully avoided working in areas/specialties where death would be at an increased likelihood.
She explained that she wouldn't be able to cope with "all that day-in day-out death" for the long-term... and I agree with her because I feel a similar way after witnessing/experiencing a lot of deaths in my career. I used to work in palliative care. I did that for many years and was good at it, but left because it became too much.
Off the top of my head, I can think of 11 patients, from a few hours old to 18, that I have lost this year. I'm sure it's more than that, but if I carried all of them around in my head, I couldn't do this job anymore. Build walls. It doesn't make you a bad person, it's self care. Do this long enough and you realize that there are a hundred things worse than death. Those are the patients I can't forget, and the ones I apologize to in my head when I can't sleep at night.
I can think of 5 since mid-October, 2 in the last week and 1 more sent home to die on Friday. All but 1 were teenagers. The one who wasn't was days away from turning 3. All had cancer.
A cardiac arrest is almost a daily occurrence in my high volume ED. That being said, I am able to emotionally distance myself from the dead patient. It's really the family's reaction that hurts the most. Dead is dead. I see it as a stage on the spectrum of living. I think I have teared up only once at a death and it was a teenager in trauma arrest. His parents were so young. I was tearing up for the parents. In the ED you usually don't have a relationship with the patient prior to them coming in, and they come in dead, so I think it is easier to deal with it.
Quite a bit. When I was med-surg, not so much- maybe one a month who was already a DNR (happening on the floor, not necessarily my patient) or a frequent flyer passing and we were aware of it (small town) but not necessarily on my unit/shift/assignment. The very occasional code.
As an ER nurse in trauma centers... very often. Very often. They don't all distress me- but the worst are the kids and the young traumatic deaths, and the hardest part is not the actual death but seeing/hearing the family afterward. Sometimes the part that gets to me is being assigned somewhere lower acuity that day and NOT being involved in the code or the trauma call, but hearing it all- the radio call, the helicopter arriving, the family wailing- and not knowing the details or having the chance to help, just having to get on with my work and swab people's throats or bandage their lacs while hearing the extreme pain of strangers coming from just down the hall and knowing what has likely happened.
I often think if I ever burn out completely on ER it will be for that reason- that I just couldn't stand the sadness of hearing one more family screaming at the news of the sudden death of a child.
I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.
When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.
When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.
Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.
I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.
And I agree with Commuter that the worst potential outcome for many people, things I've seen in elderly patients, were all sustained conditions that seemed much worse than death. As in, given the choice between experiencing them indefinitely and death, I would unhesitatingly choose death. So it is not really the deaths themselves that typically distress me, but the extreme pain and grief of the survivors.
Sometimes I think I would find satisfaction in palliative care- I *do* find it very, very distressing how many patients I see in the ED who are dying and would benefit from palliative care but are still being treated aggressively and seem to be in unimaginable amounts of pain- but since loss of my own loved ones is a major focus of my anxiety disorder, I'm not sure it would be healthy for me in the long run to constantly be in very close proximity to both the dying and the grieving survivors..
Specializes in Critical care, ER, stepdown, PACU, LTC.
In the ED you usually don't have a relationship with the patient prior to them coming in and they come in dead, so I think it is easier to deal with it.[/quote']
Unfortunately not true if you work in a small town ER when you grew up in the same small town. After being a nurse for 17 years, I've seen too many deaths to remember. The three that I will never forget: a six month old SIDS victim, a three year old post MVC, and an early thirties full arrest with lung cancer. We had debriefing sessions for both the children, I went to both to support my coworkers who were having a hard time dealing with the deaths. I was able to separate myself from those two since I didn't know them or their families. The gentleman with lung cancer was much harder since I had gone to school with him and his brother. His death still haunts me sometimes.
Specializes in LTC, assisted living, med-surg, psych.
Working in long-term care for as long as I did, I saw a lot of deaths. Some were harder on me than others because I'd formed relationships with the resident and/or family, but I never let myself break down in front of family members or co-workers. I was always able to put my feelings away until I got in the car after my shift was over.
I've been out of nursing for awhile, and I don't miss the death and dying part of it. The last passing I witnessed was my husband's this past July, and I basically pronounced him because there was no staff in the room when he let go of life. He'd been battling pancreatic cancer for almost three years and he was suffering so much that it was time for it to be over, but I'll never forget how he reached out his hand at the final moment. And even so, I managed not to fall apart (I waited till later to do that), but maintained that professional demeanor that I'd perfected in my career. It stays with one, you know.
I'm at a LTC/rehab facility, where I've had to 'pronounce' a number, but not really all that many, considering. Some have passed when I was off, or in a hospital. And besides that, people aren't dying nearly as often in a place like that as you might imagine.
And I agree with Commuter that the worst potential outcome for many people, things I've seen in elderly patients, were all sustained conditions that seemed much worse than death. As in, given the choice between experiencing them indefinitely and death, I would unhesitatingly choose death. So it is not really the deaths themselves that typically distress me, but the extreme pain and grief of the survivors.
Sometimes I think I would find satisfaction in palliative care- I *do* find it very, very distressing how many patients I see in the ED who are dying and would benefit from palliative care...
That's sadly not always true. Palliative care doesn't always = quality of life. Or at least that is what I saw in adult & geriatric palliative care. The hardest for me were the patients with ALS, end-stage cancers, dementia, Parkinson's. A lot of people in palliative care unfortunately suffer (a lot) right up until their expected death. Also, staffing is an issue (ex. 1 nurse to 6-8 patients) and these patients are TOTAL care patients (100% dependent for bathing, clothing, feeding, voiding, all physical movement). I'm not going to post the details (of how they suffer) for the sake of anyone reading this whose loved ones might be in palliative care... and I'm sorry if this offends anyone, but a lot of these patients cry out for a quicker death. They beg and plead with you, and as a palliative care nurse, there is not much you can do but to hear them cry and watch their suffering and repeatedly consult with the MD/inter-professional team to try the next intervention, the next intervention, the next intervention, etc... All these interventions will only work, short-term... Then, for example, the patient's excruciating pain returns. Everyday until they die. There's a point in palliative care where even pain management fails. Palliative care nurses are IMO the toughest breed to endure that 24/7 and do it with a comforting smile amidst management pressures for lean principles.
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KelRN215, BSN, RN
1 Article; 7,349 Posts
I can think of 5 since mid-October, 2 in the last week and 1 more sent home to die on Friday. All but 1 were teenagers. The one who wasn't was days away from turning 3. All had cancer.