Loss of a patient

Nurses General Nursing


I lost my first pt on Friday. I'm still in nursing school and happened to be in the ER for a clinical rotation and barely an hour in, a pt came in and required CPR...I performed the compressions and she was pronounced while my hands were still on her. I'm having a hard time with this. I can remember the feel of her bones under my hands and the sound of her breath leaving her. What can I do to get back on track?

I'm genuinely not trying to be "mean", but the best thing to remember is that this person's death is not about you. That person presumably had friends and family who are suffering a real loss. As someone who stepped into their life only during the final moments and in an impersonal manner, it seems dramatic that you're feeling for yourself.

It might also help you to remember that death is not the worst outcome ...not by far.

I lost my first pt on Friday.

No you did not. Somebody may have lost a mother, daughter, wife, or sister. You did not lose anybody or anything. As the above poster said, this had nothing to do with you. Assuming you did what you were trained to do to the best of your ability. Did you? Or did you stop compressions to answer a text? If so, then yes, this is partly on you. Otherwise, you need to have boundaries.

So far, historically speaking, everybody dies. Working in an ER does not change that fact. Work hard, study hard, keep your skills sharp, and you will sleep well at night regardless of the outcome.

Certainly in your career as a nurse you will encounter death, some of which will bother you. But having your personal well being depend on the outcomes of CPR is not a good long term strategy.

There is nothing wrong with the fact that having a code called while you were trying to save a life bothered you. That makes you human. But as humans, we have limitations- we don't decide who gets to live.

Best of luck as you continue. It gets easier.

Specializes in Emergency Department.

What you do is you make peace with it. We do the best we can to nudge someone back toward life but ultimately that nudge isn't enough because it's either "their time" or their illness is too great. I've almost literally been in your shoes. I remember my first CPR and patient death and I remember my most recent. The rest blur together, with only a couple that stick out in my memory. I've been an EMT and Paramedic for more than 20 years now and was very active at it for 7 of those years, and I've been an ED RN for all 3 of my working years. I really suggest that you give great consideration of the idea of making peace with death. I'm not saying you should seek it out or be fatalistic or anything like that, but just make peace with the idea that we all will die and that our role is to try to provide that nudge toward life and that often we fail in our efforts. When that happens, we do our best to provide a good transition from life. I find it an honor to be allowed to be part of that process. The last patient of mine that passed was a DNR. I did my best to ensure that the family was present and that they understood the process and that there weren't any surprises. That passing was relatively gentle for all.

And you also remember that our patient isn't just the person on the gurney in front of us or under our hands... they're often also standing in the room with us: the family! Always remember the family is as much "the patient" for us to care for as the actual patient is. Take care of them too. You should find a way to make work fun. I enjoy every day that I'm at work and I find fun in what I do. If you were to watch me work and you saw me suddenly become very serious, that's a tell that something is very wrong with one of my patients...

Above all, take care of yourself. If you don't take care of yourself, nobody else will and neglecting yourself easily results in compassion fatigue.

What can I do to get back on track?

As a former cop and soldier not to be harsh but:

Admit that you didnt know them and move on. People die. It happens.

If it wasnt someone you knew or cared for, dont worry about it.

Im not saying not to have empathy for another person's death or their family's loss, but you dont need to be grieving either.

Do you have counselling available through your school? Did you debrief with your clinical instructor or staff? It's hard when a patient passes; codes are hard because your adrenaline is pumping and then it just ends. Know that you and the staff did everything you could, but sometimes people are just that sick and there is nothing left that we can do. It will become easier in time

With the appropriate respect to those above me - -

You guys, those things are much easier to say after a number of experiences. Then the wisdom of your words can be better understood. And they are very wise. I'm not sure how realistic they are for someone who just experienced Patient Death #1. I don't think that getting to where you/we are now is a decision that can be made; rather, it's kind of a natural process over time.

Plenty of students haven't even laid eyes on a deceased human being who wasn't covered in an inch of make-up. That in and of itself can be a jarring experience.

OP - you are experiencing natural feelings. Let yourself process it. You don't have to feel anything in particular right now. Why don't you write/journal about your experience just to get some of your private feelings off your chest? Also, please ask your instructor to review this with you (debriefing).

It'll be okay.

Specializes in LTC, assisted living, med-surg, psych.

The first patient death is always the hardest, and we never forget it. Some deaths bother us more than others, but we have to carry on because there are more patients to take care of and it's our job to walk into the next room with a smile on our faces. You are not a nurse yet, but as others have said here, you will have to learn coping skills to deal with the inevitable, and there's no time like the present. This patient's death is a good place to start.

That being said, don't ever lose the awe and respect for the dying process and those who are going through it. Nothing is worse than a nurse who can't *feel*. It is a privilege to be there for a person in his or her final moments on this earth; while you can't allow your emotions to rule you, I hope you'll always be able to care.

I lost my first pt on Friday. I'm still in nursing school and happened to be in the ER for a clinical rotation and barely an hour in, a pt came in and required CPR...I performed the compressions and she was pronounced while my hands were still on her. I'm having a hard time with this. I can remember the feel of her bones under my hands and the sound of her breath leaving her. What can I do to get back on track?

How you move on depends on your preference and the support that is available to you.

First of all, it is very normal that the first death experienced keeps you somewhat busy - but it should not result in an all-consuming feeling or keep you busy to the degree you cannot focus on anything else.

It is part of most nurses work to deal with death and dying as well as after death care in many areas.

Personally, I view death as a normal occurrence, something that happens. I have spiritual beliefs that I find helpful. Working as a palliative and hospice nurse means that I am exposed quite often - sometimes it is good to share an experience that bothers me with my colleagues. Sometimes I feel that a spiritual ritual helps me to move on when there was something unusual about somebody's end of life.

A lot of people (me included) find it helpful to journal and write about things that need to be processed in some way. It is a good way of expressing the underlying feeling or realizing what is unsettling about an event.

If you need to see a counselor I am sure that your nursing school has some mental health services...

For everyone commenting that OP should just move on, I can only assume years of dealing with death have made you forget what it's like the first time you are intimately involved in another person last moments. Most people in the world do not experience this and death is not something we talk about freely outside of healthcare. I think seeing someone die, even if don't know them well, changes you just like seeing a birth does. OP, give yourself a little time. Also recognize that you did not "fail' the person or do anything wrong. CPR often does not work to revive a person. We all have this TV version of how CPR/resuscitation efforts magically bring back to life a dying person but the reality is that everyone dies at some point. Best wishes to moving forward.

These comments seem a bit harsh. This is a student. First compressions, first death. My first patient in nursing school died, and she was A&O x 3 the day before, we come back for clinical and learned that she coded and died.

Not everyone dies or is pronounced dead while your doing compressions.

I'm commenting even though its late, I'm exhausted, and I only accidentally read your post when looking for something else, but I felt compelled because some of the real ridiculous comments above from people who have lost all compassion and should rethink their careers.

Loosing your first patient is tough. I remember mine, a little boy and soft hair that had been accidentally left in a car. The blood spilled out of his little nose as by the time I was there to do compressions it was much much too late for anyone to save him. I will say, that you deal with it better with time when you get to see the good that you do. I had an amazing doctor whom, even 45 years into his career with accolades miles long, told me that what we are doing is postponing death and we don't always win, and that is not something to be too upset about because many times we do win.

If you're like me, that first code and lost patient hurts not because we feel like we really personally lost that person, as some of the more insensitive posters have claimed, but because our empathy allows for us to feel for the patients and their families in ways that do cause true grief and trauma. But through patience in your nursing practice and through rededicating yourself to the work you do, you will move on, and you will work harder, smarter, and continuously more thoughtful because of the experience. It is always okay to feel things in our profession and don't let any stodgy nurse tell you otherwise, as long as you harness these feelings to do good and be your best, you will be fine. If anything, my best moments in nursing have been those moments where I could hold someones hand and truly connect with them. I have ran many codes in the ED and likely helped save a lot of lives, but those hand-holding moments are the ones that have changed me and made me a better person and a better nurse.

Long story short, it's okay to grieve, but remember to focus on the good that we as nurses do. And most importantly, WELCOME to the greatest profession there is (biases accounted for ;) )

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