My first ever patient passed away..

[imaginations]

I'm a new grad nurse in my seventh month. I spent six months on the ward before moving to the ICU where I have been for a month now.

On my very first day on the ward as a registered nurse I met a month old baby and her family. The baby was known to have a life limiting condition and had an end of life care plan in place however she exceeded all our expectations and kept kicking on. Just before I moved to the ICU she was moved to the ICU as well.. In short, I've known and cared for this child and her family for seven months with the knowledge that she wasn't going to live.

She passed away on the weekend in the ICU, unexpectedly, with her whole family around her. I wasn't at work but my preceptor in the ICU texted me to let me know and the girls from my old ward who went to see her afterwards phoned me to tell me how peaceful she looked. They said that her mum wanted to make sure I knew. As people have started returning to work after their days off I've received more and more text messages and phone calls from other nurses who've heard and knew that I was very fond of this little girl to make sure that I was alright. I feel very lucky to work with such caring people.

However my question is this:

Is it unprofessional/crossing professional boundaries/inappropriate to care so much about this little girl? When I first heard I cried. & when the girls from the ward phoned me I was holding back more tears when they described how peaceful she looked. & then a song came on the radio this evening that we played for her constantly on her CD player and I burst into tears. I feel really sad even though I know that she isn't suffering anymore and I hope that she's in a better, beautiful place.

I spoke with my new graduate supervisor a few weeks about the fact that I was very fond of the baby and knew the family well. A few of the things she said really struck me, in particular that I shouldn't be thinking about baby at home. This worries me because I don't want to cross any lines but at the same time, I can't help but feel sad.

What is the most appropriate way to manage this?

[xstarsfallingx]

A death is still a death. Some people watch a new story about someone dying and they cry their eyes out. How are you expected to care for a child for months and not feel a loss? Nurses are not stoic robots who lose a patient and move on like they misplaced their keys for a minute. It's not healthy. I am not sure why some people feel this is the case. Pediatrics blurs the lines even more, especially with chronic patients. You did not call to ask about the child. What you think and feel at home is yours. Don't let someone make you feel guilty for FEELING or for second guessing your professionalism. I've lost a few patients in the last year and yes, it hurt. Their families even invite us to go to the funeral services. Now is that crossing the line? I'll leave that to you to decide, everyone has different moral beliefs. Personally, if nurses aren't given a chance to cope with loss too, we'd all go crazy before retirement.

[Glycerine82, LPN]

IMHO, it would be wrong not to care. The fact that you got so attached means you are in the right field. Bless you, I dread the day I lose a patient as young as that. The first time I saw someone die I left the room because I didn't think I was supposed to cry. Beast been one yet that didn't make me sad for many days afterwards.

"No day but today"

[Double-Helix, BSN, RN]

It's definitely not unprofessional or inappropriate to feel grief over the death of a patient- especially one who's care you were so involved with. We are human. We have feelings, we make attachments, we feel pain. Being a nurse doesn't change that. The only time it becomes unprofessional is when it interferes with your ability to provide quality care.

About six months ago we lost a patient who had been in and out of our unit for six months. He bounced between PICU and peds, with PICU stretched often lasting a month or more. He had a rare cancer and his prognosis was poor from the beginning. But being such a long-term patient, many of us got attached to him. I was caring for him the day that his parents decided to change him to comfort care only, and he passed away. I cried in the room with his family, other staff cried, I cried on the way home when I heard a song that reminded me of him, and I went to his funeral (along with several other staff members) and cried there as well. His family took such comfort in the fact that we cared so much about their child.

The first death is always hard. Your first code where the patient doesn't make it will likely be something you never forget. You won't be that attached to all your patients and some deaths will affect you less, and some will affect you as much, or more, than this one. It's normal, and grief doesn't make you a bad nurse. In fact, it makes you a better one.

[NickB]

There is absolutely nothing wrong with how you felt. I often go home for a long stretch and will call the unit to check on a critical patient that I was taking care of. I think the key is that you never ever make anything about you. We are human and we work with children who sometimes die and it is sad. There is nothing wrong with being sad. Heck, we celebrate with the family when patients who have been with us defy all odds and finally go home after months of being in the hospital. Is it wrong to be happy for them and show our happiness?

[rnkaytee]

I work in the NICU, not PICU, but I can still tell you the names of every patient I took care of that passed away. Of course you're going to think of that patient, especially if its your first. It is important to take care of yourself and get some counseling if you feel like the experience is getting in the way of moving forward and taking care of other kids. We see the best and worst in this job - and the worst really sucks. I take comfort in knowing that I did the best I could while I was taking care of them.

[la_chica_suerte85, BSN, RN]

I had a prof who is a pediatric hem onc nurse and there is one story she always tells of a pt dying that still brings her to tears. She said, though it wasn't appropriate that she attend the funeral even at the request of the family, it was appropriate to feel these feelings. It's hard for me sometimes to think of what pts go through, especially our older, lonely, more vulnerable ones and, though I know I can't be a sobbing mess everyday, I know I'm human and that it's okay to cry. In your case, it shows how much you want to care for these babies and even though this was her destiny, you cared for her in a way that still acknowledged the tremendous value and impact her short life had. Acknowledge it, let it process, don't fight it, and time will make it easier.

[hubcaps]

It is great that you are seeking advice from various sources because you'll get so many different responses. Everyone process death/grieves differently so there is no easy answer to how you should process this. I think the previous responses are great. My advice is to be aware of your own boundaries and learn where to stand with various situations. At times you may cross them but the risk may be worth it. Some of my friends have relationships with families years after their child's death, but it is part of the healing process of the the family and the RN. Knowing myself, I can't do that, but I am so grateful that there are nurses like them.