Nurses Coping with Personal Grief

Because nurses work so closely with dying patients....providing intimate care to the whole person...including physical, emotional, and spiritual care.....sharing in conversation the patient's fears and concerns...... we expose ourselves...our personal feelings. When patients die, we seldom allow ourselves to adequately acknowledge our own losses, or to fully comprehend the intimacy of our relationships with clients. Nurses Announcements Archive Article

How many of you have felt helpless or guilty when caring for a seriously ill or dying patient?

How many become overwhelmed with emotion after a particularly "bad death", or the death of a patient you have allowed yourself to become attached to?

What should nurses do to avoid the pain that such circumstances often cause?

Or are there appropriate ways to deal with these feelings?

Too often we think we are to be "pillars of strength" in times of crisis or death. While we provide supportive care to patients and families, we fail to recognize our personal need to process loss. We fail to see our need to grieve.

In order to offer compassionate care for the critically sick and for the dying, as nurses we must be able give of ourselves without being destroyed in the process. For self preservation, we may resort to ineffective coping mechanisms such as withdrawal, psychological numbing, and avoidance of personal involvement with patients. Failure to work through the grieving process leads to potential burnout.

As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by dying patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others.

What are some of the ways you have found to cope with the repetitive emotional strain that you face on a daily basis as you care for people in physical, emotional, and spiritual pain?

It is important that we see ourselves as humans and recognize the emotional reactions that traumatic events evoke in us. Acknowledgment of our vulnerability to tragedy is a fundamental factor in the way each of us handles the senseless losses we are faced with every day in our professional lives.

Feel free to share your stories of situations that have been particularly difficult for you to deal with. We can learn from each other.

I worked in the primary care setting as a MA for years. My perspective is a little different, because I was with patients for years at a time. I've had older patients pass, and been with patients from diagnosis to death.

I had a patient in my age range who had a type of osteosarcoma. My age - it was my "that is not fair moment". We were quite close, as was his family. I was with this man as he fought with every fibre of his being. He was amazing! But he didn't succeed and he did eventually go to hospice and died. I worked very hard with his physician to make sure that he was adequately medicated for pain, that he got the referrals to specialists that he needed, and eventually that he and his family got the hospice care he needed. I went to his funeral, and I cried. I had been with this family for several years. I knew about his work, his life, his girlfriend. He knew about nursing school and prereqs while I worked. His family came to thank the doctor and I for the care that all of them received. Before he went into hospice in his last office visit he told me that he thought I would be a wonderful nurse. That's a recommendation that I will never forget.

I think that sometimes to protect ourselves we distance ourselves from patients, and yes sometimes you need to keep perspective. These are not your best friends. But they are human beings, with lives and hopes and dreams, and sometimes those are cut short early. As they are in our own families, with our own friends.

I'm "only" a nursing student, but it seems to me a good cry once in a while never hurt anyone. We also are human beings, not just human DOINGS - we are more than the sum of our nursing interventions. We need to give ourselves permission to be, to feel, and to accept.

Sorry that's so long - but I obviously have some strong feelings on this one.

Very well written. It is so true when you speak that we as nurses have to at times, distance ourselves. Some of us do condition ourselves not to cry. When my beloved grandmother when into respiratory distress, she was put on hospice. A fiercy independent woman who shunned the thought of giving up her boyfriend or apartment and living with any of us. So on that last day, hospice was arranged as well as discharge to her home. Her well meaning children didn't understand that hospice would not be there 24/7. It was I that had to explain this to them after they practically attacked the poor hospice nurse. Then in their grief, things were said, feelings got hurt and some decided to leave to go eat and cool off. Again, it was I that had to tell them not to go because "grandma wouldn't be here by the time they got back". Then the attack was towards me, as if it was I who was taking her from them and not the granddaughter who loved her so! But as trained, I saw behind their anger, fear, and rage to their helplessness and sadness, and just took it. Within the hour she was gone. Everyone cried, even my solid as a rock father. Well, everyone, except me. It was so hard for me to understand at the time. This was the one and only person in the world that loved me unconditionally, and I could not cry. I did not even feel and I did not understand...me! Well, it took several days and then only away from the people that needed my strength, when I was alone, could I begin to grieve. And then began my inner scolding and confusion as to why it took me so long. It is only after several years did I understand that it was the nurse in me, that was there to 'help' others and that I had forgotten the fact that I was also a human. A granddaughter. HER beloved granddaughter that I could understand and forgive myself. You are wise to acknowledge your human side my friend! I wish you the very best!

Sian.........First let me welcome you to allnurses. I am so glad you found the site and especially am glad that you found my blog.

I feel your pain.....I really do. Part of the inspiration for writing this entry in my blog was the loss of my father a little of a year ago. Like you, I was Daddy's little girl, as well as "his nurse". He always looked to me for medical advice. But it became more emotionally difficult for me as his condition progressed.

Let me just share a few personal opinions and heart-felt advice.....from my experience.

As his daughter (who just happens to be a nurse), I could not just stand by and take off my nursing hat, so to speak. This was my most important patient......my Dad. I used my heart and my nursing knowledge to be the best advocate I could. I was able to do for him what no one else could...... He trusted me.

I know it is a difficult position for you to be in. You are a nurse who not only knows the implications of his tests, his condition, the doctor's words. But you are also his daughter. All of this affects you deeply. But your family looks to you to help them understand the doctor's words. They look to you for guidance in this most difficult time.

One thing that I did......rather than try to explain everything to my dad and the family......I helped him explore the questions he had and helped him direct these questions to the doctor. I let the doctor address these issues and made sure he explained things in a way that Dad and my sister could understand. Many times I would meet with the doctor before he entered the room and share my concerns. I felt this method allowed my dad to still have some sense of control. Plus, it placed the responsibility back on the doctor to do his job.

Of course I was at Dad's side as much as possible, which I would do even if I wasn't a nurse. But, I tried to take as many breaks as I could. It is important to eat. I didn't feel like eating much, but I made sure I left the room, even if it was just to walk down to the cafeteria to get a drink. You need to give yourself time to be alone......to regroup......to cry........to phone a friend......to pray. This is really important. I hope you have a good friend that you can talk to. You need to make sure to take care of yourself.

I don't know if you are a religious person or not, but there is a peace and a strength that passes all understanding that comes from the Lord at times like this. When he was able, my dad was at church every time the doors were opened. He had a very strong faith. We both found great comfort in the daily visits from the pastor. I would stay in the room for a short time, and then step out to let Dad and the pastor have some private time. I knew Dad had concerns and questions that he wouldn't address in front of me......... wanted to remain strong for his little girl. And the pastor and I had private time as well to address my own concerns. For me, this was instrumental. Spiritual needs are so great during these rough times. Even if you or your father are not religious, you still have spiritual needs. I would request a visit from the chaplain. He/she can address your needs, even if you are a non-believer.

For me it was impossible to not be a nurse. Any loving daughter would want the best care for her father in his dying days. As a nurse, you are able to provide things that others can't. Yes it is a difficult position to be in. But, you are going to grieve......whether you are a nurse or not. It will be painful now and in the days, weeks, months.......and years to come. For me, looking back........I am glad I had the special knowledge to insure that Dad got the treatment he needed and his questions answered. But more importantly...... this was my special gift to him.....My love. Yes it was and still is painful. It will affect you. You can't really stop the pain.....during or after. But you will know that you were there for him just as he was always there for you when you were his little girl.

I don't know if this has helped or not. I know you are going through a terrible time. Please let me know how things are going for you. You and your family are in my thoughts and prayers.

Thank you so much for this blog...I believe it will help many nurses. The position of being a nurse as well as a loving daughter is as you say 'a difficult position' at best. This occured the last time for me with my mother. A strong healthy woman all of my life as I knew it. Never sick. Never in the hospital. Then came the dreaded diagnosis of lung ca. She lasted a year through daily regimen of chemo with radiation, then just radiation, then more chemo/radiation. Then surgery. All seemed to go well til the follow up chemo. She only lasted through 3 treatments. The last thing she said to me (and only after everyone else had left the room mementarily) was "Well Rob, do you think I'l make it out of this one?" To which I assured her that she would. Then before we could talk further, family reentered the room. Always the one to reassure others and show her strength, she rested and told us to go home. That was the last time I ever spoke to her as she went into ARDS and was intubated before we could get to her. I have not been able to work as a nurse fully since then. I cannot forgive myself for leaving for leaving her. I still wonder did we do all that we could. My mind screams at me "How can you ever care for another human being again when you weren't even there for your own mother! When you couldn't even help her!"

Oh well, sorry....guess it's still raw. I know that I am not God. I know that I don't control life and death and butterfly I am soooo grateful that she had recently made her peice with God. That is at least a comfort. Don't know why I wrote all of this...it is terribly self-indulgent and full of self-pity, but I just wish I could find some peace! I loved nursing and know that I was able to help when others were not, but I just can't seem to get myself back there and well, I guess that I think if I can get this out enough times, peace will come if by no other way than I will get sick of saying it...of living it.

Thank you for sharing about how you made it through! Thank you everyone for being open enough to share! God Bless~

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

LockportRN...... If I may ask, how long has it been since your mother's death? I know following my dad's death, I had to take some time off. I could not even bear to go into the hospital. It was even hard for me to see people his age healthy and enjoying life. i know that may sound crazy......but it made me sad because my dad was no longer here enjoying life. Of course, I know he is in a much better place.....no more pain and suffering...... But it doesn't make me miss him any less.

I understand your feelings of guilt. I have had my share of that as well. Since I lived more than 700 miles from Dad, being the long-distance caregiver was hard. It was especially hard when I talked to him for the last time and realized he was probably dying. I am the one who alerted the nurses in the ALF that he was in trouble. I was the one who called the ER to be told that your dad is unresponsive and we intubated him. I am the one who tried my best to get to him in a chartered plane.....but I was too late. He died 30 minutes before I landed.

Not a day goes by that I don't think of Dad.....wondering what I could've done differently. I know he was living on borrowed time. In the 3 months before he died, I was at his house for over a month. I took him to the ER 3 times and he was admitted each time for a week. I know if I hadn't been there at that time, her would've died. But........like you......I was not with him when he did die. And....like you.....I did talk to him just minutes before he arrested in the ambulance.

Guilt is a hard thing to deal with. We can beat ourselves up with it. Your mother loved and trusted you. You were there for her throughout her care. You need to try to focus on that time.....the many special moments that you shared.

Don't apologize for wanting to talk about your grief. You are simply sharing from your heart----in a very healthy way--some of the pain you still have inside. Sometimes when we start to do this, something causes our social conditioning to kick in, and the myth that we are well beyond the "accepted" grief period causes us to feel guilty for talking about our losses. It doesn't matter how long ago your loss occurred or how many times you have already shared your story. If something is still weighing heavily on your heart, it is healthy....and healing......to talk about it. Give yourself permission to grieve for as long as you need to. Your loss has shaken your life, and it takes a long time to pick up the pieces and find a way to put them back together again

Butterfly thank you again for sharing and listening. I am a little ashamed to say that it has been 2 years Aug 7th. I have had 2 jobs since then, but felt 'disconnected'. So much so that I even called some of my nurse friends and former administrator to ask them "Was I any good as a DON or did I just think I was?".

I guess the hardest part is that in the end she asked me to watch over my little sister as "she is the only one that would have a hard time if I died". She didn't know how very much I still needed her. I guess as the big sister, I have always been responsible for her. As the eldest and most independent child, she assumed that I would be ok. Funny thing is, I am the only one that really fell apart. I am the only one of 11 children that is 'lost'. So many, many patients have I been there for, often at the end with no family in sight, and here, I was not there for her. I did not have POH for HC, and so I really did not have any say. I keep thinking of oh so many patients that had round after round of ABTs until FINALLY they turned the corner. Not here. Not for my mom. My brother insisted that she would not want to be on a respirator. And yes, she did sign a DNR stating this, but ... There is this constant "What if..." I have seen so many 'miracles' and I just don't know "what if...I fought harder...was more convincing....had stayed that night to be there when her fight became too hard!

Lord help me...I wish I could let this go. I wish I could find some peace. Wow, butterfly what a thread! I haven't cried like this in so long. I thought I was over it.

My heart goes out to you and again (not to sound redundant) thank you for sharing your heart with us. With me. Thank you because you have helped me to identify my issues with going back to nursing. May God bless!

Guess what...I was there, holding his hand. I still find other things to feel guilty about. Then I tell myself, "Enough, enough already, This IS NOT what Daddy would want for me. It's been 10 years since Daddy's death. Let it be already. (still talking to myself) Actually, it's like I can hear him saying, Get on with your life, Baby. (in a sweet way)

Daddy lived 500 miles away. I went on FMLA and went for a week or two at a time until I went through all my sick and vacation time. I had just received the papers to fill out for unpaid leave when he passed. I even feel a little guilty about that, like maybe I had said something when I really shouldn't have in casual conversation. 'I'm a loser, baby... Then I tell myself stop again.

I'm reading a wonderful book now by Wayne Dyer. He interprets the Tao verse by verse. It's called 'Change Your Thoughts, Change Your Life". I'm finding it very enlightening and comforting. It talks about your spirit going on forever. My Dad enjoyed reading books when he was going through his journey. I remember my sister got him the book, Conversations With God. He seemed to enjoy that a lot. Sian, maybe your Dad might like a book too. I know the Bible is always a good book.

I also really liked the part in Dyer's book about we are not what we do or what we've accomplished. We are all children of God supposed to love one another not judge and set external rating systems, which can be so much a part of nursing. Even if you do a 5 star job with patients if you don't ignore/tolerate the games encountered in an unprofessional and/or bullying work environment where the main goal is to avoid work and or helping one another equally, than you may be up the creek without a paddle anyhow, if you are in a will to work state.

Enough was enough. I tried to do something and lost my job too, the one I tried so hard to keep throughout Daddy's illness. It seemed so important then. I haven't worked in 4 years. I supposedly went out of the chain of command for help and got fired. My manager at the end, my last 4 years of employ, was not a nurse and definitely had her faves. I should've so not trusted her and not been so stubborn and transferred out like she suggested, but no, I had to give her the pleasure of firing me. Enough was enough.

I worked so hard there and only wanted to advance in my position like I had previously in the hospital area. I should've ignored all her assaults and unjustified write ups and left instead of losing 17 years time in this fine teaching level III trauma center of the mid south that I loved. I feel guilty I just didn't quit when Dad was dying.

I feel guilty and selfish right now for talking about this when Sian and other peoples loved ones are dying. I guess since the blog is about grief that's why.

Now when I really think about it why grieve a lost job these past 4 years when I could've been grieving, and even more fun, rejoicing really important Beings not things like a job. I let it become too much of me.

My nursing job was not who I was even though I have to say I loved it and spread as much love and healing as I learned and knew how. I hope I can spread some more here by sharing this. It seems to help me to know there are others out there who have felt the pain that is similar. Thanks for that, tnbutterfly, and everybody else too for sharing. It ain't easy. For today, I will go with the flow w/o judging (including myself) as much as possible and I wish the same for you all. :cool:

i lost my father to prostate cancer july 2008. :bluecry1: i started clinicals 6 months later. my dad and i were very very close.

everything reminded me of him... the iv stands, the meal trays, monitors, i mean everything!!!! the very first day i felt so consumed with grief but since i was working - there was no way i could sit and have a good cry. :zzzzz

i forced myself to push through it. i reminded myself that my dad would not want his death to affect my career.

i have never had to bury my emotions before, but during the first few weeks of clinicals - that is exactly what i did. i swallowed it up, and when i had brief moments where i felt on the verge of tears, i would distract myself with thoughts. such as, reciting the order of bed linens that go on the bed, making a mental list of the tasks i needed to accomplish that hour. after a couple of minutes of that line of thought, i was over my heart ache and ready to move on.

my biggest problem was working with a particular patient that: looked like my father, had prostate cancer, wore the same watch as him and always winked at me the way my dad did. for this patient, i always said hello and asked him how he was. but i realized immediately that i was associating him with my dad and worried about how that would affect my ability to work with him. so - i told my instructor about the loss of my dad and the patient. i asked to not work with him, simply because i knew that for me i would not be objective. she agreed that i would not be able to keep that emotional barrier up that nurses have to use to protect their hearts from losing patients. :redbeathe

now that i have more time under my belt since his death.... i work with hospice patients. which i never would have thought i could do, since a large majority of them have cancer. but you know what i have discovered- the pain that i went through, i can turn into experience, empathy and understanding for the patients that are going through the dying process.

i cant tell you how hard it is to lose a patient- but i can tell you that if you take that pain and tell yourself that you have to be strong for them & their families and you can have a good cry when you get home - it changes your perspective on things. :wink2:

now, i feel so blessed to be able to touch the lives of the patients i work with, as they also touch mine.

can it be painful - absoultely - but i remind myself that if they have the courage to face their disease- then i can have the courage enough to battle my own inner emotions and help them. :nurse:

Specializes in geriatrics, medsurg, group homes.

On the floor I work we deal with this from day to day. I work oncology. I don't think there is a week that goes by that either someone that we have had on a regular basis for chemo either passes away or has been told that there is nothing else that can be done.

Have I stood and cried with the patient and or with the family? Have I drove home and cried? Yes I have and I will probally continue to do so. Some have become so jaded that those tears have dried up. Hopefully I will never become like that. But also, not getting close to death is how some nurses cope, it dosent mean that they don't care.

When nurses laugh and seem like they don't care that is part of the coping mechanism. If they don't let it get close to them they can't get hurt.

Just remember don't loose the compassion.

Dear all,

Thank you for all your kind words & support, I haven't had chance reply, cos I've been back & forward to the hospital.

Dad died yesterday, after going drastically down hill on Monday, so, 2 weeks to the day, after we were given the diagnosis, which is a blessing for hime, as none of us wanted to see him suffer. Last weekend, we had a family get together, which was wonderful & despite him being very unwell on Tuesday, my family had chance to have a few laughs with him, which will feature a lot in my fond memories of him. I was able to stroke his head as he slipped away peacefully.

I will probably pop by here from time to time, still quite shell shocked, but I will get there.

Thank you again

Sian x

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
Dear all,

Thank you for all your kind words & support, I haven't had chance reply, cos I've been back & forward to the hospital.

Dad died yesterday, after going drastically down hill on Monday, so, 2 weeks to the day, after we were given the diagnosis, which is a blessing for hime, as none of us wanted to see him suffer. Last weekend, we had a family get together, which was wonderful & despite him being very unwell on Tuesday, my family had chance to have a few laughs with him, which will feature a lot in my fond memories of him. I was able to stroke his head as he slipped away peacefully.

I will probably pop by here from time to time, still quite shell shocked, but I will get there.

Thank you again

Sian x

I am so sorry to hear this. I know your heart is very heavy and you are overwhelmed right now........most likely numb from what all you've been through the past few weeks. I am so glad you were able to have some special family time and were there with him in the end. Hang on to the good memories and try to forget the painful ones.

Thanks for sharing this with us. Please feel free to come back as often as you need to. It helps to talk.

So so sorry, Sian, for the passing of your father. :crying2:

Glad you were able to have a laugh together that you will be able to cherish forever. Also, so happy you were there stroking his head. :redbeathe:redpinkhe Love and prayers are with you. Thank you for sharing. You help others heal. Thanks for that.:sniff::loveya::bow::loveya:

Dear all,

Thank you for all your kind words & support, I haven't had chance reply, cos I've been back & forward to the hospital.

Dad died yesterday, after going drastically down hill on Monday, so, 2 weeks to the day, after we were given the diagnosis, which is a blessing for hime, as none of us wanted to see him suffer. Last weekend, we had a family get together, which was wonderful & despite him being very unwell on Tuesday, my family had chance to have a few laughs with him, which will feature a lot in my fond memories of him. I was able to stroke his head as he slipped away peacefully.

I will probably pop by here from time to time, still quite shell shocked, but I will get there.

Thank you again

Sian x

Sian, my heart goes out to you and yours...you will be in my prayers. I too am happy for you that you got to have some final laughs with him. I will always remember mom's smiles and bravery in her last days. And the family time was invaluable too. Just remember, if you need us, we'll be here.

dear all,

thank you for all your kind words & support, i haven't had chance reply, cos i've been back & forward to the hospital.

dad died yesterday, after going drastically down hill on monday, so, 2 weeks to the day, after we were given the diagnosis, which is a blessing for hime, as none of us wanted to see him suffer. last weekend, we had a family get together, which was wonderful & despite him being very unwell on tuesday, my family had chance to have a few laughs with him, which will feature a lot in my fond memories of him. i was able to stroke his head as he slipped away peacefully.

i will probably pop by here from time to time, still quite shell shocked, but i will get there.

thank you again

sian x

i am so sorry. hugs to you and your family. here is a poem that was given to me when my father passed away, and since then i give it to the families of my hospice patients. take care of yourself - and may god bring you peace and comfort.... ~candace~

i think of you in silence

and often speak your name

but all thats left to answer me

is a picture in a frame

a million times i've needed you,

a million times i've cried

if love could have saved you

you never would have died

it broke my heart to lose you

but you did not go alone,

a part of me went with you

on the day god took you home

god saw you getting tired,

and a cure was not to be

so he put his arms around you

and whispered "come to me"

with tearful eyes we watched

and saw you pass away

and though we loved you dearly

we could not make you stay

a golden heart stopped beating

a hard working body at rest

god broke our hearts to prove

he only takes the best