I am working on a PhD is nursing and have worked in the field of nursing for many years (I got my RN as an Undergrad). Recently, I had a patient die, which has never happened to me before. I understand that people die and I know that I am not the reason why he died, but this is all on a very cognitive level. On an emotional level, I still am finding myself feeling both guilty about the death and not sure how to process my grief. I have tried talking to my peers and other people at the hospital, but everyone keeps looking at me like I am crazy or “weak” for being sad over this patient’s death. Do you know of any resources or grief support for professionals?

- Grieving Nurse

Dear Grieving Nurse,

You’ve articulated the issue very well – you understand on an intellectual/cognitive level that experiencing the death of a patient is probably an inevitable part of being a nurse, that the death is not your fault, and that there may not have been anything you could do to prevent it—but you’re still struggling with a lot of complex emotions that don’t necessarily follow the same logic.

This definitely doesn’t mean you’re “weak” or “crazy”! In fact, it more likely suggests that you take your responsibilities of caring for your patients very seriously and that you truly cared about this individual person. Even if you may not have had a particularly close relationship with the patient, it’s possible that this experience has triggered bigger existential issues. For instance, it can be relieving to think that you’re not responsible, but the flip side is that it can be pretty scary to think that there’s nothing you could have done and that sometimes these things are completely outside of your control. Or maybe it has just highlighted the fragility of life more generally. These are all common responses to a death, and your awareness of your reactions and your willingness to reach out and seek help in working through them is actually a real sign of strength! In fact, research has shown that those healthcare workers who “buck up” and don’t allow themselves to experience and work through their grief in such situations are more likely to experience burnout later on. [1]

It sounds like it could be helpful for you to seek some individual counseling to have a safe space in which to process and work through these reactions. You might look for a therapist who specializes in grief counseling, although many therapists who offer more generalist counseling are also well equipped to work with these types of issues, so it’s always a good idea to just ask when you call to set up an appointment. Your university likely has a counseling center for students (including grad students!), where you could get free or low-cost counseling. Additionally, if the hospital where you work has bereavement support specialists, they may be good resources for referrals to therapists. If you’re not aware of such specialists, you could also just ask a social worker for some suggestions.

Your colleagues seem to be responding in an insensitive manner, but it’s important to remember that you are definitely not alone in this experience. In fact, many healthcare professionals struggle with the loss of patients—so much so that entire books and articles [2] are written on the subject. There may also be some predicable patterns of how people respond to loss, but it’s also true that everyone responds a bit differently, which is normal. If you haven’t already, I would suggest that you talk with a trusted supervisor or mentor in your training program about your experience. They are not only likely to be able to make more specific suggestions for resources or referrals, but they are also likely to view this as an opportunity to learn about appropriate self-care (a very important professional skill). Your peers may not be able to identify with your experience (or they may be to be too afraid to acknowledge that they can, or be coping through avoidance), but a supervisor who has been working in the field and training other professionals for many years is likely to have a more helpful response. Granted, some supervisors are going to be more open to these discussions than others, so you might want to be thoughtful about whom you approach.

Good luck! This is a very challenging experience; however, accepting your reactions and making a commitment to process and work through them is likely to help you have more compassion and understanding for your patients (and maybe supervisees!) in the future.

--Dana Nelson, PhD

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