How Nurses Can Grieve the Loss of a Loved One or Special Patient
10 ideas for touching the void
PJ Lykins, RN, is a rural hospice nurse who loses patients routinely, sometimes two or three in one day. She is so focused on the needs of the dying and their families that she sets aside her own feelings in order to tend to theirs. Her head tells her that losing patients is normal, the cycle of life and death, and part of her job, but in her heart of hearts she knows that it is all affecting her in ways she may not be able or willing to acknowledge.
Still, she does her duty as a nurse, goes home to tend to her family, and tries not to think about the toll that so much grief may be taking on her.
“You can’t break down,” she explains. “You have to be there for the families. But, on the other hand, you have to allow yourself to be human. When losing patients gets to a nurse, especially a hospice nurse, where we deal with death more frequently than nurses in other areas, we use fellow staff members to vent, like the chaplain or the social worker. Hospice teams seem to be on the forefront in helping nurses cope with losing patients. I’ve worked in a nursing home and a hospital, and neither setting really compares when it comes to a nurse receiving support over grief and frequent loss of patients. Most settings don’t encourage outward grieving.”
Penny goes on to say that there isn’t really much grief preparation or training incorporated into nursing courses, but thinks there should be. She adds that older, more experienced nurses sometimes talk to student nurses about the grieving process, and that this is a good informal resource to use if you‘re a new nurse struggling with grief issues.
“There is an especially high burnout, turnover rate with hospice nurses,” Penny says. “The hospice nurse lasts about two years, and then moves on to another area of nursing. I think a lot of this has to do with grief-related stress.”
All of the grief books, hospice books and counseling books in the world combined can’t begin to tell a person how to work through his or her grief because each person does this in their own way and in their own time. So the following article isn’t meant to be the definitive answer or quick study guide to the grieving process. That would be an insult. Rather, it’s merely a collection of suggestions to use when you feel alone, stuck or overwhelmed by your grief.
These suggestions were originally written by me as a social worker to assist in coping with the loss of a loved one. However, some of the ideas can be adapted to help with the loss some nurses feel at the death of a patient.
Sometimes you can get exceptionally close to patients even though you are told to do otherwise, but you are only human, so allow yourself this very human emotion.
1. Listen to music. It can be a song that you liked, that your lost loved one liked, that you both liked together, or something that speaks to and soothes your sadness, even music that brings on the tears. Music is a good way to coax out emotions that are harbored beneath the surface. Music can sometimes put a name to emotions when it is hard to speak them aloud. Let your tears be your words. Let music speak for you when you can’t.
2. Be alone with yourself. Unless you feel that you’re not safe being alone during your time of grief, then do set aside some time for yourself to contemplate, meditate, pray, remember, cry and think. It’s customary for family and friends to gather around a grieving person to share their pain, offer support and give their help, and that is perfectly fine. But be mindful to hear your own thoughts, feel your own moods, and comfort your own self with your own feelings of loss and sadness.
3. Write a letter. Sometimes it’s hard to know who to talk to, and even when we have someone to share with, words escape us in a time of grief. If you find it hard to talk about the pain out loud, then sit down in the quiet of the morning or evening, get out some paper and pen or a clear page on the computer, and write a long letter to the one who’s passed. Tell them how you feel, tell them about the emotions you’re having, positive and negative, tell them your regrets, your fears, your pain. You’ll find that writing your feelings directly to the one who has died is sometimes easier than saying them aloud to family and friends. When the letter is finished, seal it and keep it. Pull it out later, perhaps on the anniversary of your loved one’s passing.
Consider writing a letter addressed to the patients you have lost in the past who have touched you in special ways. This can help you deal with work-related grief.
4. Be with friends and family. This is the opposite of being alone, of course. As much as you want to be alone to nurse your own feelings, it’s also important to feel the support and concern that others around you are offering. We all go through grief at some point in our lives. We all feel it, even if it may be at different levels, and we all can both offer and receive words of kindness and wisdom.
Sometimes it’s overwhelming to listen to everyone who comes to talk to you, but listen and appreciate what they are saying. You don’t have to say anything back. No one expects you to have the answers or to have yourself pulled together. Just receive the compassion that is coming your way. Allow others to do something kind for you. It may be hard for you as a nurse to allow others to be helpful, but there are times when it’s okay, even beneficial, to be on the receiving end of such care and devotion.
5. Make a scrapbook. It’s something tangible you can do. Take small things and put them into a scrapbook of your loved one. Maybe it’s a ribbon they won in school, a movie ticket stub from a special date, a diploma, a folded handkerchief, button, comb or something else of significant meaning. You can even do this with patients that you lose if you have cared for them for any length of time. You don’t have to have a book for each patient, just make one of them collectively and put items in it as you acquire them.
This isn’t to say that a precious life can be summed up in a scrapbook. It could never be. But it’s a simple place to go when we want to feel close to the deceased and need something concrete we can experience in an often unreal time in our lives.
6. Get out the photo albums. It’s okay to look over the photos, to remember, laugh, cry and experience all of the emotions that come with viewing those tiny pieces of life frozen in time. Photos are a real record of a person’s existence and contributions to life. Some grieving people can’t bring themselves to look at photos, and that’s okay. Do it only if you feel comfortable.
Sharing photos is also a good way of getting grieving children to open up about their lost loved one if they’ve been reluctant to discuss their experience. Don’t hesitate to take pictures of you with your patients while they are alive, if they feel comfortable in doing so.
7. Do something in honor of your lost loved one. Your loved one would want you to carry on in a positive way and would not want you to be stalled in a perpetual state of bereavement. So one way to help you move out of your grief and into the rest of your life is to do something that honors their name. It may be planting a tree, donating to their favorite charity or finishing a project they have started—something totally unique to that person.
For the loss of one particular patient, or all of them as a whole, you can mount a bulletin board on the wall and place little mementos that represent who they were and what they meant to you. This is a good way to get bereaved children to work through their painful feelings, a way to focus on the celebration of the loved one’s life rather than the tragedy of their death.
8. Clear out the mementos, not the memories. Holding on to all of the clothes, belongings and mementos of your lost loved one seems like the right and comfortable thing to do. We all know of bedrooms that have remained untouched, desks that have never been cleaned out, garages that have never been reorganized, sewing rooms that haven’t been disturbed. We feel that holding onto the mementos of our lost one means holding on to the memories of that lost person, and that if we let go of the mementos, we let go of the person—but that couldn’t be further from the truth.
Our memories are in our hearts, minds and souls, not in fabric, glass, and wood. Take all the tangible items away, and what do you have? Memories. And those are the most powerful reminders of our loved one. The concrete things are just that. Things. Yes, a patient may have worn a particular hair ribbon every day. Yes, a rattle may bring memories of a baby when he was alive, but the rattle itself is just a thing. The baby lives inside your heart forever.
That doesn’t mean that you should throw out all that belonged to the person who died. Keep a few of the most meaningful, even put them in a scrapbook or small keepsake box, and donate the rest. The mementos in the attic can never represent the love you have for your dear one or be a symbol of the loss you feel or heartache you have, so let some of it go. Do it for the memory of the loved one, who will always dwell within you, regardless of how many trinkets you have or don’t have.
9. Visit a support group in person or online. It’s difficult to understand the loss of a loved one unless you’ve experienced it yourself. That’s why it’s important to share your loss and pain with others who have had similar circumstances. You can do this through a counseling or hospice agency in your neighborhood. Or, if you want to take a more anonymous approach, find one on the Internet. Either place will offer help from people just like you, who have been there, who are struggling to deal with the pain, who wonder if what they’re feeling is okay, and if they’ll ever feel normal or right again.
If you feel so overwhelmed with grief that you feel like you can’t live another day, do reach out and tell someone. It isn’t uncommon to feel that you want to die too, or join your loved one, but it is a sign that professional help may be needed. Grief is normal and we all grieve in different ways, but prolonged grief is a signal that extra attention should be given by a mental health professional. Be sure to have phone numbers handy should grief become unmanageable and unbearable.
There are support groups just for nurses, so this would be ideal for the nurse who loses patients and finds it difficult to confide in family or friends. If there aren’t support groups for nurses in your area, perhaps you could start one yourself. And if you have trouble sharing in a group, then you can participate anonymously via an online support group.
10. Help others through their grief. One of the best ways to help ourselves is by giving someone else what we need. You may find that talking to another grieving person or nurse actually benefits you.
A young woman losing her husband in an automobile accident may get more support and understanding from you, if you’ve been through a similar ordeal, than all of her family and friends combined. Remember to reach out when others are hurting and, as the old saying goes, “Give and it shall be given to you.”
Tammy Ruggles, BSW, MA, has over 10 years of experience as a social worker in the fields of mental health, hospice care and child/adult protection
Grief Over the Death of a Coworker
By Christine Contillo, RN, BSN
I walked into work recently to discover that our 31-year-old unit clerk had died in his sleep. There was no sign of substance abuse or chronic illness that I was aware of, but he had a long history of severe headaches. Vinnie was a marvelous, fun-loving man who kept our department running like a pro while attending nursing school part time, and we will all miss him terribly.
It’s the ache of missing him that brought me to the topic of nurses and grieving. Most of us have experienced dealing with death within our own families, and most will admit that the death of a loved one rightfully stirs up feelings of grief. But what of the death of a coworker, or even a patient that we’ve come to care about? Because we are nurses our relationship with our patients may begin with the fact that they are in poor health. Even professional friendships may thus be already headed toward loss. But all this doesn’t make this death any less consequential to us.
Loneliness results when we’re cut off from those we care about. My administration provided a grief counselor for us and closed the practice early to allow us ample time to attend the services. Afterward they provided a lunch so that together we could offer each other support. Nurses looking for ways to offer help can visit www.hospicefoundation.org, which provides valuable links to selected articles, teleconferences, professional education and suggestions for dealing with many aspects of loss.
Another source is WebHealing.com, an interactive grief website that has served this purpose since 1995. LCSW Thomas Golden is a specialist in the topic of healing and may serve a valuable purpose for those unable or unwilling to attend a group session.
While there’s a lot of information on family or friend grief and grieving, it’s harder to find ways to help nurses find closure with patient issues. I fear that much of their own grief work may go unresolved, increasing their emotional and job-related stress. First responders often have access to critical incident debriefing to help them, but I wonder how many staff nurses have ever had grief counseling available. If there’s a good program at your facility I’d like to hear about it.
Christine Contillo RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.