Coping After a Patient Death as a Nurse

There is no right way to feel after a patient dies, and almost any reaction is normal: sadness, numbness, guilt, relief or nothing at all in the moment. What helps most is pausing when you can, talking with people who understand, and using the support available to you, including your employee assistance program. If the distress does not ease, that is a signal to get professional support, not a sign that you are weak.

Reactions you might have

Grief in nursing does not always look like crying. Common reactions include:

• Feeling numb and getting through the rest of the shift on autopilot
• Replaying the last hours and asking what you could have done differently
• Guilt, even when you did everything right
• Irritability, trouble concentrating or unusual tiredness
• Trouble sleeping, or dreams about the patient
• Sadness that shows up days later, triggered by something small
• Relief after a long or painful death, followed by guilt about the relief

You may also feel very little, especially in settings where deaths are expected, such as hospice or critical care. That does not mean you do not care. Feelings can build up quietly over time, which is why it helps to have habits for working through them.

During the shift

You often have other patients waiting, so you may not get much time. Small things still help.

• Take a pause. Some teams stop for a moment of silence at the bedside after a death to honor the person and the care everyone gave. If your unit does not do this, you can suggest it or take a quiet moment on your own.
• Postmortem care. Caring for the body per your facility's policy can be a meaningful final act of care. Ask a colleague to help, especially if it is your first time.
• Supporting the family. Families remember kindness. You do not need perfect words. "I'm so sorry" and simply being present are often enough. Involve the chaplain or social worker per your facility's process.
• Tell your charge nurse if you need a few minutes, help with your other patients or a lighter load for the rest of the shift.
• Step away briefly if you can: a short walk, a drink of water, a few slow breaths in the stairwell.

After the shift

The drive home is often when it hits.

• Mark the end of the shift. Some nurses have a small ritual: changing clothes before going home, a moment of reflection in the car, or telling themselves "I did what I could today."
• Talk to someone who gets it. A coworker, a nurse friend or a mentor. Friends and family outside healthcare care about you but may not understand the details, so tell them what you need, whether that is listening or distraction.
• Write it down. Some nurses keep a journal about patients who stay with them. It lets you process without having to explain.
• Cover the basics. Eat something, rest, and keep the plans that bring you comfort.
• Remember the person. Some nurses find meaning in recalling something specific about the patient, such as a story they told or the family member they adored.

Debriefs and peer support

Many facilities offer some kind of debrief after deaths, especially unexpected deaths or codes. It might be a quick team huddle or a scheduled session with a chaplain, social worker or peer supporter. Go when you can. Hearing that others feel the same way helps, and a good debrief is about support and learning, not blame.

Some hospitals also run peer support programs for clinicians after difficult events. Ask your manager, educator or chaplain what exists where you work.

Your employee assistance program

Most employers offer an employee assistance program (EAP), a confidential service that typically provides short-term counseling and referrals. Many EAPs include a number of free sessions, and some can be reached by phone at any hour. Check your benefits information or ask HR for details. You do not need to be in crisis to use it; working through a hard death is exactly what it is for.

When a death follows an error or unexpected event

If a patient dies after an unexpected event, or you worry that something you did or did not do played a part, the feelings can be much more intense. Clinicians sometimes describe this experience as being a "second victim." Follow your facility's reporting process, ask about peer support, and lean on your EAP. If there will be a review, your manager, risk management team or union representative can explain what to expect.

When to seek professional help

Grief usually softens with time. Reach out to a mental health professional, your primary care provider or your EAP if you notice:

• Distress that lasts for weeks or keeps getting worse
• Intrusive memories, flashbacks or nightmares
• Dreading work or avoiding certain patients or rooms
• Drinking or using substances more to cope
• Feeling hopeless, detached or unlike yourself

If you have thoughts of harming yourself, get help right away. In the US, you can call or text 988 to reach the 988 Suicide and Crisis Lifeline, or call 911 in an emergency.

Supporting a colleague

When a coworker loses a patient, a simple "That was a hard one. How are you doing?" goes a long way. Offer to answer a call light or help with postmortem care, and check in again on the next shift.

Cumulative grief

Nurses in hospice, oncology, critical care and similar settings may face loss often. Over time, grief that never gets processed can feed into burnout; see the impact of burnout on the nursing profession and these stress management techniques. Connecting with nurses who do the same work helps. The Home Health and Hospice Nurses, Oncology Nurses and ICU Nursing Professionals groups are places to talk with people who understand, and you can post anonymously in the community if you prefer.

If you are new to nursing, your first patient death may stay with you for a long time. First Year as a Nurse: What Actually Helps has more on getting through the hardest parts of that first year.

Next step

If you want to talk with nurses who understand what this feels like, join the conversation in the Working Nurses group.

General information for nurses, not medical, legal, tax or financial advice. Follow your facility's policies, your state board of nursing and the terms of your employer or contract.