Nursing is a job where exposure to grief and loss may be a frequent occurrence. The nurse is challenged with the difficulty of how to cope while working in a chosen career that continues to create these healthcare encounters, which can be draining to the spirit. The terms coined to help describe these phenomena: burnout, compassion fatigue, and more, only scratch the surface.
Nursing articles describing how to address these issues are abundant, but little attention has been paid to nurses who experience grief in their personal lives while balancing the emotional demands of daily practice. What happens to nurses who experience a personal loss at home and then resume a career that continues to challenge their grief work? I had that experience first-hand and want to share my thoughts.
A fundamental loss
The immediate work environment is an opportunity for nurse colleagues to support one another as friendships emerge. However, those individuals who are not necessarily part of the everyday work team may experience marginalization when faced with encounters in the clinical setting. For example, I work in academics and teach students in clinical settings. My clinical specialty was neonatal intensive care, but I currently teach fundamentals of nursing practice and general medical/surgical students in clinical settings. This makes me a functioning team member but outside the scope of knowing the team on a personal level to mobilize support. As a result of my 30+ year nursing career and care specialty, I am well versed in the loss that patients and families experience. I intellectually understand the stages of grief and the support provided to clinical patients experiencing grief and loss.
This certainly did not help to prepare me when my son died suddenly as a result of drug and alcohol intoxication at 24 years old.
It is hard to put into words how devastating this loss was for my family and me. At the same time, I experienced personal shame and doubt because I had no idea of the struggle that my son was undergoing. It made me question my own abilities as a nurse and care provider because I was naive about my son’s addiction. What kind of nurse was I if I couldn’t see the signs? How could I be so ill prepared and unaware?
My immediate co-workers in the academic setting were, of course, aware of this loss and tried to bring a measure of solace and support. At the same time, there was a certain sense of inconsolability. However, the loss was a fact and life continued. I needed to return to work and resume normal activities, which included clinical instruction. Again, I am a vetted guest in clinical areas when I work with students. I may work routinely in the same units but typically maintain a working acquaintance with staff nurses and team members.
Each opportunity to work with patients who had a history of drug or alcohol addiction became a personal struggle for me. Additionally, the staff and students I worked with did not know enough about my personal experience to temper their comments and cautiously express their opinions on individual patient cases regarding addiction. I will admit that I would have, in the past, expressed the evidence-based approach to treating patients. However, my own experience made each case much more personal. Comments that would previously have been a good post-conference discussion topic became painful to discuss and my perspective was certainly much more skewed and empathetic to the family experience.
For example, one of my students cared for a young man admitted to a long-term acute-care setting for kidney failure and compartment syndrome following a drug overdose. This patient’s condition resulted in bilateral lower extremity amputation in young adulthood. He would routinely request his I.V. push opioid with Benadryl for pain management. The nurses expressed concern that the patient requested the drugs together to potentiate the effect of the opioid. “We aren’t here to feed his addiction,” was a frequently expressed statement, and you could see the students working with these nurses adopting a similar attitude.
A student brought the case to post-conference for discussion, citing information from the chart that the mother was unaware of the son’s addiction. The student began the discussion with, “She must have been fooling herself if she didn’t know.” These types of comments reflecting the values and judgments nurses sometimes place on addiction caught me by surprise. Again, cases like these provide the basis for a good discussion at the conclusion of the clinical day. At the same time, the professional development aspect of nursing can move the discussion into more meaningful aspects of care, compassion, and empathy for the individual and family.
I began to wonder if my situation was unique and, unfortunately, found little in the literature to support this experience. I also found instances where this might occur with other nurses. Agency nursing, floating to other units within a facility, and travel nursing were a few examples that might create similar experiences for nurses.
I certainly do not propose a period of personal self-disclosure in these employment situations, which might be inappropriate. However, I believe this is a single example that asks all of us as nursing professionals to self-examine and try to connect more fully with the compassion and empathy that originally drew us to nursing practice.
My daughter recently graduated from nursing school and had a unique perspective having experienced this loss as a novice nurse. She stated, “Nurses wouldn’t hesitate to treat a patient for hypertension, but they have a completely different attitude toward addiction and the care these patients need.” This was a very enlightening statement for me personally and I began to wonder more about patient cases that challenge the nurse and maintaining empathy. A patient with diabetes who has candy on the bedside table, a recently discharged patient quickly readmitted after disregarding home instructions for medical management, a morbidly obese patient on a calorie controlled diet seeking additional food servings from dietary are just a few examples. Nurses find frustration in these clinical care situations but a colleague might have a personal issue they are working through or a family dynamic that is equally frustrating and find judgmental comments isolating and adding to their stress.
Supporting each other
Nursing is a rewarding profession, but exposure to patients experiencing significant pain, suffering, or loss can be emotionally exhausting. Nurses can offer a unique perspective within the work environment to provide support to one another as long as attitudes remain open to a caring approach. This includes patient interactions and also to other nurses. We, as a community of caregivers, cannot possibly know all that our colleagues are experiencing in daily life. However, it is important to recognize the impact of our attitudes and casual conversations on others: patients, families, and colleagues. Recognizing the positive impact of empathic nursing care is a first step and committing to the consistent delivery of caring approaches maintains the high regard for nurses now and in the future.
Nancy Urrutia EdD, is an assistant professor of nursing at Lorain County Community College in Elyria, Ohio.