Processing Patient Death: The Stages of Grief for Nurses

As nurses, we take countless courses, exams, and clinical experience before diving into our careers. But no amount of studying or clinical preparation prepares us for the death of a patient.

We work with people when they’re at their most vulnerable, both physically and emotionally, paving the way for meaningful connections. Unfortunately, this connection also makes a patient’s expected or unexpected passing all the more impactful.

While experiencing patient deaths is often an inevitable part of our journeys as nurses, it can be difficult to navigate the grief. However, it’s vital that you allow yourself to feel the emotions associated with the pain of loss, as it will help you heal and move forward.

Stages of Grief Nurses Might Experience

The seven stages of grief were first identified by Dr. Elisabeth Kübler-Ross and David Kressler. As death is an unavoidable part of health care in many instances, these stages are something you’ve likely learned in nursing classes in application to patients and their family members. But these stages can also be applied to ourselves.

Remember that not everyone will experience every stage in sequence or for a set period of time. You may move back and forth between stages, skipping others, before reaching acceptance. But these phases highlight the range of emotions and reactions people may have in the face of a loss.

When faced with a patient’s death, you might experience any or all of the following seven stages of grief:

1. Shock

Even in specialities where death is more common than others, it’s not always expected. Sometimes when you first hear of a patient’s death, you may not believe it or even process the information at the time. Perhaps they were just fine yesterday when you said goodbye to them at the end of your shift. 

The shock may make you feel numb or seemingly feel nothing at all. This stage provides an emotional buffer between yourself and the situation at hand, preventing you from feeling overwhelmed.

2. Denial and Isolation

While denial may exist as rejecting the reality of the patient’s death, it’s more common to deny whatever emotions you might be feeling. This can be especially true considering how fast-paced nursing work can be. Acknowledging grief can take time, and for many of us, time is a luxury we don’t often have on shifts.

You may continue to feel numb, and life can seem overwhelming and even meaningless. You may also isolate yourself to avoid confronting your emotions or situations that could trigger them.

Moving through this phase appropriately by giving yourself time allows you to experience the loss at your own pace, when and where you can handle it. As you move through the other phases of grief, denial and isolation will start to subside.

3. Anger

Anger can come in many forms. You may feel angry at yourself or a team member for “letting a patient die” or “not doing enough to save them.” You might channel that anger toward the patient or family if they didn’t take precautions or put themselves at risk. Perhaps you may turn your anger toward a higher power for allowing the death to happen.

For many of us, our anger may turn inward to how we feel. Maybe you’ll feel angry that your emotions are hindering your work or concentration.

While these emotions can be scary, anger is important to the healing process, as it promotes some level of connection with the grief. Some may struggle to feel or express their anger, but addressing it is necessary to move forward.

As with any stage of the grieving process, take the time to acknowledge all your emotions, including any frustration or anger. Let it vent out in appropriate, HIPAA-appropriate ways, so that you can move on.

4. Bargaining

Bargaining can present as trying to “make a deal” to spare the patient’s life, or at least to rid yourself of the emotions associated with their death. 

You may also find yourself bargaining in the form of “what if” statements, such as what might have happened if you had tried a different form of treatment or if the patient came into your facility sooner. It’s common to feel guilt and ruminate on the past during this phase.

5. Depression

After thinking about the past and what could have been done differently, you’ll eventually be confronted with thoughts of the present. At this point, we realize the reality of the situation, and many of the repressed emotions in the previous phases may rush in. You might feel intense sadness.

Depression following a patient’s death is a natural part of the process, although in some cases it may be appropriate to reach out to a mental health professional to help navigate these feelings.

6. Testing

In this phase, you may be seeking and trying out realistic ways to deal with the grief. You may be signing up for a support group, talking to a trusted colleague or friend, or even just developing new coping strategies. The testing phase allows you to start moving into your “new normal.”

7. Acceptance

The final stage of grief means that you have accepted the death of the patient and what it means for you moving forward. You don’t necessarily have to feel “okay” with the loss (immediately or ever), and you may not feel the same way as you used to about your work or the field. 

However, when you are in the stage of acceptance, you acknowledge the reality of the situation and are ready for your life to continue.

Tips for Processing Patient Death

It’s never easy to process a death, especially of a patient who was in your care. However, death is inevitable in nursing, and there are many ways to cope, so you can move forward and support the patient’s loved ones.

1. Take Care of Yourself

Grief affects the body and mind, and neglecting your own self-care can make the feelings of grief that much worse. Make sure you’re getting enough sleep, eating well, and exercising or moving regularly.

2. Acknowledge the Death

Take the time to talk to other people about the patient and their death (with express permission or with identifying details removed). This can be especially healing if you’ve witnessed a traumatic death or if your unit doesn’t frequently deal with the end-of-life process.

3. Seek Help If You Need It

If the death is particularly impactful, talk to your supervisor about the situation, or ask if they can refer you to grief counseling or spiritual care. You can also reach out to your state nurses’ association for additional resources, or seek out the services of a mental health professional.

4. Allow Yourself to Feel Joy

Even in a situation as serious and difficult as death, there will be moments of humor and joy. You may share a funny or heartwarming memory with the patient’s loved ones, or you may have a positive experience with another patient. 

Allowing yourself to feel these positive emotions can help relieve stress and allow you to move through the grieving process more easily.

5. Be Patient

There is no timeline for healing, and it certainly doesn’t happen overnight or all at once. Give yourself (and others) some grace, and remember that you will get through the pain.

Remember, it’s okay to grieve over a patient’s death. An important part of being a great nurse is our ability to empathize with patients. Although that can be painful sometimes, it’s an ability that makes us better nurses as well as better people.