How to Deal With Loss as a New Perioperative Nurse

When we start nursing school, we know there likely will be a time that we will have to face the one thing that we are constantly trying to prevent: death. Depending on your life experience, you may have already encountered death, but you will find that coping with death as an OR nurse is a little different and has unique challenges.  

Seeing the end of someone’s life is a difficult experience regardless of who it is or what their specific connection is to you. Life is sacred, beautiful, and cherished. To see someone pass from this life is jarring to say the least. As nurses, we are educated about comfort care at the bedside during someone’s final days and hours. But in the OR, there is no “bedside.” There is no holding a hand while they breathe their last. There is no comfort care in the OR. 

Usually in the OR, a death comes after a frantic attempt to stabilize the situation. Every single member of the surgical team is hustling to do all the little things that will hopefully edge the situation back to stable. We strain and hurry to beat death and then, suddenly, it’s there. And we stop and don’t really believe that it’s over. We are not given the luxury of time: noticing a decline, notifying family, initiating comfort care, and then preparing mentally for the imminent as we support the patient and their loved ones. For the perioperative nurse, it is often high adrenaline followed by an emotional crash as things abruptly end. 

Common Responses to Death 

Our first response is sometimes an overwhelming feeling of failure. Feeling guilty that we could have done more or even feeling like we aren’t as skilled as we thought we were. Most of the time, however, even if we could have performed perfectly, the end result for that patient still would have been the same. Even if you determine that you could have done better, it doesn’t necessarily mean that there would have been a different ending.  

There is also a sense of emptiness. We usually don’t get to know our patients very well other than their NPO status and what metal implants they have. When they pass without us really knowing their story, it can feel like a lost opportunity. The human connection in us inherently wonders about who they really were.  

The abruptness, no time to slow down and mentally prepare, feelings of guilt, questioning our skills, and not truly knowing the life lost can really create a complex grief picture.  

It is tempting to try and set aside the event and associated feelings and just move into the next task. Don’t give into the stigma that hiding it away or pushing it down will make it disappear. It won’t. In reality, it can make it grow. There is also a pervasive stereotype in nursing that we should be strong and able to move on without losses or hardships affecting us. But these things do affect us whether we admit it or not. It is not weak to use healthy coping mechanisms. In fact, not utilizing useful coping mechanisms will make you weak and burnt out. The only way to truly process these heavy situations is to go through the grief, not around it. 

Coping With Death  

The biggest help is to talk about it. Hopefully, after a death in your unit, your management team will offer a debrief. These meetings can be extremely helpful. If facilitated properly, it allows all team members involved to tell their perspective so that everyone can fully understand what happened. This allows for us to learn from the situation as hard as it is to do so. It can also help alleviate feelings of regret and guilt as you hear all the efforts that were made (and recognize your own) trying to spare the life.  

This also allows caregivers to share how they feel about what happened. There is something mysterious that happens when we talk about difficult events and our feelings about those events. While the listener can’t “fix” how we feel, just them listening helps the emotional burden seem lighter.  

You can also talk to a trusted friend. Someone who works in the same unit is a great choice as they will already understand the environment and are likely aware of the details. (Be sure that when you talk to someone, you abide by Health Insurance Portability and Accountability Act guidelines.) There are also online resources and apps that offer listening ears as you try to make sense of it all. If needed, seek out a therapist who can help you sort through the effects of the loss. Hospitals often have chaplains or connections to counselors for their employees. We aren’t given the luxury of mentally coming to terms with the loss, so we must do it after the fact through conversation. 

Finally, take a break. Sometimes just stepping away for a day and reconnecting with nature and your personal life can help you process the events. Remind yourself that you are a good nurse and have taken care of many people well. It wasn’t your fault. 

Conclusion 

The takeaway is to let yourself grieve. It’s okay to feel sad, mad, and uncertain. It is normal and it’s how we process difficult times. Express those feelings with a trusted someone and acknowledge the reality of loss. 

The odds are that you will have to deal with death eventually. As nurses, we do hard things that sometimes knock us down. Then we get up and do more hard things. Take care of yourself when going through loss: participate in debriefs, talk with a friend or therapist, take a break, and learn what you can to keep growing as an amazing OR nurse. Get help and support. We all need it, not just new nurses.