By Mariam Wisnewski, MSN, RN
As nurses, we are taught the value of saving the lives of our patients, young and old. I do not dispute that, but I am here to tell you that after more than 25 years of nursing the critically ill, saving lives is not all there is. Nurses have a unique view on life and death, one others often cannot and do not understand. My first rule, and one I insist will be on my own epitaph, is: Just because something can be done, doesn’t mean it should.
As a nurse, you are trained in assessment, diagnosis, evaluation and treatment. You focus on making your patients well, because that is what you are taught. But the reality is, even with the technological advances available to us in healthcare, we can’t save everyone. And death does not discriminate for age, economic status or religious affiliation.
Handling the loss of a patient is as individual an experience as the death itself, and one that most nurses will face many times during their careers. That’s why I believe nurses should be given the opportunity to learn about end-of-life care — a topic not traditionally covered in nursing school curricula — during their training.
End-of-life care will mostly come from experience over time, and it can be difficult to learn. But if you start your career as a nurse understanding that death is part of life, that it can be as peaceful an experience as it is allowed to be, and that it is sometimes the right and most compassionate thing you can advocate for a patient, you will be a blessing to your patients at the end of their lives, and to their families.
End-of-life care, and not just of patients but often moreso of their families, takes a special kind of nurse. You can teach yourself to be one of those special nurses by seeking information about who your patients were before they became patients. What was their quality of life? What was most important to them? Will they ever be able to return to their activities or lives they lived before? If not, consider helping them transition from focusing on treating to cure, to being made comfortable and freed from aggressive medical interventions.
Nurses mourn the loss of their patients and deal with that loss in their own way. I have always allowed myself to retreat to the break room and cry if necessary. The day I stop crying over the loss of a patient is the day I need to find another line of work. I also find comfort in being able to honor patients and their families after death. I facilitate their mourning, often attend viewings, and make sure the family’s needs are met before they leave the hospital after a loss.
I have lost count of the patients whom I have had to keep alive because they had not made their end-of-life wishes known or because family members disregarded those wishes, unable to accept the impending loss. We have an obligation as human beings, not just as nurses, to facilitate the honorable deaths of those patients whose chances for recovery have diminished to random miracle, or whose quality of life will never be the same.
Don’t be discouraged when you lose a patient for whom you have tried your best, or for whom no interventions have succeeded. It is not a personal failure for you nor the physician, who will often be more reluctant to stop offering aggressive treatment measures than you will. It is a necessary transition, and wherever you believe your patients go after death, helping them get there peacefully is a true honor of the nursing profession.
Mariam Wisnewski, MSN, RN, is a nursing practice specialist at Lee Memorial Health System in Ft. Myers, Fla.
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