How to deal with the loss of patients during the COVID-19 pandemic

To a certain degree, nurses are trained to deal with death and dying. Even insensible morbidity and mortality–like the COPD patient wheeling themselves off hospital property to go for a smoke right up until the day they pass, or the noncompliant diabetic rolling into the ED for yet another round of ketoacidosis management. We can recite end-of-life care plans, reflect on the  importance of palliative care, and willingly participate in staff debriefing sessions after particularly hard losses. 

It’s not just the death of our patients that affects us.

We bear witness to the pain of the families left behind, often in a state of shock. We hope they had meaningful last conversations with their loved ones. We, too, feel comforted by the mercy of  closure for both our patients and the ones who will grieve their absence. Most of the time, we take it in stride–after all, it’s part of our job. 

But death is still death. 

The COVID-19 pandemic has left us all reeling from the sheer number of lives lost. How could it not? We’re human, and death rocks our existential boats; even the seasoned nurses who have learned mechanisms to cope with loss–they still require steadying in a strong storm. Each new nursing survey returns bearing the same troubling news: nurses are more anxious, depressed, and burnt out than they have ever been before.

The continual waves of COVID variants, vaccines that haven’t brought us the relief that we had hoped for, and yes–the continued loss of patients from these two factors have only added to a lingering feeling of senselessness. 

In addition to the routine demands of our careers, nurses now must learn how to manage the feelings of grief–both personally and professionally–as part of our job requirements. Everyone experiences grief in different ways, and with varying degrees of intensity. Common symptoms of grief include sadness, anger, apathy, helplessness, and frustration. In a prolonged state of grief, finding joy in anything becomes even more difficult–but nevertheless, important. 

It’s important to highlight the different ways nurses experience grief based on years in practice; for newer nurses, grief can be overwhelming, causing them to question everything about their career choice and diminishing their overall ability to cope. For more seasoned nurses, compassion fatigue and exhaustion can result. 

For all, being repeatedly subjected to suffering significantly affects well-being. Feelings of anxiety and anger mingle and snowball into a growing sense of profound irritation. The stress from this can start to impact one’s physical health as well as their mental health. 

So, knowing all that we do about death, dying, and stress management, what’s a nurse to do when it comes to  carrying on? There are several methods to deal with the madness.

• Name it – Being able to name what you’re feeling is the first step in coping with loss. Expressing whatever emotions might be coming up for you in a safe space–among co-workers, in a therapist’s office, or perhaps, in an online community of like-minded nurses grants you the permission to expunge them from your body. We all have had those moments of release in a med room, break room bathroom, or alone on our commute home in the form of hot tears, but being able to do so in the company of others who get it allows for an added layer of support.

• Meaningful routines – It sounds trite, but getting enough sleep, fitting in nutritional meals, and engaging in exercise consistently are very important in times of stress. Mental health and physical health are intertwined. When one system is under duress, making the effort to keep the other in check can give you a sense of control over your entire being.

• Delve into spiritual practice – Meditation, yoga, conversations with religious providers, Bible study, hikes alone in the woods–whatever connects you to The Bigger Picture/a Higher Power can help tremendously to turn down the anxiety dial. If ‘spiritual practice’ is a term that leaves you without recourse, simply following a curious mind into its possible benefit can provide a welcome respite.

• Uphold boundaries – The continued loss of patients at work from COVID is outside of our control–no matter how much we strive to care for and heal them. Therefore, separating oneself from this very environment is tantamount to our being able to return to it. We all know the term ‘work-life balance’ but that only comes from actively setting and maintaining boundaries between the two. Having after-work rituals, taking PTO regularly, limiting overtime shifts, and making defined efforts to “leave work at work,” are key, especially when our shifts are filled with loss.

We as nursing providers now see the writing on the wall–there likely is not going to be any “return to normal” when it comes to COVID. While we are all making course-corrections in real time to make it through each and every shift while bearing the load of this knowledge, know that you are not alone in your struggles with grief. One of the best and certainly most important things you can do when you are feeling overwhelmed by feelings of grief is to reach out for help. As professional caregivers, we must honor our own health as much as our patients’.