The Lived Experience of Work-Related Loss and Grief Among Pediatric Oncology Nurses

Teresa M. Conte, PhD, CPNP


Journal of Hospice and Palliative Nursing. 2014;16(1):40-46. 

In This Article


A qualitative research methodology was used to analyze interviews conducted with pediatric oncology nurses with the goal of gaining information about how they experienced work-related loss and grief. The results yielded five major themes and demonstrated positive and negative effects of work-related loss and grief on pediatric oncology nurses.

Participants described the connectedness they felt from having formed bonds with their patients and patients' families. Being connected to patients assisted the nurses in providing holistic care to their patients. In multiple studies investigating the grief responses of nurses, subjects spoke about their feelings of a perceived connection or bond with their patients.[13,14]

While close patient bonds are mainly viewed as being positive, the close nature of these bonds intensifies emotional reactions to work-related losses. Nurses in this study reported reactions that were similar to nurses from other studies.[13,15]

Nurses shared the importance of being connected to their fellow nurses. They used these connections to establish a support system that they relied on to help them process emotionally difficult work-related situations. Nurses relying on fellow staff for support has been well established in literature.[16,17] Nurses in this study detailed how peer-to-peer support allowed them the opportunity to process their grief and make meaning from their patient experiences.

Nurses felt alienated by those who view the specialty of pediatric oncology nursing as intensely depressing. Comments made by individuals such as "That is so sad. I could never do that…" instantly made the nurses reluctant to share any other details of their jobs for fear of upsetting others. In addition, nurses used "purposeful" alienation with their loved ones so as to not cause them any duress from hearing their work-related stories. Nurses felt the need to protect their loved ones from work-related losses that were experienced. However, by the nature of alienating their loved ones in order to protect them, the nurses alienated themselves from the support of those loved ones. It appears that this phenomenon is similar to emotional distancing that is used by nurses to work through emotionally devastating work-related losses. Emotional distancing has been described as periods when nurses allow themselves to either express or repress emotions in the event of a patient loss. Emotional distancing allows nurses to continue to fulfill their professional responsibilities in the face of work-related losses.

Participants in this study detailed how they utilized alienation or emotional distancing to maintain control over their emotions during intense patient care situations. Nurses described the importance of controlling their emotions in order to continue to provide quality patient care.

Nurses discussed the difficulty of having to continue working after a patient loss, and most stated that there was insufficient time to process work-related losses at work. Some nurses explained that they struggled to continue to fulfill their professional responsibilities in the event of a patient loss.

Nurses reflected on the sense of meaning in their work and how they obtained it. The ability of nurses to derive meaning from their work with dying patients often centers around the nurses feeling that they did everything in their power to assist their patients at the end of life. Nurses in this study reflected this idea and spoke about feeling a sense of professional accomplishment when they perceived themselves as providing a caring and compassionate experience for their patients. They also described having a better appreciation for life as a result of working with their pediatric oncology patients.

The concept of having a positively altered life view as a result of working with patients has been reported in the literature.[13,18] Findings of this study were similar, as participants spoke about how their work in pediatric oncology made them more appreciative for life and less likely to worry about things they cannot control.

A unique thread that presented itself in this present study was the negative perceptions of pediatric oncology by laypersons. The negativity expressed by the laypeople centered on the perceived sadness that they believed permeated the specialty. These beliefs caused some distress among participants as they felt they had to explain their choices to practice in the specialty of pediatric oncology. This idea has not been discussed in other research studies.