Navigating the Loss and Grief of a Nurse Suicide

Matthew S. Howard, DNP, RN, CEN, TCRN, CPEN, CPN; Michelle Buck, MSN, APRN; Holly Carpenter, BSN, RN; Kendra McMillan, MPH, RN


Am Nurs Journal. 2021;16(3) 

In This Article

Stages of Grief

Grief is something we all share. Meller and Wilson and Errasti-Ibarrondo have found that whether they experience the loss of a loved one, long-term patient, coworker, or friend, nurses' grief may have some commonalities.

Several models depict the stages of grief, but the most notable is by Dr. Elisabeth Kübler-Ross. In 1969, Kübler-Ross published her seminal work on the five stages of grief, On Death and Dying. Developed initially to explain the phases patients experience when coping with a terminal illness, Kübler-Ross identified five unique stages of the process: denial, anger, bargaining, depression, and acceptance. Over time, two stages were added: shock and testing.

In the initial stage (shock), the grieving individual may experience feelings of disbelief or emotional numbness. This intense feeling frequently is handled as though the loss doesn't exist. After shock begins to wear off, sorrow and anguish begin the second stage—denial. This common defense mechanism dulls the emotional shock of the news. This stage can consume the grieving person with sadness and remorse. They question whether they could have done something to prevent the event or they regret not taking the chance to make peace with the deceased.

These feelings of guilt frequently lead to resentment, which begins the anger stage. Many people experience rage and frustration exacerbated by a lack of control. They then begin to haggle in an attempt to negotiate the loss away with their psyche. This is the fourth stage of grief, bargaining.

Unfortunately, the inability to bargain away the loss and pain can lead to profound depression, which may result in self-imposed isolation and loneliness. Feelings of disconnectedness and loneliness are risk factors for self-harm and suicide.

Even during an overwhelming depressive state, reality eventually begins to approach. In the sixth stage of grief, testing, the bereaved person begins looking for realistic actions they can take to help their situation. The testing stage was added to address how grieving individuals begin to work their way out of their depressive state. They begin to feel as though they're managing their loss. They become more hopeful about life until they finally reach stage seven, acceptance.

In the acceptance stage, the grieving person comes to terms with their loss. Acceptance includes recognizing a loss or death and understanding that their reality has changed. They now acknowledge and endure the need to develop a new functioning reality.

The grieving process is normal and individual grief is subjective. No concrete order exists for how individuals progress through the stages, and not everyone will or should go through each or even all of them. Corr and Stroebe and colleagues suggest that identifying stages for bereaved individuals can be harmful and should be done with caution. If a person who's grieving believes they've skipped a stage, their healing process may be harmed.