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She and her fellow nurses then must prepare the deceased for the mortuary-which sometimes involves the surreal exercise of shrouding the body, or wrapping it in plastic to better preserve fluids.

"Our environment usually does not allow us the opportunity to grieve," Weydt said, "and over time, that can take a toll."

Weydt and others say that despite the hectic pace of a nursing shift, a growing number of hospitals around the country have recognized that incidents of sudden death cannot go ignored. As a result, they have developed small and informal ways of coping with such occurrences, ranging from holding quick "debriefing sessions" right after the death with someone from social or psychological services to bringing in the hospital chaplain to hashing out the whole affair with each other over food and drinks after the shift.

"What helps me the most is talking with other nurses," said Laurel Galletch, MA, RN, nurse manager for medical/surgical services at Alta Bates Medical Center in Oakland, Calif. "We have informal debriefings where we'll step into a conference room and quietly walk through the events that just happened and how we feel about the loss of this person."

Many nurses say, however, that they ultimately try to come to grips with such deaths on their own. "I have a 40-minute drive from work, and I may cry the entire way home," Chichwak said. "You spend the whole day holding yourself together and doing what you have to do, and you need time to let go."

But most nurses agree that what would help is a greater effort on the part of hospitals to establish more organized outlets-from group therapy sessions to stress management seminars-for opening up.

"We desperately need it," Chichwak said. "It's so hard to find the time to talk to each other about what happens here, and it's hard to get this stuff off your chest at home. You need to be with people who understand what you're talking about." Weydt agrees. "We need to design a system that provides the staff time during their shift to process their grief," she said.

St. Joseph Hospital in Orange, Calif., is an example of a facility that has done just that. Katie Skelton, MSN, RN, vice president of patient care services, explains that officials at the hospital recently devised what is known as a critical incident stress debriefing policy. Within 12 hours after a particularly traumatic occurrence-including a sudden death-the hospital dispatches a team led by a specially trained stress manager to meet with employees and help them to better cope with what they've encountered.

"It's a way for us to help our nurses and other staff members stay emotionally and mentally healthy," Skelton said. "Police officers and firefighters receive this kind of attention and nurses should, too, because we also deal with such difficult life-and-death circumstances every day."

Family support

In addition to coping with personal feelings of shock and loss, nurses also must gear up to face the families. Family members often react to the unexpected death of a loved one with anger and frustration. They want answers-and they're not always polite about getting them.

"The family issue is a tough part of all this, and it really can wear on you mentally and emotionally," said Randy Smith, RN, nurse manager of medical intensive care at The Ohio State University Medical Center in Columbus. "You expect people to get loud and upset, but they can also get very abusive, and that's when it gets to you."

Smith said that the center has tried to create a less explosive atmosphere by dispatching a team from the various service-related departments of the hospital-pastoral and customer services, for example-to talk with families who have suddenly lost a loved one. "We want them to know that the entire hospital community is there for them and ready to address the many different issues they may have," he said.