Have you ever come home from a nursing shift in ‘moral distress’?
Almost 50 percent of 400 hospital-based nurses surveyed in New Zealand have considered quitting after struggling with moral issues beyond their control.
The ‘moral distress’ survey was conducted by Massey University School of Health and Social Services researchers.
Dr Martin Woods, a nursing ethicist who led the study, says preliminary results show 48 percent of nurses had considered leaving their current position and 16 percent were currently considering leaving due to moral or ethical difficulties.
“It’s very disturbing; half the nursing workforce at some stage have had such moral disquiet that they wanted to leave … Moral distress is a reality nurses are struggling with – and they are really struggling. Stories of burnout and leaving not just a given position but nursing itself must be taken seriously.”
Dr Martin Woods
The New Zealand Nurses Organisation is backing the study. Professional services manager Susanne Trim said it supported what the organisation had been telling district health boards for years. “There is a serious missmatch between the nursing hours available to meet patient needs. Ten years ago that was happening on occasions but now it is a more common occurrence and that’s what causes the rise in moral distress that the study has identified. That is also why we are seeing a large number of nurses reconsidering whether nursing is a career for them.”
Dr Woods said that moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of internal or external constraints.
The survey revealed five major issues of moral difficulty challenging nurses.
- Moral concerns over the delivery of less than optimal care due to pressures from management to reduce costs
- Watching patient care suffer because of a lack of provider continuity
- Working with nurses or other health care workers who are not as competent as the patient’s care requires
- Carrying out physician’s orders for what was considered by the nurse to be unnecessary tests and treatments
- Initiating extensive life-saving actions when the nurse thought she/he was only (unnecessarily) prolonging the dying process.
One participant summed up the mood: “I am considering leaving the job that I generally enjoy due to the lack of leadership and pressures from management to accept more numbers of patients or patients with high acuity of care with no increase in resources.”
Younger nurses aged 25-34, experienced higher moral distress (63 percent) than other age groups – a concern when the average age of the nursing workforce is over 40.
Nurse Uncut is sure that these pressures and dilemmas are present in Australian nursing too. Do you agree?
Image credit: Massey University
I felt I couldn’t continue working in Residential Aged Care.
Even after completing a Masters in Gerontology, I could no longer tolerate the systemic abuse of the most vulnerable of residents, at the hands of private providers ( both ‘For Profit’ and ‘Not For Profit’ groups ).
Working with people who have no chance of recovery, no quality of life and in an environment where MONEY is all that counts … I couldn’t do it any more!
I totally agree with Gordo.
Until we force a judicial enquiry nurses will not feel free to express all their concerns. June
As a mature age new grad I thought it was ‘just me’ – that maybe my expectations of nursing as a caring, patient-centred profession were too high. I can totally relate to moral distress (such a good term) and I’m only 6 months out.
Moral burnout is what killed my love for my chosen profession. Actually, it didnt kill the love, it just killed my ability to remain working within the profession.
As a midwife of 25 yrs experience, I came to feel completely useless against the apparently ‘safer’ medical model we embrace in this archaic country.
Two critical incidents sealed my fate. 1. We tried to attract the medical attention for a primip in labour who ‘wasnt right’. Couldnt identify why, we just knew something was going wrong. We got prioritised behind 3 emergency ! c/s for serious ( not) issues like pushing for more than 1.5hrs as policy states… All too late, the primip started pushing … had a stroke … died on the bed. My highly developed intuition skills meant NOUGHT within that juggernaut.
Secondly, a celebrity primip hellbent on telling us she had been in labour for 3 days was granted an epidural at less than 1cm dilatation. Whereupon she sat up in bed, did her hair, rang her celebrity husband (who insisted upon telling he was %^^%^%^% 3 times… (*yawn*) and said ‘How will I be able to tell when the baby is ready to be born?”… oh FFS.. Did I look like the cleaner instead of the highly skilled professional I was?
I still cry for the loss of my profession. I cant see any model in this country that will meet my needs for being respected for my knowledge whilst working within a medical system that offers support and help when the situation steps out of the guidelines of ‘normal’ birth.
Increasingly over the last few years I have become disillusioned with age care providers not caring about the elderly. Too often I have experienced less than poor management, untrained and often uncaring staff and disassembly of the model of holistic care which we worked so hard to attain. Lack of support for good staff is continuing to become a big issue with an ‘anything goes’ approach from management. Morally and ethically it’s very difficult to remain in an aged care system that is worse than it was 25 years ago – how did this happen?
Helen, it happens because we have an Aged Care system that relies upon the (false belief) that the NGO care providers are (actually) doing a good job. We as professional nurses know that is not the case.
Aged Care is about making money from Fed. Govt. handouts and grants – it is not about a system of NGOs actually caring for the Aged. They are a component of the system, but not the real reason NGOs want to be involved.
Today, a message came through, via the NSWNA – the ABC is doing a follow-up story on anti-psychotics in Aged Care (especially residential Dementia residents). They want staff to speak up about their personal experiences in situations where residents have been ‘abused’ by excessive doses of anti-psychotics etc.
When I have participated in these exercises in the past, I have been victimised by employers and my own mental health suffers as a result.
I would love to talk about my past employers in Aged Care, but I don’t want to risk my current employment situation by being seen to (continue ) to be an agitator.
Really, by asking staff to go ‘public’, they are effectively placing those staff at risk of professional suicide.
Gordo, as you know, that request for people – staff, relatives – to speak about over-use of drugs in nursing homes came from Alztheimers Australia and is for a possible ABC current affairs story. Certainly everyone should think carefully before agreeing to be on the media and make sure that they trust the journalists and media channels that are involved, but it is very important for nurses to make their stories heard – even if under the cover of an alias, as we offer here on Nurse Uncut.
So, the fallout from the ABC’s show has now sparked a witchhunt for those who put it together and perhaps those nurses who voiced their opinions/concerns.
Govt. agents will always come after you, if you have a case against the Govt.
It’s ‘Craig Knowles’ all over again …
Here is the biggest ethical dilemma. Every day nurses care for patients with diseases that are being controlled by drugs. However most of these diseases are curable and the doctors never bother to tell the patient. How can we live with ourselves? Doctors and drug companies make a fortune by creating illness then treating the symptoms as though they were separate diseases. But in today’s world a good nurse is one who is as ignorant as the patient or at least pretends to be and thus just goes with the flow.
Doctors don’t tell patients that most of the health problems we simply control today were preventable and curable in the past. Medicine hasn’t moved forward, it has moved backwards and it has done this because there is more money in treating disease than there is in curing and preventing disease. I am talking about strokes, coronary artery disease, hypertension, macular degeneration, retinopathy, renal failure etc.