Blog » When the ‘Right Thing’ Isn’t an Option

When the ‘Right Thing’ Isn’t an Option

Created Feb 13 2017, 07:00 PM by Lippincott Solutions
  • burnout
  • AONE
  • moral distress
  • patient safety
  • retention
  • Journal of Nursing Administration
  • quality of care
  • American Organization of Nurse Executives
  • job satisfaction

Tuesday, February 14, 2017

Health care is rife with opportunities to make a meaningful difference. On the other side of the coin, it’s a field where reality often falls painfully fall short of ideals: Budgets don’t support the nurse-patient ratio you yearn for. A physician insists on a medical intervention you consider unnecessary. Parents cling to vaccination beliefs you see as ill-informed and potentially dangerous to their child.

When health care professionals are prevented from doing what they see as ethically right, the result is moral regret. And when it builds, moral regret can morph into real moral distress and lead to burnout, warns a recent article in The Journal of Nursing Administration.

“Nurses who experience moral distress are more likely to feel angry, sad, helpless, frustrated,” explains the article, “disappointed, depressed, and physically and/or psychologically exhausted.”

But is moral distress simply part of the job? An annoyance best downplayed so you can move on to more practical concerns that really matter? If you’re tempted to dismiss it as such, don’t. According to the article, moral distress can play a significant role in several important areas, such as:

  • job satisfaction,
  • retention,
  • patient safety, and
  • quality of care.

So what’s a nurse leader to do?


“Leadership that recognizes and responds quickly to moral distress can have a positive effect on work engagement, nurse-physician collaboration, work environments, patient safety, and quality care,” continues the article.

Its authors — Carol Pavlish, PhD, RN, FAAN, Katherine Brown-Saltzman, MA, RN, Loretta So, MSN, RN, CGRN, and Julia Wong, BS, all of the University of California, Los Angeles —go on to present readers with an action guide they developed for helping nurse leaders and staff nurses cope with moral distress. Called “SUPPORT,” the guide has one primary aim: to promote a caring culture and a supportive environment for the people who work there.

Because when it comes down to it, support is key.

“Low levels of manager support are a significant predictor of higher levels of burnout and compassion fatigue,” according to the authors. “In contrast, leaders’ support of nurses increased nurses’ ability to practice ethically and take action in potentially distressing situations.”

(A quick side note worth mentioning, research conducted by the authors and covered in the article suggests moral distress may be higher among staff nurses compared with nurse leaders. The authors speculate nurse leaders may feel more empowered than staff nurses to act in ways that support their moral integrity, while staff nurses providing direct care may be exposed to potentially distressing situations more frequently.)  


Here’s a brief rundown of the authors’ SUPPORT guide for proactively dealing with moral distress among your staff.

  • See it, seek it out — Nurse leaders should be aware moral distress exists and actively look for it.
  • Understand it — Aim to understand the distress experienced rather than correct it or explain it away.
  • Pay attention — Assess the work culture for power issues and whether nurses who speak up are exposed to professional risks.
  • Promote receptive environment and engagement — Normalize discussion of ethical issues and change the environment so nurses don’t require courage to speak up.
  • Open opportunities for dialogue —Debrief, review and analyze ethically complex situations with staff.
  • Reflect, evaluate, revise — Encourage stakeholders to develop practices to ease future ethical conflicts, integrate ethics into performance reviews, and promote self-care to nourish resiliency.
  • Transform environment — Use resources such as the American Nurses Association’s Code of Ethics for Nurses and the American Association of Critical-Care Nurses’ Healthy Work Environment standards to promote positive work conditions.


In health care, moral regret is unavoidable. How it’s handled, however, can make all the difference.

 “Nurse leaders are in a pivotal position to create cultures of care that promote high ethical standards while also supporting nurses … [in] ethically complex situations,” the authors write. “Because moral distress situations often result in collective suffering of patients, families, and providers, nurse leaders’ ongoing assessments, focused attention and prompt action can make a profound difference.”

How is moral distress addressed in your workplace?