Moral distress, coping mechanisms, and turnover intent among doctors, nurses, and in-home or community care providers in British Columbia

Abstract

Objectives:Moral distress has been identified as both a contributor to healthcare worker attrition as well as an outcome of it. To this aim, our study applies intersectional analysis to explore moral distress levels among doctors, nurses, and in-home- or community-care-providers in British Columbia, Canada with a specific focus on the intersection of race and gender identity. Furthermore, it aims to identify which experiences were more distressing, and the predicted turnover intent for each intersecting identity and profession.Methods:We conducted an online survey of 1,314 healthcare professionals from all health regions of BC. Our descriptive analysis was stratified by the participants’ profession. The categorical variables included age, gender, racial identity, migratory history, and type of work contract. The continuous variables included a moral distress score (range: 0 to 144) and a mitigation score consisting of 11 distress-coping strategies (range: 0 to 275).Results:Nurses had significantly higher moral distress scores compared to physicians and in-home- or community-care-practitioners (H-CCPs). Only 24.7% of physicians had considered leaving their position or had already left, compared to 61.3% of H-CCP, and 72.7% of nurses. White women had significantly higher moral distress levels than White and Indigenous men, whereas women of colour were more distressed than White men, though these differences were no longer significant after adjusting the scores by profession. Men had higher mitigation scores than women across all groups. Sources of distress and mitigation strategies differed across identity groups. White men had a significantly lower turnover intention (15.3%) than all other groups. Conclusion:High distress scores and turnover intention responses, particularly among women and racialized healthcare workers indicate an urgent need to address the root causes of moral distress.