Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic

Sheppard, Katherine N.; Runk, Barbara G.; Maduro, Ralitsa S.; Fancher, M.P.H. Tonya L.; Mayo, Andrea N.; Wilmoth, Donna D.; Morgan, Merri K.; Zimbro, Kathie S.

doi:10.1097/ncq.0000000000000596

Cited by 52 publications

(71 citation statements)

References 24 publications

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“…The moral distress nurses face due to system-related factors [50] and their work environment [51] could increase turnover intention. Moral distress is connected to perceived quality of care [80], which itself was shown to be associated with turnover intention [40,53] in this review.…”

Section: Organizational Factorsmentioning

confidence: 99%

Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

2022

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Background During the COVID-19 pandemic, shortage of nursing staff became even more evident. Nurses experienced great strain, putting them at risk to leave their jobs. Individual and organizational factors were known to be associated with nurses’ turnover intention before the pandemic. The knowledge of factors associated with turnover intention during the pandemic could help to foster nurses’ retention. Therefore, this review aims to identify factors associated with nurses’ turnover intention during the COVID-19 pandemic. Methods After a systematic search of six databases, the resulting records were screened in a two-step process based on pre-defined inclusion and exclusion criteria. The included quantitative studies were synthesized qualitatively due to their methodological heterogeneity. Results A total of 19 articles were included in the analysis. Individual factors such as health factors or psychological symptoms and demographic characteristics were associated with nurses’ turnover intention. Organizational factors associated with turnover intention were e.g., caring for COVID-19 patients, low job control or high job demands, and moral distress. Resilience and supporting leadership could mitigate adverse associations with turnover intention. Conclusions The results help to identify high-risk groups according to individual factors and to develop possible interventions, such as trainings for nurses and their superiors, addressing individual and organizational factors. Future research should focus on longitudinal designs applying carefully defined concepts of turnover intention.

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Section: Organizational Factorsmentioning

confidence: 99%

Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

2022

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“…Ideally, an integrated continuum of care approach should be instituted, including E-Mental Health Interventions (21), crisis leadership consultation and training, staff peer support teams, multidisciplinary rounds, recreation spaces, wellness programs, support groups, and psychological/psychiatric services (29)(30)(31). Such coordinated programs may be cost-effective because of their positive effects on absenteeism and turnover (32,33). A problem may be that hours devoted to staff support usually are non-billable.…”

Section: Specific Services Of Covid-psycare For Hospital Staffmentioning

confidence: 99%

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland

Schaefert

Stein²,

Meinlschmidt³

et al. 2022

Front. Psychiatry

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement.MethodsWe conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services.ResultsWe included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that “COVID-19-related psychosocial care” (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential.ConclusionMore than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support.Trial RegistrationClinicalTrials.gov NCT04753242, version 11 February 2021.

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“…Studies of moral distress related to the COVID-19 pandemic have reported that approximately 60% to 80% of health care workers have experienced at least some situations that generate moral distress [ 9 – 13 ]. However, the intensity (severity) of moral distress among health workers during the pandemic, in those studies that reported mean moral distress levels, has been found to be low in most [ 11 , 13 – 21 ] though not all [ 22 – 24 ] studies. Among these studies, some assessed the intensity of moral distress for specific situations [ 15 , 20 ], some assessed both the frequency and intensity of moral distress for specific situations [ 13 , 14 , 17 , 18 , 21 , 22 , 24 , 25 ] and others assessed it with a global measure of moral distress without anchoring the assessment to specific potentially-morally-distressing situations [ 11 , 19 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the intensity (severity) of moral distress among health workers during the pandemic, in those studies that reported mean moral distress levels, has been found to be low in most [ 11 , 13 – 21 ] though not all [ 22 – 24 ] studies. Among these studies, some assessed the intensity of moral distress for specific situations [ 15 , 20 ], some assessed both the frequency and intensity of moral distress for specific situations [ 13 , 14 , 17 , 18 , 21 , 22 , 24 , 25 ] and others assessed it with a global measure of moral distress without anchoring the assessment to specific potentially-morally-distressing situations [ 11 , 19 , 23 ]. The systematic reviews by Gianetta and colleagues [ 1 ] and by Tian and colleagues [ 26 ] provide comprehensive discussions of instruments that have been used to measure moral distress.…”

Section: Introductionmentioning

confidence: 99%

“…Most of the studies were based on non-U.S. samples [ 9 , 10 , 13 – 15 , 17 – 23 , 25 ]; applicability to the United States, given differences in health systems, and organizational responses to the pandemic, is unclear. The studies based on U.S. samples [ 13 , 16 , 24 ] assessed moral distress among health workers at one [ 13 , 16 ] or two [ 24 ] medical centers in the Northeast United States and the findings may not be applicable to physicians throughout the U.S.…”

Section: Introductionmentioning

confidence: 99%

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A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

2022

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Background There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. Methods We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. Results The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. Conclusions The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.

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Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 52 publications

References 24 publications

Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

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