The Nurse Manager's Experience of Moral Distress

Abstract

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Being unable to observe patients achieve the outcomes that they would typically achieve prior to the pandemic led to feelings of hopelessness and lack of control ( 48 , 53 , 72 ) (United States, China). These experiences were also reported in HCW managers who described their own MD when managing and supporting staff, in addition to the MD experienced by their team ( 88 ) (United States). Conflicts between colleagues in patient care plan decisions and witnessing inadequate provision of care were described as a source of MD ( 83 ) (United States).…”

“…Given an early lack of clinical guidelines and evidence surrounding COVID-19, HCWs described difficulty deciding on and communicating an appropriate therapeutic course of action and a realistic prognosis in many cases ( 48 , 51 , 53 , 81 , 83 ) (United States, South Africa). Thirty-three articles (57.9%) discussed the idea of providing suboptimal care, representing diverse samples across the globe, including the Americas ( n = 15) ( 7 , 11 , 48 – 54 , 83 – 88 ), Europe ( n = 9) ( 56 – 58 , 60 – 62 , 89 – 91 ), Western Pacific ( n = 3) ( 70 , 72 , 92 ), Eastern Mediterranean ( n = 2) ( 74 , 93 ), South-east Asia ( n = 2) ( 67 , 94 ), and one from Africa ( 81 ) and another with a global scope ( 44 ). From these articles, three subcategories were formed: “PPE negatively impacting care”; “Inability to provide a good death”; and “Unprepared for novel tasks.” HCWs drew connections between providing suboptimal care or seeing patients dying alone and feelings of guilt ( 50 , 54 , 74 ), sorrow ( 11 , 51 ), worry ( 70 , 88 ), and powerlessness ( 72 , 84 ).…”

“…Concerns about the quality of care and support provided to patients were commonly reported ( 48 , 49 , 54 , 83 , 88 , 93 ) (United States, Canada, Iran). HCWs often reported feeling responsible for the patients’ outcomes and experiencing intrusive thoughts and feelings of guilt, despite following institutional recommendations ( 54 , 74 , 83 , 85 ) (United States, Lebanon).…”

Building Nurse Manager Well-being by Reducing Healthcare System Demands

“…6,7 Compounding competition for nurse managers' time and attention, many report having much accountability without the necessary authority to promote change. 8 Organizational leaders who empower nurse managers to make decisions create greater joy and meaning in work. 6,7 Nurse managers who are empowered to make decisions feel valued and extend empowerment to others to perform their jobs, creating cultures of trust over fear of failure.…”

“…Compounding competition for nurse managers' time and attention, many report having much accountability without the necessary authority to promote change 8 . Organizational leaders who empower nurse managers to make decisions create greater joy and meaning in work 6,7 .…”