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Nurse Retention: Nurses Encounter Moral Distress

Written by LeAnn Thieman, CSP, March 4th, 2014

When nurses encounter ethical dilemmas in situations where they can’t do what they consider “the right thing,” they experience moral distress. Some have the courage to speak up or take action, others do not. This has a profound impact on nurse retention.

“There is such a moral burden to witnessing the suffering of patients and trying to balance the suffering vs. the benefit, and the complexity of decisions that can be made in the acute-care setting,” said Mary K. Walton MSN, MBE, RN, nurse ethicist at the Hospital of the University of Pennsylvania. “The basic questions are ‘What is the right thing to do?’ and ‘What makes it so?’”

Part of nursing is the relief of suffering, but complex interventions often cause patients to suffer while restoring them to health.

Carol Pavlish, RN, PhD, FAAN, associate professor at the UCLA School of Nursing in Los Angeles, has studied early indicators of ethical challenges nurses face and has developed some strategies for helping them.

“Challenges primarily had to do with watching patients suffer, which nurses find is unnecessary suffering,” Pavlish agreed. Nursing interventions may increase the patients’ suffering without necessarily improving an outcome.

Pavlish found nurses were also concerned that patients and families were not fully informed about treatment options and their clinical prognosis. Some question whether the patient voice was represented. For instance, advance directives were not being followed because families wanted something else.

Nurses often come to Walton with concerns about informed consent, pain and going beyond a common goal, but dilemmas in nursing ethics are not limited to end-of-life care.

Moral distress is when nurses and healthcare givers feel they know the correct action but cannot carry it out because of their organizational environment.

The American Nurses Association (ANA) responds to members’ who write in about ethical concerns and then tallies the queries to learn the themes. Martha Turner, PhD, RN-BC, assistant director of ANA’s Center for Ethics and Human Rights, reported that the work environment, integrating genomics and genetics into practice, and end-of-life issues and palliative care round out the top three nurses report.

ANA’s position statements on ethics and human rights can guide nurses and aid in their dealing with the ethical challenges they face in practice.

To tackle moral distress head-on and increase your nurse retention and nurse recruitment efforts, visit SelfCare for HealthCare™. CONTACT ME to bring this powerful program to your nurses.

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