By Caitlin Renneson
As a hospital screener during visitor restrictions, you must say no when a woman asks to visit her husband of 30 years. Your supervisor pressures you to order what you consider to be unnecessary tests for a patient.
When you feel that circumstances beyond your control are affecting the safety or integrity of your work, you might be experiencing moral distress.
Three experts from The Ottawa Hospital provide insight into how to identify moral distress—and what to do if it happens to you.
What is moral distress?
Moral distress can occur in the workplace when you feel that circumstances beyond your control are affecting the safety or integrity of your work. This is important because our feeling of moral integrity is fundamental to our experience of moral meaning as health-care workers.
“Moral integrity is the alignment between our moral beliefs and our actions,” explained Mike Kekewich, Director of Clinical and Organizational Ethics at The Ottawa Hospital. “When different circumstances or events disrupt this alignment, we are at risk of experiencing moral distress because we may feel we are doing the wrong thing.”
The risk of experiencing moral distress may be higher during public health emergencies or in situations when extreme resource limitations impact the safety or integrity of your work.
How to identify moral distress
“It is difficult to identify all potential sources of moral distress because it is difficult to identify all of the moral values held by different professionals,” said Dr. Nathalie Fleming, Medical Director, Physician Health and Wellness and Professor in the Department of Obstetrics and Gynecology at the University of Ottawa. Examples include:
- Feeling unable to perform your work to the level that’s needed because your workload is too high or you are too tired.
- Witnessing health-care providers giving “false hope” to a patient or family.
- Following a family’s insistence to continue aggressive treatment even though you believe it is not in the best interest of the patient.
- Feeling pressured to order or carry out orders for what you consider to be unnecessary or inappropriate tests and treatments.
- Watching patient care suffer because of a lack of provider continuity.
- Being unable to book or perform surgeries for patients who need them due to surgery backlog.
- Witnessing a violation of a standard of practice or a code of ethics and not feeling sufficiently supported to report the violation.
- Denying time off to staff members who clearly need and deserve it when staffing quotas cannot be met.
- Lack of clarity because the instructions or guidance you are given is constantly changing.
Not everyone experiences moral distress the same way. Depending on the person and the event, it can range from being easily manageable to completely impairing.
How to work through moral distress
Some level of moral distress is inherent in daily life and work, and for most people, this is easily manageable. However, studies on this topic note that moral distress has led to people leaving or considering leaving their jobs. Consider the intensity and frequency of distress, and whether it is something that needs to be addressed to be healthy and safe at work.
“It is important to identify and work through moral distress when it takes place because if you have multiple experiences of moral distress without a return to your normal baseline in between, they might become more difficult to manage as they build on each other,” said Dr. Kerri Ritchie, Clinical and Health Psychologist and Professional Practice Coordinator for the Psychology Department at The Ottawa Hospital. “This is similar to how someone might experience episodes of acute stress building into chronic stress.”
To learn more about moral distress, listen to “What is moral distress?,” an episode of On Call: The Ottawa Hospital podcast where Dr. Ritchie and Mike further discuss the topic.
And consult these resources for physicians by the Canadian Medical Association:
Caitlin Renneson is a Content Writer at The Ottawa Hospital.
