DiversityNursing Blog

Chief Nursing Officers Suffer Moral Distress in Isolation

Posted by Pat Magrath

Thu, Mar 09, 2017 @ 10:46 AM

work-stress-title-image_tcm7-212368.jpgHave you heard the term “moral distress”? It might be something you deal with occasionally in your job. You might have to go along with a decision made by a patient’s family member or it could be a decision made at you place of employment that makes you uncomfortable. This is moral distress.
 
We deal with it in our personal  and professional lives. This article talks about moral distress for CNO’s. We hope it’s enlightening.
 
The concept of moral distress in nursing—the disequilibrium resulting from the recognition of and inability to react ethically to a situation—has been around since the 1980s, and it's been acknowledged that some bedside nurses experience it during challenging situations such as when there is a conflict surrounding end-of-life care.

But what about chief nursing officers? They aren't providing direct care at the bedside, but do they still experience moral distress?

The answer, according to a qualitative study published in the Journal of Nursing Administration in February, is yes. It's just taboo to talk about it.

"There's shame and isolation when you do have the experience, so it can make it very difficult for people to feel like they can openly discuss it," says Rose O. Sherman, EdD, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Florida Atlantic University.

Sherman is one of the study's authors. "I think that the other piece of it is, CNOs might not always label it as moral distress. But these are uncomfortable situations where they're making decisions against their values systems."

Through oral interviews, Sherman and her co-author, Angela S. Prestia, PhD, RN, NE-BC, discussed chief nursing officers' experiences of moral distress, including its short and long-term effects. Prestia is corporate chief nurse at The GEO Group.

The study's 20 participants described their experiences of moral distress, and several said they experienced it on more than one occasion. It was often related to issues around staff salaries and compensation, financial constraints, hiring limits, increased nurse-to-patient ratios to drive productivity, counterproductive relationships, and authoritative improprieties.

"For example, a physician went to someone over a CNO's head and said, 'I think you should pay a scrub tech more. She is very valuable to me," Prestia says. "And of course he was a high-admitter, high-profile physician."

The CEO approved the special compensation, creating a salary inequity among the other scrub techs.

In another scenario, six participants reported their CEOs had improper sexual relationships with staff members. Prestia points out that the CNOs did not object to these relationships because of religious or moral beliefs, but because they were harming productivity at the organization.

"In their [the CNOs'] mind' of right and wrong, these people had access to things that they should not have had access to and [those relationships] create barriers to getting the work of the organization accomplished."

Lasting Effects 
The study uncovered six significant themes related to CNO moral distress:

  1. Lacking psychological safety
  2. Feeling a sense of powerlessness
  3. Seeking to maintain moral compass
  4. Drawing strength from networking
  5. Moral residue
  6. Living with the consequences

CNOs reported they often felt very isolated during the experience of moral distress.

"If they pushed back on a decision because they felt it was in conflict with their values they were isolated within the organization and they no longer felt safe. They weren't invited to meetings. They weren't included in decision making," Sherman says.

Even though they took steps to do what they felt was right—documenting meeting minutes, reviewing policies and procedures, and referring to The Joint Commission standards—to maintain their moral compass, those efforts were often unsuccessful.

"What happened was when they were in this situation… they were beat down at every turn," Prestia says. "Then the 'flight' started to set in. 'Maybe I need to leave? Maybe I should resign? Maybe I need to start planning my exit strategy?' Or before they could do that, they were terminated."

Moral Residue
Even once they were out of the situation, many CNOs reported the experience left them with a 'moral residue.'

"It is a lingering effect of the moral distress. I liken it to a fine talc that lingers on your skin and it manifests itself either physically or emotionally," Prestia says. "We actually had several participants say, 'When I get a call about staffing now in my new job, all of a sudden I get this feeling of impending doom.'''

Both Sherman and Prestia hope this research will open up a larger conversation about CNOs and moral distress. They will present their findings at the AONE 2017 conference in March.

"What we found in the work that we did was, clearly, collegial support from a strong network is very important in building one's resiliency and being able to deal with these situations," Sherman says.

"I think that having others who've been through it is very important, which is why forums that allow people to talk about this candidly, when a CNO finds him or herself in this situation, become critical."

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Topics: moral distress, CNO, chief nursing officer, nursing stress

Nurse researcher studies moral distress in ICU for burn patients

Posted by Alycia Sullivan

Thu, Dec 12, 2013 @ 12:23 PM

Researchers at Loyola University Medical Center in Maywood, Ill., have published a study of emotional and psychological anguish, known as moral distress, experienced by nurses in an ICU for burn patients.

The study by first author Jeanie M. Leggett, RN, BSN, MA, and colleagues is published in the Journal of Burn Care and Research.

Moral distress occurs when a person believes he or she knows the ethically ideal or right action to take, but is prevented from doing so because of internal or institutional barriers. Moral distress can result in depression, anxiety, emotional withdrawal, frustration, anger and a variety of physical symptoms. It also can lead to job burnout.

“Given the intense and potentially distressing nature of nursing in a burn ICU, it is reasonable to hypothesize that nurses in these settings are likely to experience some level of moral distress,” Leggett, manager of Loyola’s Burn Center, and co-authors Katherine Wasson, PhD, MPH; James M. Sinacore, PhD; and Richard L. Gamelli, MD, FACS, wrote, according to a news release.

The pilot study included 13 nurses in Loyola’s burn ICU who participated in a four-week educational intervention intended to decrease moral distress. The intervention consisted of four one-hour weekly sessions. The first session outlined the study aims, definitions of moral distress and related concepts. Session two focused on signs and symptoms of moral distress. Session three dealt with barriers to addressing moral distress. And in session four, nurses were encouraged to identify strategies they could use or employ to deal with moral distress. 

The nurses completed a questionnaire called the Moral Distress Scale-Revised that measures the intensity and frequency of moral distress. They were divided into two groups: One group completed the survey before the intervention, and the other group took the survey after completing the sessions.

Researchers had expected that the group taking the survey after the intervention might have lower moral distress scores. But they found just the opposite: The group taking the survey after the intervention had a median moral distress score of 92, which was significantly higher than the 40.5 median score of the group that filled out the survey before taking the course. (The moral distress score can range from 0 to 336, with higher scores indicating greater moral distress).

Researchers said in the release that the reason moral distress scores were higher among nurses who took the survey after the educational sessions could be due to a heightened awareness. 

Six weeks after completing the intervention, both groups took the moral distress questionnaire again, and this time, there were not significant differences in their scores. There also was no significant difference between the groups’ scores on a second questionnaire called Self-Efficacy Scale, which is designed to measure a person’s effectiveness in coping with daily stressful events.

After each weekly session, nurses completed a written evaluation. 

“They appreciated the individual sessions and case discussions, felt the session lengths were appropriate and expressed validation of their feelings of moral distress after having participated,” researchers wrote. “They indicated that learning the definition of moral distress was valuable, found it helpful to learn that others in similar work environments were experiencing moral distress and appreciated hearing what others do to cope with moral distress. Participants expressed a desire for this type of intervention to continue in the future and for more time to be spent on coping strategies.”

Researchers concluded that a larger study, involving more nurses from multiple burn centers, is needed. 

“The larger study should be refined to develop strategies for implementing effective interventions that become part of the culture and that ultimately reduce moral distress,” researchers concluded. “In so doing, effective strategies for dealing with the moral distress experienced by this population can be more readily put in place to help cope with it.” 

Source: Nurse.com

Topics: ICU, Loyola University Medical Center, burn patients, moral distress

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