Moral Distress in Emergency Nursing Found Unique
Study finds ER nurses need different solutions
By Debra Wood, RN, contributor
While nurses in all settings can experience moral distress, emergency nurses’ distress frequently results from the setting in the emergency department and its lack of resources, according to a study from the Emergency Nurses Association (ENA).
“In the emergency department, the cause of the moral distress is a perceived inability to provide adequate patient care,” said Lisa A. Wolf, PhD, RN, CEN, FAEN, lead author. “Nurses are saying there is a standard of care we should be providing, and we are unable to do it.”
Wolf explained that moral distress experienced by nurses working on inpatient units tends to be interaction-based, be it with a specific patient, family members or a physician encounter. However poor staffing and limited time in the emergency room lead to the distress in ER nurses.
“The cause of that inability [to provide a standard of care] is not enough resources, not enough staff, working too many hours and an uncontrolled volume of patients,” Wolf said. “It is placed into the moral realm, because they are distressed they are unable to provide care at the standard they believe patients deserve.”
In addition to the emotional fallout, the responding ER nurses reported physical symptoms, including difficulty sleeping, change in food intake, fatigue, gastrointestinal distress and high blood pressure.
The search for solutions in emergency nursing
Traditional recommendations for dealing with moral distress, such as calling the ethics committee and good self-care, do not work well in the emergency department setting, Wolf explained, because the environment is causing the problem.
Wolf indicated the unique practice environment, with changing acuity and census, makes it difficult to determine a staffing schedule for ER nurses.
“More nurses would be a good start,” Wolf said.
Travel nurses can fill some of those ER jobs. And if they begin to experience moral distress, they may be able to discuss it with one of their staffing company’s clinical liaisons.
Additional data is needed to gain administrative buy-in to support investing in more ER nurses, Wolf suggested. Emergency nurses may need to make a business case. Moral distress leads to burnout, staff turnover and nurses present but not feeling good about their situations or truly caring. Turnover and burnout can result in significant hospital costs.
“There are several steps nurses can take, but they are advocacy actions,” Wolf said.
The study provides a tool as a first step. It documents the problem and offers solutions. “Print it out and take it to your manager,” Wolf advised.
In addition to staffing issues, nurses cited the focus on documentation as contributing to their moral distress, describing it as caring for the computer rather than the patient. It may take multiple clicks to document something simple.
“If nurses feel the art of nursing is being subverted to charting about good nursing care rather than actually doing it, it becomes a source of distress,” Wolf said. She suggested more streamlined and interoperable computer systems are needed.
Nurses reported that frequent users of the emergency department were another source of distress, because the patients’ problems were so complex and resources were lacking within the organization and community. One nurse mentioned boarding a psychiatric patient for more than a week.
The emergency nurses also reported using unhealthy coping mechanisms, such as going home and having a couple of glasses of wine, but they acknowledged concern about that. Some of the nurses reported more adaptive coping mechanisms, such as exercise, counseling, staff debriefings and stress management.
ENA President Matthew F. Powers, MS, BSN, RN, MICP, CEN, called the study an excellent beginning toward understanding the causes of moral distress in emergency nurses and how to address it. ENA plans to develop a tool to measure moral distress. As interventions are developed, the tool will help in evaluating their effectiveness.
“The factors of moral distress in the emergency department are more environmental than in inpatient areas, so the tools and solutions useful in inpatient areas may not be useful in the emergency department,” Wolf concluded. “We need to look at new ways of recognizing and managing this distress.”
Your ideal travel nursing job is out there--let TravelNursing.com help you find it! Complete our Design Your Ideal Job form and let us do the searching for you.
© 2015. AMN Healthcare, Inc. All Rights Reserved.