By Debra Wood, RN, contributor

The difficult ethical challenges nurse face while caring for patients led 25 percent of practicing nurses and social workers to say they want to leave the field and 41 percent indicate they would not choose the profession again, according to a recent study from the University of Pennsylvania School of Nursing.

“Working in highly technological environments and working with a large population of chronically ill and aging patients present different types of ethical challenges,” said lead author Connie Ulrich, Ph.D., RN, assistant professor at the University of Pennsylvania School of Nursing.

Connie Ulrich, Ph.D., RN, assistant professor at the University of Pennsylvania School of Nursing, studied how moral issues affect nurses.

Protecting patients’ rights, supporting them in end-of-life decisions and the fair distribution of resources contribute to nurses and social workers moral distress. Nearly two-thirds of the sample indicated they faced ethical issues over which they had no control.

“They felt as though they didn’t know how to protect patients’ rights or they were concerned about issues of informed consent and autonomy and staffing, just the daily challenges of work,” Ulrich said.

Lack of respect and trust also had a strong influence on nurses’ and social workers’ intent to leave. Only 58.3 percent of the respondents said that members of their profession and physicians respect each other and 55.4 percent reported the different professions trusted each other.

“Nurses do not feel respected within the system,” Ulrich said.

Ulrich and colleagues conducted one of the first studies investigating the relationship between ethics and intent to leave nursing. She surveyed a random sample of 1,215 licensed nurses and social workers in four states: California, Maryland, Massachusetts and Ohio. The study’s findings were published in Social Science and Medicine.

More than 52 percent of responding nurses and social workers reported that moral distress causes them to feel frustration, 40 percent fatigue, 34.7 percent overwhelmed, and 32.5 percent powerlessness.

“I was a bit surprised by the percentage of nurses and social workers who felt powerless and overwhelmed with the ethical issues they were facing,” Ulrich said.

Respondents working in hospitals were more likely to report ethical stress than professional caregivers employed in other settings. Thirty-nine percent said they have no organizational resource to assist them with ethical concerns.

In an unexpected finding, black nurses reported more ethical stress and were three times more likely than Caucasian nurses to say they wanted to leave the field. Ulrich said future research is needed to explore cultural and language variables and their effect on moral distress.

Nearly 25 percent of the nurses reported they had not received ethics training.

“We have to have a dialogue about the preparation of nurses and how we are preparing nurses to face the ethical problems, if we want them to remain in the system,” Ulrich said. “We have to incorporate it into the curriculum, so we can help them with ethical problems.”

However, the nurses and social workers with more ethics education tended to report more job dissatisfaction, something Ulrich and the authors suggest indicates that limited or no access to resources for a supportive ethical climate in which to practice may lead to frustration.

Ulrich said more research is needed to understand coping strategies nurses use to handle moral distress. She also suggested looking at the environment for things that could be changed, such as offering an ethics committee where nurses could discuss issues of concern and share in the decision making.

“We need to develop interventions to focus on this moral distress, so we can retain nurses within the system,” Ulrich said.

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