Employers urged to take post-Covid moral distress among nurses ‘seriously’

Researchers have urged health organisations to take moral distress ‘seriously’ after a survey revealed nurses working during the Covid-19 pandemic suffered from subsequent mental health issues.

A survey conducted at Cardiff University revealed that nurses working during the Covid-19 pandemic experienced ‘distress strongly associated with depression and linked to intentions to leave the profession’.

Lead researchers are now urging organisations to take mental health concerns seriously as the pressures have ‘not abated and sequelae likely continue’.

Dr Anna Marguerite Sydor, senior lecturer at Cardiff University who was part of the research team, said that moral distress ‘continues’ for nurses, and that other pressures including inadequate staffing have created difficult working environments.

Moral distress, is said to occur when one has made a moral judgement but is unable to act upon it. It can cause psychological unease and emotional suffering.

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‘Registered nurses are the backbone of the healthcare system,’ she said. ‘They are vital to enhancing patients’ health outcomes and safety.

‘Experiences of working under intense, sustained pressure at the height of the Covid-19 pandemic heightened our awareness of the problem of moral distress among registered nurses.

‘Our findings reported in this paper have relevance for moral distress continues to impact registered nurses every day.’

She added: ‘Inadequate staffing and skill mix mean registered nurses continue to work in exceptionally challenging environments.

‘Demands and expectations can undermine patient outcomes and safety and conflict with core personal and professional values, affecting registered nurses’ physical health, wellbeing and retention.

‘With a duty of care towards their staff, organisations need to take moral distress seriously.’

The researchers have stressed that ‘independent, accessible psychological support and organisational reforms are essential’.

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They recommended renewed focus on staff wellbeing, improved pandemic preparedness, and normalising help-seeking among healthcare workers.

The team is also calling for further research into interventions that reduce moral distress and for healthcare leaders to involve frontline staff in designing future preparedness strategies.

A total of 287 registered nurses and nursing students in Wales were surveyed between October 2021 and April 2022 as part of the study. Of the respondents, 41 met criteria consistent with post-traumatic stress disorder (PTSD) or complex PTSD.

Distress was higher among nurses with two to six years of experience who had cared for more than 40 Covid-19 patients and those experiencing greater distress were more likely to consider leaving nursing.

The study, funded by the Burdett Trust for Nursing, found that three-quarters of participants intended to remain in the profession, but over one in five were unsure about their future in nursing, raising concerns about workforce sustainability.

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Researchers concluded that the study, titled Moral distress among nurses during the Covid-19 Pandemic: a cross-sectional survey,  shows the ‘lasting psychological impact of pandemic working conditions’ and ‘underline the urgent need for targeted mental health support across the nursing workforce’.

The conclusion reads: ‘High levels of moral distress and an association with depression were found among nurses working during the pandemic in Wales.

‘Exceptional workforce pressures and their impact during this period cannot be ignored. As these pressures have not abated and sequelae likely continue, interventions that address moral distress and depression among the nursing workforce remain necessary.’