What chief nursing officers say contributes to moral distress: 5 notes

The COVID-19 pandemic forced chief nursing officers to make tough decisions that led to moral distress, such as selecting nurses to work in COVID-19 units, according to a study published Aug. 31 in the Journal of Nursing Management. 

From October 2021 to January, researchers conducted virtual interviews with 13 chief and assistant chief nursing officers to explore the causes and effects of moral distress during the pandemic. Participants were required to have served as a chief/assistant nurse officer during the pandemic and to have been in their current position for at least one year. 

Five findings: 

1. Decisions challenging fairness, such as selecting which nurses to assign to COVID-19 clinics or units, were among drivers of moral distress.

2. Exclusion from decision-making and failure to protect professional autonomy were also contributors to moral distress among CNOs. Decisions deemed invalid or overridden by senior management "caused CNOs to feel that they were not empowered with adequate professional autonomy in their current position," researchers said. 

3. The inability to maintain continuity and quality of healthcare services was another driver of moral distress. Participants said they experienced this during COVID-19 peaks when hospitalizations increased and nurses became ill. 

4. Chief nursing officers experienced emotional and physical effects stemming from moral distress. Emotional effects included feeling unhappy, hopeless and angry, and physical effects included sleep disturbances, palpitations and headaches. Some also considered quitting, the study found. 

5. Staying up to date with the latest COVID-19 guidelines, effective communication and team collaboration were among factors that CNOs said mitigated their moral distress.

Click here to view the full report. 

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