The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey

Summary & key facts

Researchers followed 213 hospital workers through six surveys over about 15 months during the COVID-19 pandemic. They measured moral distress (feeling torn or upset by situations that threaten a person’s sense of right and wrong) and three parts of burnout (feeling emotionally drained, feeling detached from patients, and feeling less effective). They found that earlier signs of burnout and job role helped explain who later had more moral distress. They also found that higher moral distress later predicted more burnout and more people thinking about leaving their job. The results suggest moral distress and burnout can feed into each other, and that reducing moral distress might help keep staff from quitting, but the study shows links not final proof of cause and effect.

Key facts:

• 213 hospital workers completed surveys at six time points over about 15 months during the COVID-19 pandemic.
• The study used standard questions to measure moral distress and three parts of professional burnout: emotional exhaustion, feeling detached from patients, and reduced personal accomplishment.
• Job role and an earlier measure of feeling detached from patients explained about 45% of the differences in who had higher moral distress later on.
• Nurses reported the highest levels of moral distress compared with other job groups.
• Higher moral distress measured in the middle of the study predicted greater emotional exhaustion and greater detachment from patients later on.
• Higher moral distress was also linked with a greater chance that people were thinking about leaving their job or leaving healthcare.
• The authors describe these patterns as consistent with a possible vicious circle: burnout can make moral distress worse, and moral distress can increase burnout. But the study shows strong links rather than final proof that one causes the other.

Abstract

Aspects of burnout that were associated with experiencing greater moral distress occurred both prior to and following moral distress, consistent with the hypotheses that burnout both amplifies moral distress and is increased by moral distress. This potential vicious circle, in addition to an association between moral distress and considering leaving one's job, suggests that interventions for moral distress may help mitigate a workforce that is both depleted and burdened with burnout.

Topics

Ethics in medical practice Healthcare professionals’ stress and burnout

Categories

General Health Professions Health Professions Health Sciences

Tags

Burnout Clinical psychology Depersonalization Distress Emotional exhaustion Job satisfaction Medicine Nursing Psychology Social psychology

Conditions & symptoms

Anxiety Burnout Depression PTSD Anxiety or worry Lack of energy or motivation Poor sleep Sadness or low mood