‘Moral distress’ and burnout of healthcare workers is another COVID consequence

Since last spring, media headlines have been inundated with stories describing the scary circumstances facing medical workers in hospitals and facilities across the U.S. Medical workers have been praised as heroes and regarded as the backbone of fighting this pandemic. We have heard stories of 80-plus hour work weeks, with physical and mental exhaustion, along with many of them contracting COVID themselves, sometimes fatally. The long-term consequences of their work during the pandemic is not yet known. Recently, as the COVID-19 surge overwhelms hospitals and triggers restrictions again, we are hearing cries of burnout and hypothetical phrases like, “you think COVID is bad, wait till you don’t have an ICU nurse.” And they’re not wrong.

Some may be familiar with the concept of burnout — the point at which a helping professional has reached maximum capacity to be able to care compassionately while still preserving some trace amounts of sanity and emotional reserve. But what we’re not talking about is the devastating consequences that something called “moral distress” is causing and will likely cause long-term. Moral distress is the immediate and lingering reaction healthcare professionals have when they cannot do what they feel is ethically and morally right to do. Moral distress can cause psychological, emotional, and physical pain and consistently contributes to why professionals quit their professions. Moral distress is not a new concept in healthcare but is likely exacerbated by the pandemic. Examples of moral distress could be when there is not enough personal protective equipment (PPE) or staff to care for a patient, or a medical worker cannot alleviate suffering at the end of life. Feelings like powerlessness, anger, worry, and guilt wreak havoc as so many helping professionals tie their identity to their professional identity; it’s who they are. If I cannot do my job as I am professionally obligated to do, what does that say about me? These reactions occur despite many of the situations being out of their control.

We do not yet know how to alleviate moral distress without addressing the sociopolitical and environmental factors that contribute to its presence in the first place. For some, talking with other people and naming their distress has been helpful. For others, distraction and avoidance to get through it seem like the best thing to do. Treatment for moral injury, a similar concept rooted in military service, tells us that acceptance and forgiveness may help lessen the impacts of accumulating moral distress. But accepting difficult and distressing thoughts and feelings and then forgiving ourselves or others is not an easy task. It is especially challenging when so many of these circumstances could be avoided by the actions of others. But latching on to blame and anger has typically only worsened distressing feelings, as natural and expected as these feelings may be. Although there are no easy answers or quick fixes to a complicated problem, talking about it may be a start.

Abigail Latimer is a licensed clinical social worker and a Ph.D. candidate with the University of Kentucky College of Social Work researching moral distress in healthcare professionals and advanced illnesses in older adults.