Moral stress major issue for nurses, survey finds

About 600 nurses currently work at Rotorua and Taupo hospitals, and according to research many of them face moral dilemmas.

A Massey University study, which surveyed 412 hospital-based nurses in New Zealand, found almost half of them had considered quitting after struggling with moral issues beyond their control.
The Massey University survey, led by nursing ethics and education expert Martin Woods, found younger nurses experienced higher moral distress than other age groups.

Waiariki Institute of Technology school of nursing director Ngaira Harker said a common concern for younger nurses in many hospitals was not knowing where to voice their concerns. She said as a result it could produce a lot of distress.

“It is quite common to see nurses who haven’t learnt or don’t understand the system of management in hospitals. They don’t know how to communicate.”

She said at Waiariki, as part of their course, the Nursing Union talk to students about how they could voice concerns in a union.

“However some forget that they have this avenue, so one of our goals is to try and keep [our nursing students] politically aware.”

Lakes District Health Board associate director of nursing Cheryl Atherfold said the number of resignations from nurses at Rotorua and Taupo hospitals was very low.
“This doesn’t necessarily mean that moral dilemmas don’t occur, but it is about how we equip and support nurses to work within the challenges of their practice.”

She said to combat the challenges nurses face, the health board had invested in strong communication pathways and education for its nurses.

Mrs Atherfold said, for example, their nurses were taught how to prioritise care when two patients needed the same level of care at the same time.

“One of the things that we have put in place over recent years, for both Rotorua and Taupo Hospital, is an increased focus on education that equips nurses to use planned care and clinical reasoning to support this prioritisation in decision making.”

Long-serving Rotorua Hospital nurse Andrea Colby said the hospital was very good at making sure all nurses knew where to voice any moral concerns.

“We have a whole nursing leadership structure and this helps provide a range of positions and colleagues to whom we can go for help. To toss around issues and to discuss patient care and specific issues arising, some of them having ethical aspects.”

She said good communication with patients and families could help when working through common moral issues, like pressure for beds.

“Communication is always a key to working through any issue, and a moral issue is no different.”

The Massey University study found in nearly all cases it was the institutional constraints, not personal factors, that caused distress in the workplace.

Dr Woods said one nurse who took part in the anonymous survey summed up the common concern.

“I am considering leaving the job that I generally enjoy due to … pressures from management to accept more numbers of patients, or patients with high acuity of care, with no increase in resources,” the nurse said.