“…distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient.”
Part of the reason that burnout is not purely psychological is because this model dictates that the person doesn’t have the tolerance for the mental aspect of the game that is being played.
My game of choice is physical therapy. Burnout is happening in this profession and it still baffles me at times, but I am starting to have a more thorough understanding of it as I apply research from other sectors to our profession. For instance, there are therapists that pride themselves on treating multiple patients per hour. Some therapists are able to handle the load of multiple patients, but once they understand the purpose of treating multiple patients at once, said therapist may no longer feel proud of doing this. Some clinics need to treat multiple patients per hour to keep the doors open, which is noble for the therapist to feel like he/she is greatly helping the clinic, whereas others are doing it only to fatten a pocketbook.
“shortages of resources, such as shortages of time and staff, led to dispiritedness, a lack of respect, and an absence of recognition for both patients and staff, all of which severely diminished the ability of staff to provide high-quality care.”
In healthcare, it’s all about how much work can be done in a specific time period. This is measured by patients seen/hour or units billed/hour or dollars made/day. We are always being asked to do more with less. Guess what? Us and almost every other industry out there. This is not just healthcare, but in a limited scope its what we focus on here. Because of this, some may feel unappreciated and believe that the big bosses (administration) don’t see our struggles. We can either play the victim or we can take action.
I don’t know if I agree with the last part of the statement “diminished the ability” etc. The ability has not changed. The skills have not changed. The personal drive should not have changed. I have worked in environments where morale was down because of this exact scenario and still never understood it.
We make choices everyday. We made a choice when entering this profession that we would place the patient’s needs above all else. I made that choice. I have to live with that choice and can’t allow other outside influences to impede the decision that I made.
I think that more in the healthcare profession need to go back and examine their personal mission. Mine is short and sweet.
“The consequences of moral distress for nurses and other health care providers include feelings of anger, frustration, guilt, and powerlessness.”
I’ve seen this firsthand. People stop caring. It’s sad to walk around in an environment where the employees don’t feel heard. If things in an specific environment always remain the same, then where is the impetus for change? Are you a flea?
“…moral distress can also occur when clinicians internalize external constraints to such a point that their own moral values begin to shift, causing them to disengage morally, compromise their integrity, and possibly engage in harmful practice.”
I have had conversations with those that enforce the rules (read that as members of the department of justice) and there was something said that has stuck with me all these years. To paraphrase: people don’t start out with the intention to deceive, but they may slightly overbill every once in a while. If they don’t get caught, then there is no external pressure not to do it and then other vices take over such as greed.
Understand the why behind actions and it is easier to understand the actions.
“…moral resilience, which can be understood as ‘the capacity of an individual to sustain or restore [his or her] integrity in response to moral complexity, confusion, distress, or setbacks.'”
Some people are just stronger. That’s not wrong to say. It holds true in many aspects of life. I am a bigger guy, so I am in the bottom half of runners. I’m just not a strong runner. I have seen people get shot. I’ve had friends killed. I’ve had family in prison. I’ve seen bad stuff. I have a stronger resilience to bad stuff than others and I don’t tend to panic quickly. I know…I know… “I have a high pain tolerance.” I hear it all the time from patients, but I believe that my moral compass is on point because of my experiences. I don’t believe that there are many in healthcare with my experiences.
Question of the day:
Do you have moral resilience? This means can you stand up for what you believe in or are you going to get knocked down and not have the ability to stand up for yourself again?
Excerpts take from:
Rodney PA. WHat We Know About Moral Distress: Looking over three decades of research and exploring ways to move the concept forward. AJN. 2017;117(2):S7-S10.