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Nurses Want to Leave Hospitals Due to 'Moral Distress'

A study from the University of Pennsylvania School of Nursing has found that 25 percent of practicing nurses and social workers experience "moral distress" causing them to want to leave their current positions, and fully 41 percent failed to say they would chose their profession again.

In one of the first studies to investigate the relationship between ethics and intent to leave, Penn Nursing assistant professor Connie Ulrich, PhD, RN, found "moral distress" led to feelings of powerlessness (32.5 percent), feeling overwhelmed (34.7 percent), frustration (52.8 percent) and fatigue (40 percent), noting that the nurses' desire to leave is in part fueled by experiencing more "ethical stress" and an inadequate level of institutional support for dealing with ethical decisions, as well as a perception of little respect for their profession. The study's findings were published in Social Science and Medicine.

Issues causing moral distress include protecting patients' rights, supporting them through difficult decisions at the end of life, and fairly distributing resources. "Nurses reported feeling that they cannot adequately protect patient's rights or the informed decisions of patients and must balance these and other conflicting issues with a hospital's bottom line," Ulrich said.

Lack of respect and trust also had a strong influence on nurses and social workers' intent to leave. "Only 58.3 percent reported that members of  "my profession and physicians respect each other," and only 55.4 percent indicated that there was trust among nurses and social workers and physicians, the study found.

Nearly two-thirds of the sample reported facing ethical issues over which they have no control with nearly 25 percent reporting having received no ethics training. "With the plethora of career options available today, young nurses and social workers may leave a profession if they feel stress, disrespect and dissatisfaction," said Ulrich. "This is why a positive ethical environment is so critical." Ulrich suggests investing in institutional ethics resources and establishing a climate of respect for the contributions of nurses and social workers to ethical decision making, as ways to possibly increase job satisfaction and decrease turnover.

U.S. hospitals expect a 20 percent nursing shortage by the year 2020 and a need for a 30 percent increase in social workers by 2010.

The study surveyed 1,215 nurses and social workers from California, Maryland, Massachusetts and Ohio. It was funded by the National Institutes of Health Clinical Center's departments of Bioethics and Social Work. To view the abstract of the article, visit this link.

Source: University of Pennsylvania School of Nursing


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As a 30-year veteran nurse I have been fired from several hospitals just for mentioning safety concerns to management. This is much worse than mere disrespect- it is hostility and retaliation by management. They treat us like dirt because we let them; we don't organize into unions, like RNs did in California. See the CNA/NOC website to start organizing.

Laura January 31, 2009
Efland, NC

Nurses work for a living.
You have to be mute and sometimes blind to just work in the field nowadays.

Marilyn Dziedzic,  RNAugust 03, 2008

I've heard excessive cursing by other nurses.
I've seen disrespect by Dr.'s, along with patients and other nurses.
I've seen different ethnic races cling to each other right or wrong, cliques in nursing, gangs in nursing.
Does anyone really wonder why nurses leave nursing?

Marilyn Dziedzic,  RN,  variedAugust 03, 2008
Palm Springs, CA

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