Nurses inevitably encounter situations that cause moral distress. At the height of the Covid-19 pandemic, though—when there was no vaccine, and it was still assumed that for at least two years there would be no protection beyond masking and social distancing—moral distress became a daily ordeal for many frontline nurses.
Among those hardest hit by moral distress were the nurses of color working through a pandemic that exacted a disproportionate toll on Black, Filipino, Latino, and Native American minorities. Their experiences during the early days of Covid are at the core of a new study from researchers at DePaul University’s School of Nursing. In interviews with a diverse group of nurses located across the US, investigators found that moral distress was an almost inevitable affliction when lack of support made it impossible for nurses to provide high-quality care based on their training.
Nurses on the frontlines faced unrivaled psychological and physical demands during the pandemic, noted researchers. Voices of nurses from this moment in history could help inform policies and laws to improve retention and reduce burnout among nurses in the U.S. “People need to listen to nurses more, and nurses need to feel empowered to share their experiences at every level of leadership,” said principal investigator Shannon Simonovich, PhD, RN, an assistant professor of nursing at DePaul.
“Diverse nurses caring for a diverse patient population”
In 2020, many news stories about health care heroes featured white, female nurses, Simonovich said. In reality, nurses from many personal, ethnic and geographic backgrounds with a varying levels of education were caring for COVID-19 patients.
Simonovich recruited a diverse group of DePaul nurse researchers to conduct the study, which in turn helped recruit a diverse group of 100 nurses to be interviewed, according to assistant professor and coauthor Kashica Webber-Ritchey. “We captured the voices of diverse nurses caring for a diverse patient population that was being disproportionately impacted by COVID-19,” Webber-Ritchey said. In the DePaul sample, 65% of the nurses identified as a member of a racial, ethnic, or gender minority group.
Many nurses from these represented populations have lost their lives to COVID-19. Researchers at DePaul cite a tally that more than 3,300 U.S. nurses, doctors, social workers and physical therapists died of COVID-19 between February 2020 and February 2021.
DePaul researchers conducted interviews between May and September 2020, asking nurses to describe their emotions. Nurses reported moral distress related to knowing how to treat patients and protect themselves, but not having the staff, equipment or information they needed. As a result, they reported feeling fear, frustration, powerlessness and guilt.
The toll of frustration, stress, and guilt
This qualitative study is believed to be the largest of its kind from this period—a time of great uncertainty about the virus that causes COVID-19 before the development of vaccines. Highlights include:
- Study participants described many forms of frustration while providing patient care, including frustration with healthcare leadership being out of touch with those on the frontlines.
- Nurses felt powerless to protect themselves and others from contracting COVID-19.
- Nurses described being placed in difficult patient care experiences that resulted in guilt around letting down patients and their families, as well as fellow members of the healthcare team.
““We are a largely female profession, and we don’t complain enough when things are tough.”
The burden nurses have shouldered during the COVID-19 global pandemic calls for research that describes and examines the emotional well-being of nurses during this unprecedented time in contemporary history, write the researchers. As the media coverage of nurse heroes fades, the narratives in this study should be a call to action, says Kim Amer, an associate professor with 40 years of nursing experience.
“Nurses need to come together as a profession and make our standards and our demands clear,” Amer said. “We are a largely female profession, and we don’t complain enough when things are tough. As a faculty member, we teach students that it’s OK to refuse an assignment if it’s not safe. We need to stand by that.”
The DePaul research team calls for clear, safe standards for nurses that will be legally binding and hold hospitals and health care agencies accountable. “We go into nursing with the intention of saving lives and helping people to be healthy,” said Simonovich. “Ultimately, nurses want to feel good about the work they do for individuals, families and communities.”
Investments by healthcare organizations and policymakers in mental health resources could help promote psychological resilience in nurses, noted Webber-Ritchey. “Taking time to speak to nurses to understand their needs and provide support would help with addressing moral distress,” she said.