Facing Moral Distress as an Oncology Nurse

What can nurses do when they feel powerless to make a morally just decision at work?

Oncology nurses are faced with difficult decisions every day. And while tough situations are part of the job, there may be instances where they feel that they know what is right, but cannot act on it. This is called moral distress, and there are methods nurses can use to build their resilience and better face these challenging instances.1

Natalie Correll-Yoder, MN, RN, CCRN, CCNS, a critical care clinical nurse specialist at NorthBay Healthcare recently presented on moral distress at the 2020 ONS Bridge virtual conference. Correll-Yoder cited research published in the American Journal of Clinical Care stating that nurses experience high levels of moral distress when they are treating patients who likely will not benefit.2

How Moral Distress Affects Nurses

“The stress was significantly correlated with years of nursing experience, speculating that 15 years of experience had a cumulative weight,” Correll-Yoder said. “[The researcher] found that nurses reported anger, anxiety, depression, powerlessness, and helplessness. Then there were physical symptoms, health-related symptoms, changes in their job satisfaction, their self-image and spirituality.”

After a nurse experiences repeated instances of moral distress, they might begin to experience moral residue, which builds, and may causes nurses to think to themselves, “here we go again,” the next time they face a difficult situation. Eventually, this may lead to moral outrage, which can present as anger toward physicians, other nurses or disciplines, administration, policymakers.

“We can become ungrounded and … not connected to our ethical self,” Correll-Yoders said.

Strategies to Handle Moral Distress

Correll-Yoder cited Cynda H. Ruston, PhD, MSN, RN, FAAN, who described moral resiliency as, “a distinctive sense that life is meaningful under every condition.”3

There are steps nurses can take to build their moral resiliency, including:

  • Learning to self-regulate and end negative thought patterns
  • Be flexible, especially if the situation is complex. For example, think about the patient and their family’s wishes, rather than what you think is right
  • Acknowledge factors out of your control
  • Know when to speak up if you believe something is morally wrong
  • Seek meaning in what you are doing, such as honoring patient’s wishes, acknowledging what end-of-life care means to them, etc.

“It’s tough work that we do, trying to care for our patients and provide care that is, in the long run, trying to make them better, but also care that can be adjusted,” Correll-Yoders said.

References

  • Correll-Yoder N. Dealing with ethical issues at the bedside: the journey to moral resilience in oncology nursing. Presented at: ONS Bridge Virtual Conference. Sept. 8, 10, 22, and 24, 2020. Accessed Sept.22, 2020.
  • Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care. 2005. Nov;14(6):523-30
  • Rushton CH. Moral resilience: a capacity for navigating moral distress in critical care. 2016 Feb;27(1):111-9. doi: 10.4037/aacnacc2016275.