Paper
Tuesday, November 6, 2007
586
The Relationships of Moral Distress, Ethical Climate and Intent to Turnover among Critical Care Nurses
Karla M. Fogel, PhD, RN, North Park University, School of Nursing, Chicago, IL, USA
| Learning Objective #1: Define the concepts of moral distress and ethical climate and how they impact the role of critical care nurses in the workplace. |
| Learning Objective #2: Identfy the relationships of these concepts and the nurses leaving a position in critical care or the profession of nursing. |
Abstract
The term “Moral Distress” is defined as the experience of knowing the right thing to do, but being constrained by institutional or other forces that make it nearly impossible to pursue the right course of action. Moral distress has been anecdotally associated with professional burnout and leaving a position in nursing or the profession itself. Ethical climate is an organizational variable which consists of perceptions of practices and conditions within the work environment that facilitate the discussion and resolution of difficult patient care issues and support ethical decision-making in the clinical setting. Intent to turnover is a variable which measures an individual’s likelihood of leaving a job.
The purpose of this study was to explore relationships between moral distress, likelihood of leaving a position and the moderating effects the ethical climate of the work environment. A descriptive, correlational study of these three variables was done using three Likert-type tools and a demographic data form. A sample of 100 critical care staff nurses from 2 tertiary level health care institutions in a major metropolitan area revealed significant levels of moral distress that correlated positively with intent to turnover. Factors showing the highest levels of distress were related to questions concerning aggressive treatments for terminally ill patients. The lowest levels of distress related to assisted suicide indicating that this situation rarely occurs. A positive perception of the ethical climate was strongly, negatively correlated with intent to turnover. Two demographic variables, age and length of tenure in the hospital, indicated a lower likelihood of turnover. Specific climate factors such as relationships with peers and managers as well as a feeling of competence in one’s nursing skills moderated the effect of moral distress levels on intent to turnover. Implications are noted for administrative intervention in these factors to decrease critical care staff turnover.