August 16, 2011
Response by Rosario Gallegos to the topic, “Moral Courage Amid Moral Distress: Strategies for Action” (September 30, 2010).
Reply by author Ann Gallagher
Reply by author Cynthia Ann LaSala
Recently Dr. Ann Gallagher (2010) referenced a Royal College of Nursing survey in which 70% of the nurses reported they sometimes experience feelings of distress after work, and 11% of the nurses reported feelings of distress after work all of the time, because they were unable to deliver ‘the kind of dignifying care they knew they should provide.’ Erickson (2007) has reported that at the end of the shift nurses are likely to feel exhausted, discouraged, saddened, powerless, and/or frightened. I have observed these kinds of feelings among many nurses working on a variety of nursing units.
Another article in this OJIN topic addressing moral distress and moral courage stated that nurses experience moral distress when financial constraints or inadequate staffing compromise their ability to provide quality patient care (LaSala & Bjarnason, 2010). Based on my personal experience, I agree that inadequate staffing is indeed the primary cause of moral distress for nurses working in hospitals. However, both Gallagher (2010) and LaSala & Bjarnason (2010) delved into other sources of moral distress and gave little importance to inadequate staffing as a source of moral distress.
I recognize that there are multiple sources of moral distress in the work place. However, 16 years of experience as a registered nurse have taught me that nurses getting ready to go to work fear not the ethical or moral dilemmas they are going to confront during their shift, nor how doing the right thing may expose them to hostility, harassment, or risk of termination.Rather nurses are more likely to be worried about the staffing situation they will find when they arrive at work and whether the acuity of the patients will further compromise an inadequate nurse-patient ratio. Nurses know inadequate staffing will affect the quality and the safety of their practice.
Many nurses do not feel empowered to produce effective changes in their current work settings due to the high cost of healthcare that currently consumes 16% of our gross domestic product (GDP). This cost will soar to 20% of our GDP by 2016 as estimated by the Congressional Budget Office (The Congress of the United States, 2007). Additionally, future shortages of nurses are also predicted. With these burdens at the global level falling on the shoulders of the nursing workforce, it is clear to me that all nurses who put on their badge, and faithful to their commitment, go to work to provide care in the best way possible, in spite of the personal and legal risks, are already showing a great deal of moral courage.
Rosario Gallegos, RN
University of Texas at El Paso
Nursing Student RN to BSN
Congress of the United States, Congressional Budget Office. (2007). Research on the comparative effectiveness of medical treatments: Issues and options for and expanded federal role (CBO publication No. 2975) Retrieved from: www.cbo.gov/ftpdocs/88xx/doc8891/12-18-comparativeEffectiveness.pdf
Erickson, R., & Grove, W. (2007). Why emotions matter: Age, agitation, and burnout among registered nurses. OJIN: The Online Journal of Issues in Nursing, 13(1). Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/WhyEmotionsMatterAgeAgitationandBurnoutAmongRegisteredNurses.aspx
Gallagher, A. (2010). Moral distress and moral courage in everyday nursing practice. OJIN: The Online Journal of Issues in Nursing, 16(2). Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Articles-Previous-Topics/Moral-Distress-and-Courage-in-Everyday-Practice-.aspx
LaSala, C.A., & Bjarnason, D. (2010). Creating workplace environments that support moral courage. OJIN: The Online Journal of Issues in Nursing, 15(3). Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No3-Sept-2010/Workplace-Environments-and-Moral-Courage.aspx