News release

From: Murdoch University

Emergency nurses across Australia are experiencing a hidden form of psychological harm that experts say is contributing to burnout, workforce shortages and impacting patient care.

New research, led by Murdoch University Lecturer and PhD candidate Clare Walters in the School of Nursing at Murdoch University, has found that many emergency nurses experience moral distress – the emotional impact of knowing the right thing to do for a patient, but being unable to provide that patient care due to factors beyond their control.

The scoping review, published in the Journal of Clinical Nursing, examined a decade of international research into moral distress among emergency department nurses and identified consistent patterns that are affecting nurses across healthcare systems.

This is a topic that is deeply personal to Ms Walters.

“I’ve been that nurse. I’ve stood in overcrowded emergency departments trying to provide safe, compassionate care, while managing too many patients with too few resources” Ms Walters said.

“Those experiences stay with you. They don’t just end when the shift finishes.”

The review found that nurses commonly experience moral distress when:

• System pressures prevent them from delivering the standard of care they know patients need, including overcrowding, understaffing, high patient demand and limited resources

• The emotional impact extends beyond the workplace, contributing to burnout, emotional exhaustion and nurses leaving the profession

• Healthcare organisations fail to address the underlying causes.

The research found that moral distress can have significant professional and personal consequences, including emotional exhaustion, reduced workplace engagement, lower job satisfaction and a greater intention to leave the profession.

With the World Health Organization predicting a global shortage of more than four million nurses by 2030, noting that significant investment is required to educate and retain the workforce, Ms Walters said understanding moral distress is becoming increasingly urgent.

“If we want to retain experienced emergency nurses, we need to stop thinking of resilience as an individual responsibility,” she said.

“We cannot keep asking nurses to become more resilient, while simultaneously expecting them to work in systems that repeatedly place them in ethically impossible situations.”

The authors of the review found that organisations can reduce the moral distress.

They suggest that organisations should focus on system-level changes, including having safe staffing levels specifically for emergency departments; supporting early-career nurses; strengthening clinical leadership; and ensuring a culture where staff not only feel safe to raise concerns, but feel that their concerns are acted on.

Ms Walters is currently undertaking further national research into practical strategies which can be used in Australia, as part of her PhD studies.

“This is not just about nurse wellbeing. It is about the patients waiting hours to be seen, only to be put in a corridor bed with no privacy,” Ms Walters said.

“It’s about creating a healthcare system where nurses can provide the care they came into the profession to give.”

The full research When Ethics Hurts: The Causes and Impact of Moral Distress on Emergency Department Nurses: A Scoping Review is available in the Journal of Clinical Nursing.