Penn Researcher Identifies "Moral Stress" as a Cause for Nurses Wanting to Leave Hospitals

PHILADELPHIA –- A new study from the University of Pennsylvania School of Nursing found that 25% of practicing nurses and social workers experience “moral distress,” causing them to want to leave their positions. Forty-one percent failed to say that they would choose nursing as a profession again.

In one of the first studies to investigate the relationship between ethics and intent to leave, Connie Ulrich, an assistant professor in Penn Nursing, found “moral distress” led to feelings of powerlessness (33 percent), feeling overwhelmed (35 percent), frustration (53 percent) and fatigue (40 percent), noting the nurses’ desire to leave is, in part, fueled by experiencing more “ethical stress” and an inadequate level of institutional support for dealing with ethical decisions, as well as a perception of little respect for their profession. The study’s findings were recently published in Social Science and Medicine.

Issues causing moral distress include protecting patients’ rights, supporting them through end-of-life decisions and fairly distributing resources.

“Nurses reported feeling that they cannot adequately protect patients’ rights or the informed decisions of patients and must balance these and other conflicting issues with a hospital’s bottom line,” Ulrich said.

Lack of respect and trust also had a strong influence on nurses and social workers’ intent to leave.

“Only 58% reported that members of the nursing profession and physicians respect each other,” she said, and only 55% indicated that there was trust among nurses and social workers and physicians, the study found.

Nearly two-thirds of the sample reported facing ethical issues over which they have no control, with nearly 25 percent reporting having received no ethics training.

“With the plethora of career options available today, young nurses and social workers may leave a profession if they feel stress, disrespect and dissatisfaction,” Ulrich said. “This is why a positive ethical environment is so critical.”

Ulrich suggests investing in institutional ethics resources and establishing a climate of respect for the contributions of nurses and social workers to ethical decision-making as ways to possibly increase job satisfaction and decrease turnover.

U.S. hospitals expect a 20 percent nursing shortage by 2020 and a need for a 30 percent increase in social workers by 2010.

The study surveyed 1,215 nurses and social workers from California, Maryland, Massachusetts and Ohio. It was funded by the National Institutes of Health Clinical Center’s Departments of Bioethics and Social Work.