Facing Moral Distress in Medicine; Bioethics Conference Will Address the Issue, a Factor in Burnout, Turnover

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Byline: Drew Dixon

Nurses are under more "moral distress" than ever when dealing with medical decisions and the people and families they impact, and this is contributing to burnout and turnover in the field, say some experts.

The Pediatric Bioethics Conference at the University of North Florida will address the moral dilemmas facing the medical field today. And while child care is a driving force of the event, one of the many break-out sessions will address moral distress among health-care professionals and ways to stem turnover and burnout.

Kelly Komatz, an associate professor at the University of Florida College of Medicine, Jacksonville, who is giving the presentation on moral distress, says the issue affects many aspects of the health-care industry, but it is acute in nursing.

"They're the ones in most cases that are left to have to carry out orders or do procedures and ready patients for certain things," said Komatz. "Moral distress is when one is apt to do things for a patient that just doesn't sit right with the person that needs to do it."

Diane Raines, senior vice president and chief nursing officer at Baptist Health in Jacksonville, said nurses face difficult moral issues because they have the most contact with patients in a health-care facility.

"Nurses are often the health-care providers that spend the most direct contact time with patients and families and therefore may have prolonged exposure to whatever the ethical dilemma is," said Raines. "[But] I don't believe moral distress uniquely belongs to nursing."

When a physician issues a medical directive for a patient, the nurses who have to carry out the order may have moral reservations, said Komatz. For instance, a physician, perhaps on the orders of a family, may continue to prescribe life support to a patient that clearly will not survive. The nurse, while knowing the directive may not help the patient, still has to administer the care that may seem futile.

"The nurses have to do things that in the long run aren't going to change the outcome for that patient," Komatz said. "That creates a dilemma for them when in their heart they want to only be able to comfort. It's hard to separate yourself from your work when you go home and maintain another life, if you will."

Both Raines and Komatz agree that the resolution to moral distress in the health-care field is to have a complete approach, drawing in all professionals at a facility. …