Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;78(3):799-809.
doi: 10.1111/jan.15013. Epub 2021 Aug 17.

Hospital nurses' moral distress and mental health during COVID-19

Eileen T Lake  1 , Aliza M Narva  2 , Sara Holland  2 , Jessica G Smith  3 , Emily Cramer  4 , Kathleen E Fitzpatrick Rosenbaum  1 , Rachel French  1 , Rebecca R S Clark  1 , Jeannette A Rogowski  5
Affiliations

Hospital nurses' moral distress and mental health during COVID-19

Eileen T Lake et al. J Adv Nurs. 2022 Mar.

Abstract

Aims: To explore factors associated with nurses' moral distress during the first COVID-19 surge and their longer-term mental health.

Design: Cross-sectional, correlational survey study.

Methods: Registered nurses were surveyed in September 2020 about their experiences during the first peak month of COVID-19 using the new, validated, COVID-19 Moral Distress Scale for Nurses. Nurses' mental health was measured by recently experienced symptoms. Analyses included descriptive statistics and regression analysis. Outcome variables were moral distress and mental health. Explanatory variables were frequency of COVID-19 patients, leadership communication and personal protective equipment/cleaning supplies access. The sample comprised 307 nurses (43% response rate) from two academic medical centres.

Results: Many respondents had difficulty accessing personal protective equipment. Most nurses reported that hospital leadership communication was transparent, effective and timely. The most distressing situations were the transmission risk to nurses' family members, caring for patients without family members present, and caring for patients dying without family or clergy present. These occurred occasionally with moderate distress. Nurses reported 2.5 days each in the past week of feeling anxiety, withdrawn and having difficulty sleeping. Moral distress decreased with effective communication and access to personal protective equipment. Moral distress was associated with longer-term mental health.

Conclusion: Pandemic patient care situations are the greatest sources of nurses' moral distress. Effective leadership communication, fewer COVID-19 patients, and access to protective equipment decrease moral distress, which influences longer-term mental health.

Impact: Little was known about the impact of COVID-19 on nurses' moral distress. We found that nurses' moral distress was associated with the volume of care for infected patients, access to personal protective equipment, and communication from leaders. We found that moral distress was associated with longer-term mental health. Leaders should communicate transparently to decrease nurses' moral distress and the negative effects of global crises on nurses' longer-term mental health.

Keywords: COVID-19; communication; leadership; management; mental health; moral distress; nurses; pandemics; personal protective equipment; surveys.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Frequency of COVID‐19 patient care during the peak month. [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Frequency of workarounds for personal protective equipment and cleaning supplies. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. American Nurses Association . (2020a). Crisis standard of care: COVID‐19 pandemic. https://www.nursingworld.org/~496044/globalassets/practiceandpolicy/work...
    1. American Nurses Association . (2020b). Well being initiative. https://www.nursingworld.org/practice‐policy/work‐environment/health‐saf...
    1. American Nurses Association . (2020c). What 32,000 nurses want you to know about treating COVID‐19. https://www.nursingworld.org/~4987e5/globalassets/covid19/ana_covid19inf...
    1. American Nurses Foundation . (2021). Year One COVID‐19 Impact Assessment. https://www.nursingworld.org/practice‐policy/work‐environment/health‐saf...
    1. Arnetz, J. E. , Goetz, C. M. , Sudan, S. , Arble, E. , Janisse, J. , & Arnetz, B. B. (2020). Personal protective equipment and mental health symptoms among nurses during the COVID‐19 pandemic. Journal of Occupational and Environmental Medicine, 62(11), 892–897. 10.1097/JOM.0000000000001999 - DOI - PubMed