1. Section Editor(s): Laskowski-Jones, Linda MS, RN, ACNS-BC, CEN, FAWM

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A nurse colleague asked me if I'd ever written about moral distress. She'd been helping a staff member work through a situation that deeply troubled her. It's a topic that should be on our nursing leadership and organizational agendas because it can impact nurses in virtually every practice setting and at every stage in their careers.

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Moral distress is the visceral response evoked by experiencing a situation that's completely counter to a nurse's personal or professional ethics, standards, and principles. It's a terrible feeling that's worsened by the sense that damage has or will be done, and the nurse lacks the power, authority, or ability to right the wrong. The nurse may be left feeling like he or she just can't live with the situation, and feels at a loss in sorting out how to effectively resolve or move beyond it. Nurses most certainly have left jobs or careers as a result.


My first experience with moral distress occurred many years ago when I was an emergency nurse at a small community hospital. I'd just successfully completed my first ACLS course and was caring for a nice gentleman in his 90s with symptomatic bradycardia. The patient had received the maximum dose of atropine, but his heart rate continued to drop. External pacemakers weren't yet available. The patient's attending physician was at his bedside awaiting the arrival of a cardiologist to insert a temporary pacemaker. I strongly advocated that we start an infusion of isoproterenol, a second-line drug, to buy time. The physician refused, saying he had no experience with that drug. I watched in horror as we lost this patient.


Perhaps, in retrospect, the outcome would have been the same even with the isoproterenol, but I was left with a deep, lingering sense that we had failed this patient. My coping response was to become an ACLS instructor to teach caregivers how to resuscitate patients; although I couldn't help that patient, maybe I could help others.


How do you manage moral distress? First, recognize that all nurses will probably experience it. When that situation happens, it's essential to talk with trusted colleagues or counselors to express feelings and gain perspective. Healthy coping comes from finding a way to use the situation constructively for problem solving, professional growth, and for helping others when they experience it. Don't dwell on the negative; turn that energy into a positive force for change.


Until next time,


Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM

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Editor-in-Chief, Nursing2015 Vice President, Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.