1. Rushton, Cynda Hylton PhD, RN, FAAN


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We are in unprecedented times-uncertainty and fear are ever present and nurses are being called to serve others in ways that challenge our appraisal of benefit to our patients and risk to our families' health and well-being. Many of us are experiencing varying degrees of moral distress and moral outrage arising from the gaps between what we ought to be doing and what we are actually doing under these adverse conditions. It can feel as if it is impossible to do "the right thing."


What can we do to remain whole in the midst of the COVID-19 crisis? How can we accept what seems unacceptable?


Instead of using precious energy in unproductive ways, we can focus on the things that are within our control for meeting the demands of the situation with integrity.


Recognize your moral distress. It's easy to get swept away with fear. When fear takes over, we can become paralyzed-unable to think clearly or to act in accordance with our values. One way to confront our fear is to recognize and name the source of the angst.


What is causing your distress? Notice tension anywhere in your body. Accept whatever it is you find. What are the conflicting obligations you are confronting? Try to name the conflict.


You may realize that your core value in the current situation is to not cause harm to your patients. You may say to yourself, I have an obligation to care for my patients, and I am worried that because there are no beds/equipment available, I may be causing more harm than good to my patients. Such concerns are justified and rational. But because of the conditions and limitations imposed by the pandemic, our individual and collective perspectives will need to shift and expand in ways we are unfamiliar with.


Shift your perspective. It is possible to accept the reality of what has happened without abandoning what matters most. You know your patient needs more; you advocate on their behalf in order to meet their needs, but at the same time you expand your focus to encompass the needs of the larger population in need of medical and nursing care. Understandably, this shift in focus is a source of distress. It means letting go of the expectation that we can continue to operate as usual despite the shortages of resources.


Sacrifices have to be made with full awareness: we may find that we are being asked to enlarge our individual patient focus to a population focus to produce the greatest good for the greatest number of people. Such a reality may ignite feelings of anger, sadness, or despair.


But we are not being asked to abandon our values; rather, we are called to recalibrate our expectations, and perhaps to arrive at a new understanding of integrity within the current constraints. We may not be able to change the reality of the pandemic, but we can minimize harm and promote as much good as we can.


Stay focused on why you are a nurse. It's easy to be distracted by mounting issues related to the pandemic and the uncertainty about how it will unfold. It may help to reconnect to why you are doing this work. Such awareness can anchor us, motivate us, and remind us of our commitment to serve the health of others. Like us, patients and families are fearful and under stress.


Difficult choices will have to be made. Stay focused on your core work and what you can control-the patient in front of you is where your attention needs to be in this moment. You have an opportunity to bring calm and stability rather than more fear and anxiety. Your calm presence, competence and caring; your critical reasoning; and your empathy are needed now more than ever.


How you carry yourself resonates with others around you. Fear is contagious, but so is courage and compassion. Taking a deep breath before entering a patient's room and recalling why you are doing this work can help to reset your nervous system, so that whatever time is available can be used for the highest good. Notice the moments during the day when you are in sync with your values. Pause to honor your efforts and remind yourself that you are doing the best you can in a very difficult situation.


Remember you are not alone. In the context of social distancing and expanded infection control measures, it's easy to feel isolated and alone. You can bet that others are experiencing the same challenges and distress that you are. As nurses and human beings, we are "hardwired" for connection.


In response to social distancing, create new rituals to connect with your colleagues, friends, and family. Schedule a virtual team huddle at intervals during the day that includes a pause to honor the work you are doing, notice the moments of compassion and grace that arise in the workday, and offer kindness and encouragement to each other.


Ask for support-this is not the time to be a martyr; it's an all-hands-on-deck situation. Use resources such as chaplains, peer-to-peer support teams, or ethics consultants virtually or in person to help process the experiences that will inevitably arise.


Intensify connections with mentors, leaders, friends, and family you rely on when challenges arise. And join the national conversation about your experience as a nurse in this pandemic. For example, a web-based platform has been created to provide a protected space for nurses to exchange ideas, emotions, and best practices with each other until the COVID-19 pandemic has passed:


'Stewards of our own well-being and integrity.' This is likely not to be a sprint but a marathon. It is a time when we must be exquisite stewards of all our resources, including our own well-being and integrity. This is not optional; it is a moral mandate of our profession. Remember that you are already resilient; you wouldn't be a nurse if you weren't-tap into the inner resources that have supported you in the past. There is no better profession than ours to manage this crisis. Through our wisdom and courage, we will stand together to serve. I offer you these phrases as a reflection to begin and end each day:


"Strengthen me to see the wonder of my work through the eyes of those I serve."


"Enable me to serve others with respect, compassion, courage, and love."


"Let my work be a light to those in need and a beacon of hope for those who despair."


"-Author unknown"