1. Anthony, Maureen PhD, RN

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Moral distress occurs when healthcare providers, whether clinical, managerial, or administrative, know the right action to take, but other competing factors deter them from taking what they know to be the right action. Healthcare is fraught with situations that can induce moral distress, which is thought to be a significant factor contributing to employee burnout. In the Commentary column in this issue, Dr. Mary Narayan discusses the pay-per-visit model as one that can encourage home healthcare clinicians to take on more visits than they can capably handle. As a result, vulnerable patients who require longer visits to achieve quality outcomes may not receive the time and attention they need. Staffing issues can also cause moral distress to those in leadership. Although often vilified, building and maintaining the financial health of an agency is critical to the success and future of the agency. Meeting the unanticipated needs of patients is also essential. As a result, managers are in the unenviable position of encouraging staff to take on additional visits, knowing one more visit could be the legendary straw that breaks the camel's back. This is just one example of a situation that may produce moral distress. There are countless others.

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After meeting at a bioethics conference, Dr. M. Sara Rosenthal and Dr. Maria Clay recognized a need and founded the Moral Distress Education Project ( The goal of the project is to educate, inform, and destigmatize moral distress. Short videos of interviews with experts are shared on their website. Topics include origins of moral distress, signs of moral distress, consequences and preventive measures, and issues related to end of life. The University of Kentucky offers free continuing education as part of the Moral Distress Project ( The three-part video education series will help you understand what moral distress is, and how to prevent it through effective communication. Most importantly, you will know you aren't alone.


Best Wishes,

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