Moral distress is a significant contributor to burnout and turnover in the U.S. eldercare workforce.
Introduction
As the U.S. population ages, the demand for eldercare continues to rise, placing increasing pressure on the workforce in this sector. Eldercare workers frequently encounter ethically challenging situations, often leading to moral distress. This distress not only affects their emotional wellbeing but also contributes to higher rates of burnout and staff turnover. Understanding the sources of moral distress and implementing preventive strategies is crucial for improving staff wellbeing and ensuring the sustainability of the workforce.
A recent scoping review by Nikunlaakso et al. (2022), conducted in Finland, highlights the growing concern of moral distress among eldercare workers and its profound impact on their mental health and job satisfaction. This study provides valuable insights into the causes and consequences of moral distress in eldercare settings and emphasizes the urgent need for interventions. In this post, we will explore how employers and staff can identify signs of moral distress in care staff and what strategies can be implemented to alleviate this growing problem in the U.S.
What is Moral Distress?
Moral distress occurs when professionals face situations where they are unable to provide care that aligns with their ethical beliefs due to external constraints. For eldercare workers, this can arise from conflicts between patient autonomy, inadequate resources, or pressures from organizational policies (Nikunlaakso et al., 2022). These situations often leave workers feeling powerless, frustrated, and emotionally exhausted.
The scoping review by Nikunlaakso and colleagues (2022) examined 14 studies on moral distress among eldercare workers in various countries, primarily in Europe and Canada. The most common causes of moral distress identified were:
- Organizational Restraints: Policies and leadership decisions that prioritize cost-saving measures over quality care.
- Relational Conflicts: Issues with colleagues, patients, and their families that challenge ethical decision-making.
- Inadequate Care: Situations where workers are forced to provide substandard care due to a lack of resources or time.
U.S. Context and Insurance Issues
While the research findings apply broadly to eldercare workers across many countries, the U.S. eldercare system presents additional challenges, particularly regarding insurance issues that impact treatment decisions. In the U.S., insurance companies often dictate the type and extent of care elderly patients receive, which can lead to situations where care workers are unable to provide the necessary services due to coverage limitations. This creates an additional layer of moral distress as workers are forced to balance the ethical duty of providing quality care with the financial constraints imposed by insurance policies.
Several studies in the U.S. support the idea that insurance-related constraints contribute to moral distress among healthcare workers. Research indicates that healthcare providers frequently face ethical dilemmas when insurance policies limit patient care options, leading to feelings of frustration and helplessness. In a study by Epstein and Hamric (2009), healthcare providers in the U.S. reported moral distress when they were unable to offer treatments they believed were in the best interest of patients due to insurance denials or coverage restrictions.
These insurance-related challenges in the U.S. healthcare system can exacerbate the problem of moral distress, adding complexity to the ethical decision-making process and increasing the emotional burden on care workers.
Recognizing Emotional Distress in Eldercare Workers
Early recognition of emotional distress is key to preventing long-term burnout. Eldercare workers often exhibit the following signs when experiencing moral distress:
- Behavioral Changes: Workers may become withdrawn, exhibit avoidance behaviors, or even express intentions to leave their jobs. Moral distress can lead to sick leave or outright job abandonment, which exacerbates staff shortages and increases turnover (Nikunlaakso et al., 2022).
- Mental Health Concerns: Anxiety, anger, frustration, and a sense of helplessness are commonly reported symptoms. The emotional toll of repeatedly encountering ethically challenging situations without adequate support can lead to chronic stress and emotional exhaustion (Nikunlaakso et al., 2022).
- Physical Symptoms: Physical manifestations of moral distress include fatigue and exhaustion. In some cases, workers may adopt unhealthy coping mechanisms, such as disengaging from their duties or isolating themselves from colleagues (Nikunlaakso et al., 2022).
Recognizing these signs is critical for employers and managers in eldercare settings, as unchecked emotional distress can lead to high turnover rates and compromised care for elderly patients.
Preventive Strategies for Employers
Given the severity of moral distress, employers must take proactive steps to mitigate its effects. The review by Nikunlaakso et al. (2022) emphasizes the importance of developing strategies that can support the wellbeing of eldercare workers. Here are several evidence-based approaches that employers can implement to address moral distress:
Enhance Organizational Support:
- Employers should prioritize strong administrative and leadership support. Eldercare workers often feel moral distress when they lack input in care decisions or face conflicts between organizational policies and patient needs. Providing workers with avenues to voice concerns and ensuring transparency in decision-making can help alleviate some of the frustration (Nikunlaakso et al., 2022).
- In the U.S., addressing the complexities posed by insurance limitations can be particularly challenging. Employers can mitigate these challenges by advocating for their staff when insurance restrictions interfere with patient care. Ensuring adequate staffing levels to handle the additional administrative burdens associated with insurance negotiations is also essential.
Offer Professional Development and Ethical Training:
- Employers should invest in ongoing education and training programs that equip workers to handle ethically challenging situations. Training on ethical decision-making, navigating patient autonomy, and managing conflicts with families or colleagues will enable staff to feel more confident in their roles and reduce feelings of powerlessness (Nikunlaakso et al., 2022).
- Such training should also emphasize resilience and self-care, helping workers develop strategies to manage emotional distress when it arises.
Create Peer Support Networks:
- Peer support is a powerful tool for reducing moral distress. Eldercare workers benefit from sharing their experiences and discussing emotionally charged situations with colleagues. Peer groups allow for collaborative problem-solving and emotional validation, which can significantly reduce the feelings of isolation that often accompany moral distress (Nikunlaakso et al., 2022).
- Employers can facilitate regular debriefing sessions or support groups where staff can openly discuss their challenges and concerns in a safe, supportive environment.
Promote Self-Care and Access to Psychological Support:
- Employers should encourage a culture of self-care and provide access to psychological support services. Offering resources such as counseling, stress management workshops, and regular mental health check-ins can help workers maintain their emotional and physical wellbeing (Nikunlaakso et al., 2022).
- Encouraging mindfulness practices and providing breaks to reduce stress are also effective ways to prevent burnout. Workers who feel that their mental health is prioritized are more likely to remain in their roles and continue providing high-quality care.
Conclusion
Moral distress is a significant contributor to burnout and turnover in the U.S. eldercare workforce. The review by Nikunlaakso et al. (2022) underscores the need for targeted interventions to mitigate the effects of moral distress on workers’ mental health and job satisfaction. By recognizing the signs of emotional distress and implementing preventive strategies—such as enhancing organizational support, promoting peer networks, and offering training—employers can create a healthier, more sustainable work environment.
In the U.S., the additional layer of insurance-related constraints makes addressing moral distress even more urgent. Investing in the wellbeing of eldercare workers is essential not only for retaining staff but also for ensuring high-quality care for elderly patients. As the demand for eldercare continues to grow, addressing moral distress will be critical for the long-term success of the industry.
Citations
Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330-342. https://pubmed.ncbi.nlm.nih.gov/20120853/
Nikunlaakso, R., Selander, K., Weiste, E., Korkiakangas, E., Paavolainen, M., Koivisto, T., & Laitinen, J. (2022). Understanding moral distress among eldercare workers: A scoping review. International Journal of Environmental Research and Public Health, 19(15), 9303. https://doi.org/10.3390/ijerph19159303
Written by Lisa Meier with support from ChatGPT