Michele LeClaire, MD, MS
Pulmonary & Critical Care
Hennepin Health
Prior Lake, Minnesota
Disclosure information not submitted.
mark linzer, MD
Vice-Chair for Education, Mentorship and Scholarship, Professor of Medicine
Hennepin Health
Minneapolis, MN, Minnesota, United States
Disclosure information not submitted.
Rebecca Friese, MS
Biostatistician Biostatistical Design and Analysis Center (BDAC) Clinical and Translational Science
University of Minnesota, United States
Disclosure information not submitted.
sara poplau, BA
Office of Professional Worklife
Hennepin Health
Minneapolis, MN, Minnesota, United States
Disclosure information not submitted.
Crystal Audi, BA
Research Associate
University of Minnesota, United States
Disclosure information not submitted.
Title: Prevalence, components and consequences of moral injury and burnout in a safety net hospital ICUs
Background: Moral distress occurs when a professional knows the ethically appropriate action to take but feels constrained from doing it. Moral distress is associated with burnout and turnover in critical care providers and nurses. The COVID 19 pandemic has been associated with higher levels of burnout and intent to leave in frontline healthcare workers.
Methods: Critical Care Providers and Nurses at a Midwestern safety net hospital were surveyed in June 2021. A moral distress inventory was created based on the work of Epstein, and on focus groups. We sought to understand the prevalence of moral distress and co-occurrence of burnout and intent to leave the job or reduce clinical effort. Scenarios associated with moral distress were assessed on a 1-5 scale for frequency and level of distress. We chose the top 2 categories on the scale and compared those endorsing these with those endorsing lower values. Burnout was assessed using a validated single item question. Chi Square and Fisher’s test were used for comparisons.
Results: The response rate was 40% (127/319). Respondents included 107 nurses, 18 physicians and 2 advanced practice clinicians. Experiences with very high/high frequency and very high/high level of distress in order were “compromised patient care due to lack of resources “(61% /80%), “lack of administrative action for problems compromising care “(58%/75%), “non-beneficial care” (54%/61%), “caring for abusive patients or family” (42%/78%), “caring for patients whose health is complicated by structural inequities” (61%/50%), and “care that causes unnecessary suffering” (38%/62%). Sixty six percent reported burnout. Fifty percent were moderately or more likely to leave the job within 2 years, and 72% intended to reduce clinical effort. Providers had significantly less burnout than nurses (77% vs 40%, p < 0.011). Nurses more often experienced lack of resources (68% vs 20% of providers, p < 0.001), lack of administrative support (64% vs 30%, p = 0.011) and abuse by patients/family (48% vs 10%, p = 0.001).
Discussion: Burnout and moral distress have become extremely high in this ICU setting, and most often affect nursing staff. Intent to leave the job or cut back clinical effort may greatly impact clinical care. Interventions to mitigate identified areas of moral distress are being developed.