Health care is a rewarding career, but it is hard work.
Bedside nurses will tell you that they frequently come home and fall asleep before they hit the pillow or even get their scrubs off. But it is not just the 12-hour shifts.
While the work is physically hard, it is also emotionally taxing.
Yes, we get to see lives saved and babies born, but we also witness pain and grief. One of the heaviest burdens is wondering if we did enough.
Moral distress is an emotional state that is generated when a practitioner’s sense of duty is in conflict with what one is able to do. This can occur when what a physician or nurse believes to be morally right is in conflict with a hospital’s policy or state law.
While most states have laws that protect health care workers from being required to provide treatments or procedures that violate their conscience, health care workers encounter situations where policy or state law prohibits them from acting.
This could be an 85-year-old ward of the state who is on a ventilator with end stage lung cancer and the ICU staff is waiting for a judge to give them permission to transition the patient to hospice, or a 50-year-old who requests a do not resuscitate (DNR) order while her breast cancer treatment has an 80% chance of success.
COVID-19 has shoved the level of moral distress that hospital staff face into overdrive. One or two heart wrenching cases a month might be normal for a seasoned ICU nurse, but now nurses in our major cities are facing one or two a day.
Nurses are faced with conflicts of safety. Not only do they worry about providing cardio-pulmonary resuscitation (CPR) without all of the proper protective equipment, they also worry about how many patients are in their care.
Normally, an ICU nurse would have a 1-to-3 nurse to patient ratio; the hardest hit areas are exceeding the normal safety ratios.
Nurses are caught in a horrible conflict. They can either risk not providing optimum care for their patients or turn deathly ill patients away. In the mind of the practitioner, both options are unacceptable.
Physicians face similar conflict. With so much about COVID-19 unknown, they are having to make treatment decisions without a clear course of action.
Some are asking if the traditional course of ventilator treatment is helping or hurting. In other cases, they are wrestling with whether to write a DNR order based on limited facts.
These emotionally charged challenges are not new to health care. They are typically seen during a disaster and are short lived.
After a disaster, those involved will take the time to review decisions and reconcile much of the moral distress. A physician or nurse can take comfort in having others remind them that they made the best decision based on the evidence at hand.
On the other hand, a pandemic situation is like a war zone. The patients just keep coming.
Unfortunately, in the face of the coronavirus, there has not been time for health care workers in the heat of battle to stop and reflect. Self-care has been set aside.
As the country is hopefully reaching its pinnacle of COVID-19 deaths, we need to begin looking after the health care workers who have been on the front lines.
Similar to soldiers who need time to process battlefield decisions, paramedics and hospital staff need time to process the feelings of moral distress.
Unaddressed moral distress can lead to anxiety, depression and burn out among health care workers. Moral distress has been cited as one of the leading reasons individuals leave the health care profession.
Health care systems typically will provide debriefings, chaplains, clinical ethicists and employee assistant services for staff under stress. While all of this is helpful, many health care workers still look to local clergy for counsel.
So, what can be done outside the hospital?
First, we need to acknowledge that our health care professionals are facing a physical and emotional crisis.
They have been sieged with a cornucopia of complex decisions. Even when health care workers make the right decisions, negative emotions persist. Those emotions need to be discussed in a safe non-judgmental environment. There should be no better place to do that than the loving arms of the church.
Second, clergy need to remember how to listen.
As clergy, we often are quick to proclaim what the Bible says or offer a solution to someone’s problem. It is easy to sit back and declare what is right and wrong. It is difficult to live with decisions that involve life and death.
Moral distress is not about right or wrong. It is about the emotions generated by the decisions. Just like grief, moral distress needs to be processed multiple times over an extended period, and there is not a generic formula for everyone.
Finally, local clergy need to help their congregations show appreciation for the everyday sacrifices that our health care professionals make.
They work long hours every day, not just during a crisis. Many miss out on church activities, family events and children’s school activities. Few nurses or therapists join the profession for the salary. They want to help people.
Our churches need to show them the same kind of support that we give clergy and missionaries. We need to remind them that they are called by God and supported by the local church.
Monty Self is the Senior Staff Chaplain and Clinical Ethicist for the Baptist Health Medical Center Little Rock.