The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress:a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs’ perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.Methods: A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.Results: Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.Discussion: To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment

Exposure to moral stressors and associated outcomes in healthcare workers:Prevalence, correlates, and impact on job attrition

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs’ self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p &lt; .001), moral distress (AOR = 1.83; p &lt; .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one’s job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.Introducción: Los trabajadores de la salud (TS) a menudo experimentan situaciones moralmente desafiantes en sus lugares de trabajo que pueden contribuir a la rotación laboral y comprometer su bienestar. Este estudio tuvo como objetivo caracterizar la naturaleza y frecuencia de los estresores morales experimentados por los TS durante la pandemia por COVID-19, examinar su influencia en los factores psicosociales-espirituales y capturar el impacto de dichos factores y los estresores morales relacionados a las intenciones de abandono laboral de los TS.Métodos: Se incluyó en el análisis una muestra de 1.204 TS canadienses a través de una encuesta en plataforma web en la que se analizaron factores relacionados con el trabajo (p. ej., años trabajados como TS, brindando atención a pacientes con COVID-19), angustia moral (evaluado con MMD-HP), daño moral (evaluado con MIOS), sintomatología de salud mental y rotación laboral debido a angustia moral.Resultados: Los estresores morales con mayor frecuencia reportados y tasas de angustia incluyeron requerimientos de atención al paciente que excedieron la capacidad en la que los TS se sentían seguros/cómodos de manejarlos, falta de disponibilidad de recursos y la creencia de que la administración no estaba abordando los problemas que comprometían la atención al paciente. Los participantes que consideraron dejar sus trabajos (44%; N = 517) demostraron mayores puntuaciones de angustia y daño moral. La regresión logística destacó el burnout (AOR = 1,59; p &lt; 0,001), la angustia moral (AOR = 1,83; p &lt; 0,001) y el daño moral debido a la violación de la confianza (AOR = 1,30; p = 0,022) como predictores significativos asociados a la intención de dejar el trabajo.Conclusión: Si bien, es imposible eliminar por completo los estresores morales de la atención sanitaria, especialmente durante escenarios críticos y excepcionales como una pandemia global, es crucial reconocer los impactos perjudiciales para los TS. Esto subraya la necesidad urgente de realizar investigaciones adicionales para identificar factores protectores que puedan mitigar el impacto de estos factores estresantes.</div

Exposure to moral stressors and associated outcomes in healthcare workers:Prevalence, correlates, and impact on job attrition

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs’ self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p &lt; .001), moral distress (AOR = 1.83; p &lt; .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one’s job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.Introducción: Los trabajadores de la salud (TS) a menudo experimentan situaciones moralmente desafiantes en sus lugares de trabajo que pueden contribuir a la rotación laboral y comprometer su bienestar. Este estudio tuvo como objetivo caracterizar la naturaleza y frecuencia de los estresores morales experimentados por los TS durante la pandemia por COVID-19, examinar su influencia en los factores psicosociales-espirituales y capturar el impacto de dichos factores y los estresores morales relacionados a las intenciones de abandono laboral de los TS.Métodos: Se incluyó en el análisis una muestra de 1.204 TS canadienses a través de una encuesta en plataforma web en la que se analizaron factores relacionados con el trabajo (p. ej., años trabajados como TS, brindando atención a pacientes con COVID-19), angustia moral (evaluado con MMD-HP), daño moral (evaluado con MIOS), sintomatología de salud mental y rotación laboral debido a angustia moral.Resultados: Los estresores morales con mayor frecuencia reportados y tasas de angustia incluyeron requerimientos de atención al paciente que excedieron la capacidad en la que los TS se sentían seguros/cómodos de manejarlos, falta de disponibilidad de recursos y la creencia de que la administración no estaba abordando los problemas que comprometían la atención al paciente. Los participantes que consideraron dejar sus trabajos (44%; N = 517) demostraron mayores puntuaciones de angustia y daño moral. La regresión logística destacó el burnout (AOR = 1,59; p &lt; 0,001), la angustia moral (AOR = 1,83; p &lt; 0,001) y el daño moral debido a la violación de la confianza (AOR = 1,30; p = 0,022) como predictores significativos asociados a la intención de dejar el trabajo.Conclusión: Si bien, es imposible eliminar por completo los estresores morales de la atención sanitaria, especialmente durante escenarios críticos y excepcionales como una pandemia global, es crucial reconocer los impactos perjudiciales para los TS. Esto subraya la necesidad urgente de realizar investigaciones adicionales para identificar factores protectores que puedan mitigar el impacto de estos factores estresantes.</div

The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs’ perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.MethodsA total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.ResultsAssociations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.DiscussionTo ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment