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Emergency Nurses Face Unique Moral Challenges Because of Work Environment

DES PLAINES, IL – The type of moral distress experienced by emergency nurses is unique to their work environment, according to a new study, and is distinct from the difficulties faced by nurses in other settings.

The challenges include working in a high-acuity, high-demand, technical environment with insufficient resources, according to the report appearing recently in the Journal of Emergency Nursing. The study team, led by authors from the Emergency Nurses Association, urges improvement in environmental factors in emergency departments and calls for research to develop and validate an instrument to measure moral distress in ED nurses.

The study points out that moral distress, which results when someone is constrained from taking the action he or she believes is right, is different for emergency nurses than nurses in other fields, partly because they don’t have time to build relationships with patients.

"Emergency nursing is life-saving nursing and requires an environment where nurses can act in the best interest of their patients with more consideration of time constraint challenges," ENA President Matthew F. Powers, MS, BSN, RN, said in a press release. "This study is an excellent beginning to understand the distinct causes of moral distress in emergency nurses and how to address it."

The study used semi-structured focus groups for data collection, and then analyzed transcripts for common themes. Specific factors found to create moral distress for ED nurses include excessive documentation and a focus on time-based metrics, inadequate or unsafe staffing, and patients who are frequent users of the ED, such as those with addictions or behavioral disorders. Overall, the researchers explain, emergency nurses often feel they are not able to provide adequate care for patients.

"Focus group participants expressed a common desire to provide high-quality, compassionate care to their patients but also described dysfunctional and challenging aspects of the care environment that contribute to feelings of moral distress by impeding their ability to provide safe, effective patient care," the authors note. "The implications for emergency nurses as individuals, as well as for the profession, are significant and demand attention from ED and hospital administrators, but also from staff."

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