Moral distress occurs when you know the ethically correct action is not being taken. Moral distress threatens your core values and can cause compassion fatigue and burnout. Sometimes Moral distress is a gift wrapped in ugly paper.
It was summertime and good jobs were hard to find. Chris and his wife had a precious six month old little girl. She was the apple of her dad’s eye. Chris had lost his job in Texas and had made the brave decision to pack up his family and head to Michigan where he had been promised a job. He got to Michigan and went to his job interview and there the offer was rescinded. Frustrated and disappointed he arrived at his friends home and had a grand mal seizure. He was taken immediately to the hospital. The CAT scan revealed he had a glioblastoma. He had very little money and no health or life insurance.
The nursing staff embraced Chris and his little family. They brought food and baby clothes in for them. They did what they could to cheer him up. All but one of the Neurosurgeons where on vacation. The physician that was available came to see him. He explained what an aggressive tumor a glioblastoma was and offered his regrets that nothing could be done to help him. Chris asked, “How long do I have?” The physician told him 3 months and encouraged him to “get his affairs in order.” Everyone was devastated. As I sat by his bedside, he begged me and others to help him find a way to have a little more time with his baby girl. The nursing staff all wondered if every avenue of treatment had been explored for this dear man. They wondered if the physician’s workload, surgical skill set or the patient’s lack of insurance had played into the recommendations. Something felt morally wrong about all of this.
The nursing staffed discussed this for a day and decided to go over the physician’s head. A call was made to the Chief Medical Director for the hospital. He was an especially kind and caring man. He came right down and reviewed the chart and then spoke to Chris and his wife. The Medical Director called a physician friend at a major medical center and arranged for Chris to have surgery. As he left, we all wished him well and ask him to keep in touch.
At Christmas time he appeared on the unit. He wanted us to know he was doing well and thanked us for saving his life. He said he was on this way back to Texas.
Every two years or so Chris would call the unit and ask for the nurses (by name) that had helped him. His last call was to tell us that his little girl was eleven years old now and trying out for cheerleading. He once again, thanked us for saving his life.
Remember, sometimes moral distress can give you the courage to do what you need to do. Look for meaning amid adversity. Look for nurses and leaders that can help you. Think outside of the box. Develop a plan and clearly make your case. Consider what you can change and what you can’t change. Ask yourself what difference will this make to the patient or the unit. Learn to advocate for a change without making enemies of those above you. Do not be too hard on yourself if you can’t change an event. Always debrief events that impact you. Look for the gifts in life’s ugly wrappers.
