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Ethics have ICU nurses thinking of quitting

By Michael Mui, 24 Hours Vancouver



As many as 18% of current intensive care unit nurses surveyed want to leave their jobs in part due to their personal ethics clashing with their superiors’ orders.

Dr. Peter Dodek, a researcher and ICU physician from the St. Paul’s Centre for Health Evaluation and Outcome Sciences, surveyed 428 nurses at 13 hospitals in the Vancouver Coastal and Fraser Health regions, along with a smaller number of health support staff and doctors on what he calls the “moral distress” they feel at work.

“It’s the tension that’s created when there’s a difference between what somebody thinks they should be doing versus what they’re being told to do,” he said.

“You can imagine this relates to things like the level of care of patients. We’re talking intensive care — very sick people, one of the causes of this relates to end-of-life issues.”

The survey found nurses were the most adversely impacted by this type of stress — perhaps due to how they’re constantly by their patients’ side — compared to the other health workers.

Chief among the sources of distress were how some felt they provided “less than optimal care” for patients due to cost pressures from administrators or insurers.

To a lesser degree, survey respondents said they were impacted by how health-care providers can give “false hope” to family members of those admitted, or following the family’s wishes to continue life support even if that’s not the best choice for the patient.

Another pressure was disagreements on whether to initiate life-saving procedures, when “they only prolong the dying process.”

“This is not something we can’t do anything about. The causes are things related to communication issues, consistency of plans, of leadership, of teamwork,” Dodek said.

His findings were published in the February issue of the Journal of Critical Care. While nurses were the most adversely impacted — 18% of them said they would leave their job today due to moral distress, compared to 10% of other health professionals and just 7% for doctors — it’s clear the pressures had affected other hospital staff.

“It’s possible that the nurses and other professionals are the ones at the bedside pretty much continuously at shift, at work — they’re the ones witnessing these situations more intensely and more frequently,” Dodek said.

“The other explanation is that ... the physicians are the ones making some of these decisions and it’s possible the decisions are affecting the other health professionals.”