The Medicine program in your hospital has been struggling with high volumes of acutely ill patients, and short staffing due to sick calls and burnout. Normal “surge” protocols are no longer working and even the float pool is depleted. The headlines are describing a dire situation indeed, with patients and families reporting long waits for call bells to be answered, and patients left in pain and without help to get to the bathroom. After a straight week of being unable to fill all vacant nursing assistant shifts, and months of overtime, the staff on one unit ask for an ethics consultation, to help them identify priorities for care.
This is a situation that might benefit from a meeting to identify the major ethical concerns and collaborate on interventions that could relieve some of the pressure on staff.
You attend the unit just before morning shift report. Gathering as many people as possible, you convene a short unit meeting to identify the biggest ethical concerns. You assure all present that you are not there to judge or criticize, but to facilitate a discussion of the problems and possible resolutions. You acknowledge that everyone is doing their best, and that in situations where resources such as time and staff are scarce and everything cannot be accomplished, priorities must be set.
Setting the tone for a constructive dialogue in a safe space, you invite the people present to share their experiences. You begin with:
- The wife of a patient, who is in to see her husband, who is dying from end-stage cancer
- The staff working the oncoming shift
- The manager
Moral Distress resources:
Karakachian, A., & Colbert, A. (2017). Moral distress: A case study. Nursing, 47(10), 13–15. https://journals-lww-com.uml.idm.oclc.org/nursing/Fulltext/2017/10000/Moral_distress__A_case_study.5.aspx
Gerin-LaJoie, C. (2020, May 20). A clinician’s guide: How to manage morally distressing situations. https://boldly.cma.ca/blog/how-to-manage-morally-distressing-situations