Peter Barr1. 1. Department of Neonatology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia, peterbarr@bigpond.com.
Abstract
BACKGROUND: Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses. OBJECTIVES: The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses. METHODS: This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3-4 NICUs in New South Wales, Australia. RESULTS: Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (p = 0.651). Burnout (odds ratio [OR] 4.25, p < 0.001) and the hospital ethical climate (OR = 0.29, p = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (B = 0.32, 95% confidence interval [CI] [0.147-0.611]) and the hospital ethical climate (B = 0.19, 95% CI [0.085-0.382]) were significant. CONCLUSIONS: The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.
BACKGROUND: Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses. OBJECTIVES: The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses. METHODS: This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3-4 NICUs in New South Wales, Australia. RESULTS: Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (p = 0.651). Burnout (odds ratio [OR] 4.25, p < 0.001) and the hospital ethical climate (OR = 0.29, p = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (B = 0.32, 95% confidence interval [CI] [0.147-0.611]) and the hospital ethical climate (B = 0.19, 95% CI [0.085-0.382]) were significant. CONCLUSIONS: The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.
Authors: Sara Carletto; Maria Chiara Ariotti; Giulia Garelli; Ludovica Di Noto; Paola Berchialla; Francesca Malandrone; Roberta Guardione; Floriana Boarino; Maria Francesca Campagnoli; Patrizia Savant Levet; Enrico Bertino; Luca Ostacoli; Alessandra Coscia Journal: Int J Environ Res Public Health Date: 2022-07-12 Impact factor: 4.614