Since Covid-19, nurses and physicians have been facing an extraordinarily high burden of burnout, depression, PTSD, moral distress, and other psychological symptoms. To understand nurse and physician wellbeing and the factors in their work environment associated with well-being during the Covid-19 pandemic, a multidisciplinary team assessed work environments across four inpatient settings, including an academic medical center and three rural community hospitals. A mixed-methods approach was used, which combined validated surveys, focus groups, and shadowing sessions with nurses and physicians to gain a deeper understanding of contextual factors influencing well-being. The study also included a before-and-after analysis to evaluate the effectiveness of targeted improvement interventions.

Study Highlights

Nurses and physicians working in urban settings report worse work environments and lower well-being.

Results found nurses and physicians in urban areas experienced more burnout, depression, PTSD symptoms, moral distress, and overall well-being issues than those working in rural areas. When looking at working concerns, the study found different issues in rural and urban hospitals. Rural hospitals struggled with a lack of time, too much work, limited job benefits, limited health programs, and less flexibility with scheduling. Urban hospitals, on the other hand, reported problems with work fatigue, low job engagement, unsupportive work culture and low management trust. Both groups, however, shared concerns about the physical work environment, including sexual harassment, violence, and bullying.

Moral distress is associated with burnout and intent-to-leave

Regardless of the setting, nurses and physicians who were considering leaving the profession due to moral distress had significantly higher moral distress scores than nurses and physicians that were considering not leaving. Moral distress scores were significantly positively associated with burnout scores.

Our 60-day intervention reduced moral distress among nurses and physicians who were thinking about leaving their jobs

Overall, results showed that our 60-day intervention, which focused on feedback and quick improvements to working conditions, didn’t significantly reduce burnout or moral distress across all participants. However, for nurses and physicians who were thinking about leaving, there was a significant decrease in moral distress after the intervention. Our findings suggest that it is possible to retain healthcare professionals and reduce their departure from the field caused by moral distress. The American Medical Association (AMA) has developed a tool that estimates the cost of replacing a single physician at around $500,000 for organizations. Consequently, the financial implications of our efforts could reach millions of dollars, especially considering that about a third of nurses and physicians express a desire to leave their current positions.