“Should I continue with this profession or not?”: moral distress during the COVID-19 pandemic among Swiss healthcare workers

The COVID-19 pandemic led to an extraordinary situation of resource scarcity and pushed healthcare to its limits. Consequently, healthcare professionals (HCPs) faced moral and ethical challenges that served as potential triggers for moral distress. The purpose of this study was to identify moral distress experiences of HCPs during the COVID-19 pandemic. We conducted 30 semi-structured interviews with HCPs working in the German part of Switzerland. We utilized thematic analysis to examine the data and oriented within the relativist/constructionist framework. We identified four themes: 1) The burden of moral distress explores examples of morally distressing situations; 2) Precipitating factors encompass the underlying conditions that contributed to moral distress; 3) Mitigating factors refer to the elements that helped reduce the intensity of moral distress or, in some cases, prevented it from arising altogether; 4) Coping strategies capture how participants actively managed or adapted to experiences of moral distress. Our findings relay that the level of experienced moral distress is linked to the nature of the work as it was more commonly experienced by those with greater direct contact with patients and residents. Frontline HCPs found team support interventions – such as availability of low-threshold supervision – to be especially helpful in coping with moral distress. Participants in leadership positions expressed that teamwork in decision-making alleviated their moral burdens. Our findings highlight the need to address moral distress through national policies and pandemic preparedness plans, to protect healthcare workers and ensure healthcare system resilience in future crises. • Insights into Swiss healthcare professionals` moral distress are provided, showing how they experienced the extraordinary situation caused by the COVID-19 pandemic. • We expand the knowledge about the impact of a healthcare crisis on moral distress by interviewing various professional groups involved in healthcare provision. • Our findings reveal the importance of integrating strategies for addressing moral distress into national policies and in future pandemic preparedness plans.