Drivers of Moral Distress in Hospital-based Nurse Case Managers: A Qualitative Analysis

ABSTRACT Purpose of Study: Moral distress (MD) is a well-known phenomenon in nursing that is damaging and dangerous to patients, nurses, the health care system, and society. There is a gap in the literature related to the experience of MD among hospital-based nurse case managers. The purpose of this qualitative research study was to understand the experience of MD for the hospital-based nurse case managers. The research question that guided this study was: What factors or experiences are attributed as the cause of MD among hospital-based nurse case managers? Primary Practice Setting: Hospital-based Nurse Case Managers Methodology and Sample: Guided by Guzys' (2021) moral distress model, 11 hospital-based nurse case managers were recruited and participated in semi-structured interviews. Thematic analysis (Braun & Clarke, 2006) was used to identify and thematically describe the causes of MD as identified by the participants. Results: MD was described as being inherent in the practice of case management. They described the phenomenon as a heavy and stressful pressure. The causes of MD identified by the participants were categorized as patient-centered, role-related, and system-related constraints. Implications for Case Management Practice: When considering professional development, leaders and educators should focus on MD recognition, resilience development, and enhancement of communication and soft skills to help nurse case managers navigate the daily challenges of their work. Hospital and case management leadership teams should consider monitoring the departmental ethical climate and the collegiality within interdisciplinary teams to identify corrective and supportive actions to mitigate the risk of MD. Finally, case management leadership teams can use these data to develop executive and departmental practices that support and positively influence their staff's capacity to optimally perform and advocate for patients.