ArticleBMJ open2022
Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 17 citations in OpenAlex.
- Moral Injury in Gaza: The Impact on Healthcare Professionals.Health science reports · 2026Article
- Stepping outside the clinic walls: health professionals' encounters with place during the COVID-19 pandemic.BMC public health · 2026Article
- The mediation effects of moral resilience on the relationship between hospital ethical climate and work engagement among nurses: a cross-sectional study.BMC nursing · 2025Article
- Hard then, harder now: internal medicine residents' moral distress pre and amidst COVID-19.BMC medical ethics · 2025Observational
- Physician Moral Injury During the COVID-19 Pandemic.Journal of general internal medicine · 2025Article
- Validation of the scale compassion fatigue inventory in health professional Spanish-speaking: a cross-sectional study.BMC nursing · 2024Article
- Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic.Qualitative health research · 2024Article
- Family physicians' moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- System-Based Interventions to Address Physician Burnout: A Qualitative Study of Canadian Family Physicians' Experiences During the COVID-19 Pandemic.International journal of health policy and management · 2024Article
- Moral distress related to paid and unpaid care among healthcare workers during the COVID-19 pandemic.PloS one · 2024Article
- Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study.Belitung nursing journal · 2024Article
- Moral distress among intensive care unit professions in the UK: a mixed-methods study.BMJ open · 2023Article
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic.
designCross-sectional survey in late 2020, employing quantitative and qualitative analyses.
settingSafety net practices in 20 US states.
participants2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. MEASURES: Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress.
resultsWeighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported 'mild' or 'uncomfortable' levels and 26.8% characterised their moral distress as 'distressing', 'intense' or 'worst possible'. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress.
conclusionsDuring the pandemic's first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study's clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians' moral distress from witnessing inequities and other injustices for their patients and communities.
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