When incongruence causes suffering: The impact of moral distress on emotional exhaustion and cynicism among clinicians

Introduction: Moral distress is the painful feeling that occurs when healthcare professionals cannot carry out what they believe to be ethically appropriate, thereby leading to incongruence. Whereas previous studies revealed that moral distress may generate depression and job resignation, it is still unclear whether moral distress could contribute to different burnout dimensions. To fill this gap, this study aimed to analyze whether moral distress would influence emotional exhaustion and cynicism. Methods: Healthcare professionals working in different wards of an Italian community-based hospital completed questionnaires analyzing: moral distress (Italian Moral Distress Scale-Revised), emotional labor (Hospitality Emotional Labor Scale), emotional exhaustion and cynicism (Maslach Burnout Inventory). Descriptive statistics and regression analyses were conducted. Results: 153 clinicians (55% nurses, 25% healthcare assistants, 10% physicians, and 10% physiotherapists) completed the questionnaires. The results indicated that, while controlling for demographic variables (i.e., age, gender, ward, profession), moral distress (β=.09; p<.05) and the use of surface acting strategies (β=.24; p<.05) were positively related to cynicism (F(10,136)=3.23, p<.01), whereas the use of deep acting strategies was negatively associated with both cynicism (β=-.33; p<.01) and emotional exhaustion (β=-.40; p<.01), representing the only statistically significant predictor of this burnout dimension (F(10,136)=2.19, p<.05). Conclusion: Results suggest that moral distress may lead to detachment from work and a negative attitude towards patients. This may have a profound impact on the healthcare professional-patient interactions. Healthcare organizations could decrease burnout by training healthcare professionals to effectively regulate their emotions (e.g., adoption of deep acting rather than surface acting strategies) and implementing measures aimed at reducing moral distress.