Moral resilience is so important in nursing. I’d like to say I’ve always made decisions based on what was best for patients or morally right, but I’m not sure I have.
Likewise, I’d like to think I’ve always treated my co-workers with the utmost respect – but have I? Truth be told, when I think back on my career, I’ve made decisions and treated others that in retrospect, were not exactly admirable.
Every now and then I think about the times my moral compass went south. I feel the familiar pangs of regret and guilt but stop and remind myself that growth occurs through failures and mistakes.
It took me a while to develop my personal moral compass; my own sense of what was right and wrong. Only then did I develop the courage to defend that compass independent of the situation.
Becoming morally resilient is a personal, but vital process for nurses.
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What is Moral Resilience?
When you search the word moral in the Merriam-Webster dictionary, you find four definitions.
- The first definition is: of or relating to principles of right and wrong in behavior.
- Resilience is defined as: an ability to recover from or adjust easily to misfortune or change.
- In an article by Vicki D. Lachman she writes, “moral resilience is the ability and willingness to speak and take right and good action in the face of adversity that is moral/ethical in nature.”
- In an article found on the American Nurses Association site, it states that “today’s nurses face increasingly complex ethical dilemmas and that the ability to do the right thing is often made difficult by differing values and beliefs of other healthcare providers.”
Why Moral Resilience is Vital for Nurses
We know nursing can be physically and mentally exhausting. Nursing can call one’s moral principles into question on a regular basis. As Vicki D. Lachman writes, there are two ways it often happens.
- The first way is by witnessing or doing something that violates an individual’s moral code.
- The second is when an individual becomes so deeply involved in the work culture their moral code takes on elements of the surrounding culture.
What becomes normal clinical practice can violate compassionate, evidence-based care of patients in some unit/organizational cultures.
You will witness situations with outcomes far from your personal moral code. Some situations you will have control over, some you simply will not. Learning to process your feelings while holding firm to your personal moral code is a vital skill to have to provide the best care for your patients.
Gaining moral resilience will help you bounce back after a difficult situation.
Ways to Increase Moral Resilience
There are many ways to increase your moral resiliency.
Define or Refine Your Personal Moral Compass
Perhaps it’s been awhile since you’ve thought about your feelings about certain situations or outcomes. Maybe you’ve never sat down and thought through how you would feel about hard situations. Either way now is a great time to define or refine the way you feel about situations you have experienced or read about.
Define a Personal Code of Ethics
Once you have taken the time to think about your feelings, take a moment to set your code of ethics. It is great to think about it, but writing it out will help immensely. There is something about writing thoughts on paper that helps solidify your feelings about difficult subjects.
Work on Self-Awareness
Once you’ve written your thoughts out, it’s time to become self-aware. You need to realize and be willing to accept that your feelings are based upon your moral compass or code of ethics and could be biased, incorrect or based solely upon your moral standards. While this is not inherently wrong, it is important to take a step back and look at situations from a broad perspective and consider all the emotional factors at play. Being able to hold your personal moral compass high while looking at the situation from a broad perspective leads to moral resilience.
In the same vein of becoming self-aware, it is important to work on self-regulation. As Cynda Hylton Rushton, PhD., RN, FAAN points out in her article Building Moral Resistance to Neutralize Moral Distress, self-regulation includes the capacity to mindfully notice and respond to signals from the body, emotions and thought patterns to restore balance when upsets or ethical challenges occur. There are many ways we can work on our minds and bodies to help stay morally resilient. Eating well and exercising regularly help our physical selves while practicing meditation, yoga, and tai chi are proven ways to keep our minds strong. Once you have developed your moral compass, code of ethics, become self-aware and developed self-regulation, the next step in achieving moral resilience is to reach out and allow help from others.
Seeking Outside Assistance
Engage with others
We are not alone, and it is vital to reach out and leverage your personal connections to increase moral resilience. Your social circles will become your safety net when you struggle to address complex ethical situations. For the sake of your personal mental health, you need to find others to talk through situations with.
Locate Morally Resilient Mentors
There are morally resilient people all around who can help build your personal moral resilience. The trick may just be figuring out where to find them. Trusted administrators, friends, colleagues or even leaders in professional organizations are all people who can help.
Find Meaning in the Midst of Despair
As a nurse, you will witness situations that take a toll on your personal moral code. As Dr. Rushton says “When confronted with seemingly senseless situations, meaning can be an antidote to despair.” When you find yourself struggling to handle a morally intense situation, move your thoughts to a journal, attend a debriefing session, or seek out help from your trusted mentors. You will have to give yourself time to process the situation.
Once you have done that you can “release, to the extent possible, the moral residue and re-calibrate to a “new normal” that restores your mind and heart to wholeness and makes space for the moral disappointment, sense of moral failure, or moral harm that was produced.”
Building moral resiliency takes time and requires finding a personal way to handle your inner thoughts. Hopefully using some of these techniques will be a good starting point.
I’ve said many times…”Nurses have an ethical responsibility to make decisions based on what’s best for patients – not ourselves.”
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Thanks so much for reading.
Take care. Be kind. Stay connected.
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Dr. Renee Thompson works with healthcare organizations that want to overcome the leadership and clinical challenges their people face every day.
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