‘They’re waiting for us to break before they listen’: healthcare workers’ perspectives on how to mitigate moral distress in British Columbia, Canada

Objectives: Moral distress among healthcare workers can have serious repercussions, including reduced morale, decreased quality of care, apathy, burnout, and workforce attrition. While much research has documented moral distress, few studies have considered how to effectively mitigate it. This study sought to enhance understanding of moral distress by exploring not only who is affected and why, but also examining strategies for addressing it. Methods: An online survey was conducted with primary care healthcare professionals in British Columbia, Canada, from October to December 2022, including physicians, nurses, homecare aides, and long-term care aides. The survey gathered sociodemographic data, documented experiences of moral distress, and explored methods used to mitigate it. We specifically analysed responses to two open-ended questions on how respondents addressed moral distress, categorizing responses by profession, gender, and racial identity. Results: Employing a socio-ecological framework, we organized mitigation strategies across four levels: individual, interpersonal, community/organizational, and societal/systemic. Strategies ranged from personal coping mechanisms – such as mindfulness and exercise – to more collective actions aimed at changing workplace culture and policies. At the organizational and systemic levels, participants offered recommendations for structural reforms to improve support for healthcare staff. Conclusion: This study highlights the multifactorial nature of moral distress, showing that it arises from a complex interplay of systemic, organizational, interpersonal, and individual factors. Our findings emphasize the importance of developing multi-level approaches to mitigate moral distress in healthcare, addressing both immediate individual needs and broader organizational and policy changes that promote a healthier work environment.