Overcoming moral distress: The dilemma of women health-care workers

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During the pandemic, physicians and other medical staff were portrayed in the media as both heroes and as professionals who are burned out and on the verge of leaving their chosen field. The truth is more complicated, as Dr. Julia Smith noted in her two presentations to VCH medical staff in celebration of International Women’s Day. Dr. Smith, an associate professor at SFU’s Faculty of Health Sciences and the lead for the health and social inequities theme at the Pacific Institute of Pathogens, Pandemics and Society, is known for her research into public health policy, feminist analysis, and global health governance. In her interactive presentations, she focused on recent research on women health-care workers’ experiences during the COVID-19 pandemic and the gender differences of experiencing moral distress during this fraught time.

“It’s really important on International Women’s Day to celebrate all of who we are,” Dr. Smith told attendees, “in addition to our professions and the roles we fill. It helps us understand the complexities we live with and bring to our work, our allyship, our activism, and everything else we do.”

Feminist political economy 101

Dr. Smith began her talks by giving a brief overview of feminist political economy as one way to understand gender inequity. She noted the debate around agency (the power we have to make choices) and structure (social and institutional norms that facilitate or impede our ability to act on agency). She discussed the care economy and how women overwhelmingly do the double shift of paid and unpaid work and take on the majority of domestic and community management within a family unit. She also touched on the importance of resistance and resilience.

The research says…

Dr. Smith focused on two recent studies that she led, noting that gender identity, racial identity, ethnic identity, class, and our different abilities all intersect to shape our experiences, particularly around inequities. The first study she referenced was qualitative research into women’s experiences during the pandemic. She spoke with physicians, midwives, long-term care workers, nurses and community health and social care workers. Most of the women participating in this study believed they had experienced the pandemic in a significantly different way than their male colleagues and partners. They felt overwhelmingly that the difference was because of the way they struggled to manage their unpaid care burden. Schools were closed; and childcare for essential workers was generally only available from 9 am to 3 pm.

“The care deficit,” emphasized Dr. Smith, “fell on women and this was an accepted norm. Women took this on themselves, and kids expected it. This had impacts on women’s time, their careers, and their income.”

Moral distress (the experience of not being able to provide the care we feel ethically obliged to provide due to external constraints) was a common theme in the first study’s interviews and was the catalyst for a survey examining this phenomenon. This research focused on moral distress and unpaid work as caregivers. The data from that is still being analyzed but some interesting trends are already emerging. In particular, more women than other genders responded that they frequently and very frequently felt moral distress due to lacking the time to provide the physical and emotional needs their care dependents needed.

Structural care deficits

Dr. Smith notes that the pandemic was an unusual time with extraordinary pressures. This trend, however, has continued for health-care providers. This is because of the structural care deficits in Canadian society. More than a quarter of parents with young children have non-standard work hours, but less than two per cent of childcare facilities offer non-standard hours. Dr. Smith argued that we need to invest in creating these types of facilities.

Change leaders

Global data reveals that 70 per cent of health-care workers are women; but women account for only 25 per cent of health leaders. Canada is in an exceptional position in that most of our public health leaders (e.g., Dr. Theresa Tam; Dr. Bonnie Henry) are women. We have the hard work of the women who came before us to thank for this.

“On International Women’s Day, it’s important to reflect on and send out gratitude to the women who came before us: the first women to go to medical school and to practice; the first women of colour to demand the right to practice; Indigenous healers and midwives who worked so hard to make care more culturally safe and available throughout our province and country,” said Dr. Smith.

When asked what a good leader is, participants responded with adjectives such as caring, empathetic, humble, and kind. Yet crisis management, such as was seen in the pandemic, tends to be hyper-masculine: top down; based on rational calculations; focused on sustaining the organization; and following business and military models.

One woman physician in the survey noted, “Men are making more decisions now with less process or consultation. They are more directive and dictatorial. Men are advancing their careers and using a more command control model.”

Women participating in the qualitative study also related being told they care too much to lead. They were discouraged from seeking management roles because they do not fit the dominant style of leadership that is promoted.

Coping strategies

When asked what the most effective coping strategies are for addressing moral distress, most respondents selected time with family, peer support, time off, and time outside. Interestingly, the strategies that many institutions are offering (e.g., support phone numbers/apps, counselling/therapy, support from supervisors) were seen as the least effective.

Physicians attending Dr. Smith’s March 8 presentation were able to receive CME credits for their participation. There were many questions from the audience, with Dr. Smith addressing a wide variety of these from suggestions on ways to increase female physicians’ engagement in leadership roles to how to improve structures so women can exercise agency.

Dr. Smith’s March 8 session was recorded and is available here (password: ?62z4hD&). You can also view the slides from this presentation here.

Check out VPSA’s #EmbraceEquity photos here.

Post-event survey findings

  • 31 of the 68 people attending the March 8 presentation took part in the survey.
  • 84% of respondents felt the session met its stated objectives.
  • A large majority agreed they will apply content from the session to their work.

Comments from survey respondents regarding what resonated most from the session included:

  • How common it is that women have so much to do that it feels overwhelming.
  • The disconnect between an organization’s idea of providing support versus what employees actually want.
  • This went so far beyond what I was expecting. I was screen-shooting and sending to colleagues as these are issues we are actively discussing.
  • Moral distress from unpaid care: SO TRUE!
  • It was nice to have my struggles and feeling validated!
  • Importance of focus on strengths of women’s leadership, and the need for resources.

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