Story by Steve St. Angelo | Illustration by Sarah Robbins
MEPRA teaches nurses to identify moral dilemmas, speak up to address them, and move on healthfully
The statistic alone can cause distress: One third of newly licensed registered nurses leave the field after just two years. And yes, distress—moral distress, as it was named by ethicist Andrew Jameton—is a key culprit in the alarming burnout rate, says Cynda Rushton, PhD, RN, FAAN.
Rushton, Anne and George L. Bunting Professor of Clinical Ethics in the Berman Institute of Bioethics and the Johns Hopkins School of Nursing, knows the feelings of helplessness in caregivers caught, say, between the wishes of a parent and those of a medical team to end or continue treatment for a dying patient. Rushton has been there. But she might also have found one answer to that helplessness.
So far, five cohorts of nurses (about 150 altogether) have volunteered for the Mindful Ethical Practice and Resilience Academy (MEPRA), Rushton’s brainchild for helping nurses identify ethical dilemmas, address them, and move on in a healthy manner. The six-session program teaches nurses how to stabilize their nervous systems through meditation, discern and analyze ethical challenges, and confidently communicate when discussing them with patients or physicians. MEPRA puts those lessons into practice in the School of Medicine’s Simulation Center with trained actors. The experience is recorded, so participants can assess their strengths and where they can improve.
The program is being run as a study, so Rushton and her team are gathering data that they believe will show its value clearly. To them, it’s worth doing “if MEPRA prevents even one nurse from leaving Johns Hopkins Hospital for 9-12 months due to burnout or moral distress.”
“This is a very gratifying program. Nurses arrive discouraged, dispirited, depleted, and they slowly begin to open up, like lotus flowers.”
Years ago, Rushton—as a nurse with three to four years of experience in a pediatric intensive care unit—cared for a child in a persistent vegetative state. The parents wished to discontinue life support. The medical team refused, and the child languished for “month after month” before dying. It was a time when new technology allowed teams to “save lives we couldn’t save in the past, but that brought new problems. How should we use it?” Did those saved lives have quality and meaning? And whose call was it?
Rushton remembers feeling caught, dutifully caring for the body even as staff began to de-personalize the child. “It’s not something I’m proud of, but you got through however you could,” she explains. “Moral distress was not a concept in our vocabulary. The message was, suck it up and keep going. The suffering of clinicians was a radical notion.”
In 1992, she finally picked up a pen and tried a new coping strategy. A scholarly article titled “Care-giver Suffering in Critical Care” became a turning point as moral distress in nursing was forced out into the open. And today with MEPRA, she’s teaching a new generation what she wishes someone had taught her.
“This is a very gratifying program,” she says. “Nurses arrive discouraged, dispirited, depleted, and slowly begin to open up, like lotus flowers.”