The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Rachel A Plouffe; Anthony Nazarov; Ann M Heesters; Chandlee C Dickey; Laura Foxcroft; Fardous Hosseiny; Tri Le; P Andrea Lum; Maede S Nouri; Patrick Smith; J Don Richardson

doi:10.3389/fpsyg.2023.1235211

The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Front Psychol. 2023 Sep 29:14:1235211. doi: 10.3389/fpsyg.2023.1235211. eCollection 2023.

Authors

Rachel A Plouffe^{1

2

3}, Anthony Nazarov^{1

2

4}, Ann M Heesters^{5

6}, Chandlee C Dickey², Laura Foxcroft², Fardous Hosseiny⁷, Tri Le¹, P Andrea Lum², Maede S Nouri¹, Patrick Smith¹, J Don Richardson^{1

2

3

8}

Affiliations

¹ MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada.
² Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
³ Department of Psychology, University of Dundee, Dundee, United Kingdom.
⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ The Institute for Education Research (TIER), Unviersity Health Network, Toronto, ON, Canada.
⁷ Atlas Institute for Veterans and Families, Ottawa, ON, Canada.
⁸ Parkwood Institute, London, ON, Canada.

Abstract

Introduction: The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs' perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.

Methods: A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.

Results: Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.

Discussion: To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment.

Keywords: healthcare; leadership; moral distress; workplace ethics; workplace support.