When doing the right thing feels wrong: Moral distress among child welfare caseworkers

Abstract

Studied predominantly among nurses, moral distress refers to painful feelings or psychological difficulties related to awareness of the morally appropriate action to take but inability to take that action because of internal (e.g., fear) or external (e.g., lack of time or resources) constraints. However, little is known about experiences of moral distress among child welfare (CW) caseworkers. Drawing from existing moral distress and CW organizational literature, this study examined moral distress experiences among U.S. public CW caseworkers and the role of internal (professional training and psychological safety) and external (job stress and time pressure) constraints in this phenomenon. Data were drawn from a multisite CW workforce improvement project involving two state-administered and two county-administered CW agencies. These analyses utilized a subsample of CW caseworkers (N = 1,879). Logistic regression models were used to evaluate the relationships between constraint variables and two measures of moral distress, after adjusting for covariates. More than 60% of CW caseworkers reported experiencing one or both measures of moral distress. A lower sense of psychological safety, job stress, and time pressure contributed to an increased likelihood of experiencing moral distress. Results suggest that internal and external constraints play different roles in moral distress experiences, and more nuanced exploration of these relationships is warranted. Acknowledging the experiences of moral distress and understanding constraints that contribute to this phenomenon may be key to supporting CW caseworker well-being.