Nurses Coaching Nurses: RAISE Program for Charge Nurses to Mitigate Moral Distress in Critical Care

Moral distress continues to strain the nursing workforce, impacting job satisfaction, turnover, interprofessional relationships, and quality of care. The critical care setting is especially conducive to distress due to complexity of care, family dynamics, mortality, and interprofessional communication.

Stress level is one indicator measured at our urban health care center, but nurses may not be familiar with the phenomenon of moral distress. Moral distress is unique to the individual; therefore, training on its existence and ways to reduce it should include a variety of evidence-based interventions.

In this quality improvement initiative we used the Measure of Moral Distress for Healthcare Professionals survey to assess the influence of a new moral distress and peer coaching program, the RAISE program, on moral distress in the critical care environment.

The RAISE Program incorporates conflict resolution, communication, recognition, and self-care techniques. Charge nurses (primary learners) received training in the RAISE program and coached bedside nurses (secondary learners) for 3 months. The dissemination of educational and coaching efforts and its effect on moral distress was assessed before and after program implementation.

Moral distress after RAISE program implementation was statistically significantly reduced for primary learners (P = .002) but not for secondary learners (P = .44) compared with before program implementation.

The RAISE program's educational dissemination and peer-to-peer coaching did not impact moral distress for secondary learners in this short-term quality improvement initiative. However, the RAISE program is a promising intervention for decreasing moral distress in primary learners, as they learn to recognize conflict, advocate, intervene, and support and empower their peers.