Canadian respiratory therapists who considered leaving their clinical position experienced elevated moral distress and adverse psychological and functional outcomes during the COVID-19 pandemic

Introduction: Respiratory therapists (RTs) faced morally distressing situations through-out the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress (i.e. psychological distress when restricted from undertaking a known ethically appropriate course of action) is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and con-sideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consider-ation to leave a clinical position among Canadian RTs during the COVID-19 pandemic. Methods: Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected. Results: One in four RTs reported considering leaving their position because of moral distress. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagno-sis of PTSD. Previous consideration to leave a position and having left a position in the past due to moral distress each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the con-tribution of these latter factors was small. Conclusion: Canadian RTs considering leaving their position due to moral distress reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' con-sideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position depar-ture among Canadian RTs.