Many understand staff safety in the physical sense but few think of what it means to develop and safeguard the moral momentum needed to negotiate the many emotional and physical barriers to providing excellent patient care.

We have known for decades about moral distress and compassion fatigue; yet have we really accepted these challenges and hazards of clinical work, as part of the staff safety agenda? What about patients? We now have international health care scandals to remind us of what can happen when the wellspring of compassion runs dry— dreadful outcomes for patients and one would suspect staff as well.

We can and need to protect and support staff regularly exposed to traumatic and difficult cases, where their best response will be constrained by circumstances beyond their control. These include clinical staff, middle managers and executive staff facing or enacting severe budget cuts that will prevent them from delivering healthcare in the way that they aspire to according to best practice.

Health managers can respond to these challenges. In a recent article we recommended the following structural elements be introduced into the work environment. These have been shown to build and sustain ethical resilience in staff members and include:

1. promoting and scheduling regular case review for debriefing

2. establishing peer supervision

3. monitoring the case-mix for individual clinicians

4. tracking and treating levels of moral distress and compassion fatigue amongst staff

5. hiring a clinical ethicist to build ethical capacity within the organisation

These interventions act as visible markers of support for healthcare professionals to help navigate and manage the moral distress associated with many fields of modern health care practice.

But staff need to use these services before the damage is done.

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