There are moments in healthcare when something just doesn’t sit right.
A decision has been made. A service limitation is clear. A client cannot access what you believe they need. Everyone seems to understand the constraints.
You keep thinking about it.
Sometimes we turn that discomfort back onto ourselves.
Why is this affecting me so much?
Why can’t I just accept that this is how the system works?
Am I taking this too personally?
But perhaps there is another question worth asking first: What is it about this situation that doesn't sit right?
A recent paper on moral distress offers an interesting way of thinking about this. Yamamoto and Ibuki (2026) suggest that as we develop professionally, we can become increasingly sensitive to the ethical dimensions of our work.
This may make us more vulnerable to moral distress, especially when we are unable to respond in the way we believe we should.
That does not mean distress proves our interpretation is right.
It may be telling us that something deserves our attention.
We do not only learn what to do. We learn what to notice.
Moral distress has traditionally been described as knowing the right thing to do, but being prevented from doing it because of organisational or institutional constraints.
Yamamoto and Ibuki ask an earlier question:
How did the practitioner come to recognise the ethical dimensions that mattered in the first place?
Their argument is that ethical practice is not simply about knowing rules, policies or codes of conduct. Through education, experience, reflection and professional development, we gradually develop what they describe as moral sensitivity, the capacity to perceive morally significant features of a situation.
As we develop professionally, we can become more attuned to and better at noticing:
what matters.
the person behind the task.
when dignity may be compromised.
when professional judgement and available resources no longer align.
the tension between what a service permits and what good care may require.
when competing responsibilities become increasingly difficult to reconcile.
And sometimes, noticing more means carrying more.
The authors describe this as the paradox of moral distress: becoming more attuned to what matters ethically may also make us more vulnerable to distress when circumstances prevent us from responding as we believe we should.
Moral sensitivity is not moral certainty
It's an important distinction to make, particularly in how we understand and respond to our own discomfort.
Experiencing moral distress does not mean our interpretation is automatically correct.
We can misread situations. We may have incomplete information. Colleagues may reasonably see things differently. Our own experiences, emotions and assumptions shape what we notice.
But neither should experiencing moral distress automatically be interpreted as evidence that we are not coping.
Sometimes the better response is curiosity.
What am I responding to?
What feels ethically important here?
What am I unable to respond to in the way I would like?
What might I still be missing?
These questions create a very different starting point from simply asking ourselves to put the discomfort aside, toughen up, or let it go.
Distress can contain information
Sometimes moral distress may tell us something worth examining about the conditions in which we are practising.
A funding model may be impacting what care can be provided.
A policy may have unintended consequences.
Workload may be making professional standards increasingly difficult to maintain.
A practitioner may be repeatedly asked to work in ways that sit uneasily alongside their professional values or judgement.
A team may have become so accustomed to a constraint that no one questions it or even notices it anymore.
In these situations, the distress is not only an internal experience to manage.
It may also be information about the environment.
This sits alongside something I explored in my book, Caring Costs, the emotional and moral costs of care cannot always be separated from the systems in which that care is delivered. Health professionals can end up carrying the consequences of underfunding, service constraints, challenging workplace conditions and competing ethical demands.
If we respond only by helping people cope better, we may miss something important.
What do we do with what we notice?
Recognising moral distress does not magically remove the constraint.
Sometimes there is very little immediate control.
But reflection can help us separate different parts of the situation.
The next time something at work is sitting heavily with you, it may be useful to take it into supervision or another reflective space and ask:
What am I noticing?
What is constraining my response?
What might I still need to understand?
What, if anything, is within my influence?
Some distress may need care and support. Some may require advocacy.
Some may point towards something that belongs at a team, organisational or systemic level rather than being carried privately by one practitioner.
And sometimes the first useful step is simply naming clearly what is happening.
For leaders and supervisors, there is an important parallel responsibility. When a practitioner is troubled by something occurring in their work, offering support is important. But so is listening carefully to what their distress may be revealing about their work environment.
Not because their distress proves that they are right. Because it may be pointing towards something that deserves attention.
The next time you find yourself unsettled by something at work, before considering how to make the discomfort go away, consider what it might be drawing your attention to.
References
Yamamoto, K., & Ibuki, T. (2026). A philosophical reconstruction of moral distress: Its paradox and significance in healthcare practice. Nursing Ethics, 0(0), 1–12. https://doi.org/10.1177/09697330261465866
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When a practitioner is troubled by something occurring in their work, offering support is important. But so is listening carefully to what their distress may be revealing about their work environment.