Moral distress in critical and primary care providers from the COVID-19 pandemic: A cross-provincial mixed-methods case study

News reports have highlighted that hospital-based clinicians, including physicians, nurses, and social workers are leaving their professions, catalyzed by COVID-19 circumstances which resemble moral distress and moral injury. "Moral distress" is the response of a person who feels morally constrained by institutional or other constraints, and "moral injury" is when one feels morally betrayed by those in power during high stakes situations. Health care providers working in critical care and family medicine have expressed feeling more anxious and exhausted, and having negative mental health outcomes, including depression, burnout, apathy, and post-traumatic stress disorder, all of which resemble moral distress and moral injury. Critical care and family medicine were chosen for this study as their distress manifests in differing ways; these environments vary in their approaches to and goals of their clinical tasks and care provision with respect to practice settings, acuity, care continuity and relationships. This project aims to explore the effects of moral distress on health care providers in critical care and family medicine environments through the pandemic in two provinces with high infection rates (Ontario and Alberta). To do this, a case study methodology will be employed, in which quantitative data will be collected to measure rates of attrition and burnout, and qualitative methods will be employed to understand providers' experiences during the pandemic. The objective of this is to understand the contexts that shape their moral distress, in order to provide policy and institutional suggestions for stopping attrition and burnout.