“Either you feel bad and stay, or you’re smart and leave” - perspectives from emergency department staff in Stockholm, Sweden

Background Job attrition and burnout among healthcare staff is a substantial challenge for healthcare systems globally. Staff working in emergency departments (ED) face work environment challenges including moral distress. This study explores causes, consequences, and contextual dimensions of moral distress among ED staff. Methods A total of 36 healthcare professionals from EDs at two hospitals in Stockholm, Sweden, participated in the study. Seven interprofessional focus group sessions were conducted. These were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Results Participants described providing care under conditions of limited resources and high demands. Drivers of moral distress included inadequate nursing care, futile care, ethical dilemmas, organizational barriers, experiencing team-related challenges and lack of control. Ethical challenges were particularly evident in the care of vulnerable groups, especially geriatric and palliative patients. Participants identified systemic factors such as organizational errors, long waiting times, insufficient staffing, and lack of hospital beds as contributors to moral distress. Reported consequences included worsened well-being, a negatively influenced self-image, delayed reactions, and emotional numbing. Some participants expressed intentions to leave their roles, alongside frustration and distrust toward the healthcare system. Conclusions Moral distress emerged as a persistent and normalized feature of ED work, percieved to be primarily driven by resource limitation. These issues need addressing on a policy level. In parallel, strategies to manage moral distress in the ED setting are needed. This has implications for individual healthcare workers’ well-being and organizational stability. Clinical trial number Not applicable.