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Ethics and organisational culture: how healthcare staff cope with “normalised crisis” conditions

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Aisha Rahman

Abstract

This dissertation examines how healthcare staff navigate the ethical complexities and psychological burdens arising from “normalised crisis” conditions, with particular focus on corridor care within the National Health Service. Through systematic literature synthesis, this study analyses the interrelationship between organisational culture, ethical practice, and coping mechanisms employed by frontline healthcare workers. Key findings reveal that corridor care has transitioned from an emergency measure to routine practice, fundamentally compromising professional standards of dignity, privacy, and safety. Staff experience significant moral distress and moral injury when unable to deliver ethically acceptable care, whilst organisational responses critically determine whether crisis conditions become toxic or remain contested temporary deviations. Evidence demonstrates that supportive organisational cultures characterised by visible leadership, psychological safety, and relational practices buffer staff against adverse outcomes. Conversely, bureaucratic, task-driven cultures exacerbate staff distress and promote maladaptive coping strategies including emotional withdrawal. This synthesis concludes that sustainable healthcare delivery requires fundamental cultural transformation rather than policy codification of substandard practices, offering recommendations for organisational interventions that prioritise staff wellbeing whilst maintaining ethical care standards.

Introduction

Contemporary healthcare systems face unprecedented pressures characterised by chronic capacity deficits, workforce shortages, and escalating demand. Within the National Health Service, these pressures have manifested in the phenomenon of “corridor care”—the practice of managing patients in non-clinical spaces such as hospital corridors, waiting areas, and temporary treatment zones. What was previously conceived as an exceptional emergency measure has undergone a concerning transformation into normalised practice, raising profound ethical questions about the sustainability of current healthcare delivery models and their impact on both patients and staff.

The emergence of corridor care as routine practice represents more than a logistical challenge; it constitutes a fundamental ethical crisis that demands scholarly attention. When healthcare professionals are systematically required to deliver care in environments that compromise basic standards of dignity, privacy, and safety, the consequences extend beyond immediate patient outcomes to encompass professional identity, psychological wellbeing, and the moral fabric of healthcare organisations. Understanding how staff cope with these conditions is essential for developing effective interventions and policy responses.

The concept of “normalised crisis” provides a valuable analytical framework for understanding this phenomenon. When crisis conditions become embedded as standard operating procedures, they cease to provoke the urgent response typically associated with emergency situations. Instead, substandard practices become institutionalised, ethical boundaries erode, and healthcare workers must continuously navigate the tension between professional ideals and organisational realities. This normalisation process carries significant implications for staff wellbeing, patient safety, and the broader trajectory of healthcare ethics.

Organisational culture emerges as a critical mediating variable in this context. The manner in which healthcare organisations respond to crisis conditions—whether through supportive, relational leadership or bureaucratic, top-down management—substantially influences staff experiences and coping outcomes. Understanding this cultural dimension is essential for developing evidence-based strategies that protect both staff wellbeing and care quality under sustained pressure.

This dissertation addresses these concerns through systematic literature synthesis, examining the intersection of ethics, organisational culture, and coping strategies within normalised crisis conditions. The investigation holds significant academic importance in advancing theoretical understanding of moral distress and organisational resilience, whilst offering practical insights for healthcare leaders, policymakers, and frontline practitioners navigating these challenging circumstances.

Aim and objectives

Aim

To critically analyse how healthcare staff cope with “normalised crisis” conditions, examining the interplay between ethical tensions, organisational culture, and adaptive strategies within contemporary healthcare settings.

Objectives

1. To examine the ethical tensions and moral distress experienced by healthcare staff working under normalised crisis conditions, with particular reference to corridor care practices.

2. To analyse how organisational culture influences staff experiences and coping mechanisms during sustained crisis conditions.

3. To identify and categorise the multi-level coping strategies employed by healthcare workers, distinguishing between individual, team-based, and organisational responses.

4. To evaluate the characteristics of organisational cultures that either exacerbate or buffer staff distress during normalised crisis conditions.

5. To synthesise evidence-based recommendations for healthcare organisations seeking to support staff wellbeing whilst maintaining ethical care standards under crisis conditions.

Methodology

This dissertation employs a literature synthesis methodology to systematically examine existing research on healthcare staff experiences during normalised crisis conditions. Literature synthesis represents an appropriate methodological approach for this investigation, enabling comprehensive analysis of disparate evidence sources whilst identifying patterns, contradictions, and gaps in current knowledge.

Search strategy and source identification

The literature synthesis drew upon peer-reviewed academic journals, government publications, and reports from reputable healthcare organisations. Sources were identified through systematic database searches and reference list examination, prioritising publications from the period 2021-2025 to ensure contemporary relevance whilst incorporating foundational theoretical works where appropriate. The search strategy focused on key terms including “corridor care,” “moral distress,” “healthcare crisis,” “organisational culture,” “coping strategies,” and “normalised crisis.”

Inclusion and exclusion criteria

Sources were included based on their relevance to the research objectives, methodological rigour, and publication in peer-reviewed venues or by recognised institutional sources. Studies examining healthcare staff experiences during crisis conditions, organisational culture in healthcare settings, and ethical dimensions of care delivery were prioritised. Sources were excluded if they lacked clear methodological frameworks, originated from non-verified online sources, or failed to address the specific phenomenon under investigation.

Analytical approach

The synthesis employed thematic analysis to identify recurring patterns across the literature. Evidence was organised according to the key analytical dimensions of ethical tensions, organisational culture, and coping strategies. Where possible, findings were triangulated across multiple sources to enhance validity. The analysis attended to both convergent findings and areas of scholarly disagreement, acknowledging the limitations inherent in synthesising diverse methodological approaches.

Methodological limitations

Literature synthesis necessarily relies upon the quality and completeness of existing research. The contemporary nature of corridor care as a research focus means that longitudinal evidence remains limited, and some findings derive from studies conducted during the COVID-19 pandemic, which may not generalise fully to post-pandemic contexts. These limitations are acknowledged throughout the subsequent analysis.

Literature review

The emergence and normalisation of corridor care

Corridor care within the NHS has undergone a significant transformation from emergency measure to normalised mode of practice. Contemporary evidence reveals that large numbers of acutely unwell, frail, and mentally vulnerable patients are routinely managed in corridors, not merely during temporary peaks in demand but as standard operational practice (Barnes et al., 2024; Wise, 2025; Feinmann, 2025). The Royal College of Nursing has documented the scale of this phenomenon, with approximately one in five accident and emergency patients receiving treatment in trolleys or chairs in non-clinical spaces (Feinmann, 2025).

This normalisation represents a fundamental shift in healthcare delivery that challenges established ethical frameworks. Guidance from professional bodies and regulatory authorities typically conceptualises corridor care as “temporary escalation space,” presupposing brief, exceptional deployment under emergency conditions. However, this conceptualisation increasingly diverges from everyday reality, where non-clinical spaces serve as de facto treatment areas for extended periods (Sheather and Phillips, 2025). The gap between policy assumption and operational practice creates significant tensions for healthcare staff attempting to reconcile ethical obligations with workplace realities.

Research by Barnes et al. (2024) characterised corridor patients as predominantly “sick, elderly, and sad,” highlighting the vulnerability of populations most affected by these conditions. The physical characteristics of corridor environments—lacking appropriate lighting, temperature control, privacy provisions, and clinical equipment—fundamentally compromise the delivery of safe, dignified care. This evidence supports claims that safe, good-quality care and corridor treatment are fundamentally incompatible (Sheather and Phillips, 2025; Chadwick, 2025).

Ethical tensions and moral distress

Healthcare professionals experience significant moral distress when organisational conditions prevent them from meeting professional standards of dignity, privacy, and safety. Moral distress, conceptualised as the psychological response to situations where clinicians know the ethically appropriate action but are constrained from taking it, has emerged as a central concern in corridor care research (Sheather and Phillips, 2025; Chadwick, 2025; Robertson, Ryan and Talpur, 2024).

The designation of staff as effective “corridor carers” undermines professional identity and job satisfaction. Healthcare workers recognise that they are unable to provide the care they believe is ethically required, creating a persistent state of values-based conflict. This contributes to what has been termed “moral injury”—the lasting psychological harm resulting from actions, or failures to act, that violate one’s moral code (Barnes et al., 2024; Robertson, Ryan and Talpur, 2024). Unlike moral distress, which describes an immediate emotional response, moral injury refers to the enduring psychological damage that accumulates through repeated ethical compromise.

Chadwick (2025) has explored the ethical implications of treatment spaces, arguing that the physical environment of care delivery carries inherent ethical significance. Corridors, designed for transit rather than treatment, symbolically communicate that patients occupying these spaces are peripheral to the healthcare system’s primary concerns. This spatial dimension of ethics extends beyond practical considerations of equipment and privacy to encompass fundamental questions about human dignity and the meaning of care.

The tension between individual-focused ethics and utilitarian resource allocation logics becomes particularly acute under crisis conditions. Clinicians struggle to reconcile enduring commitments to treat patients based on individual need with imperatives of throughput, triage, and system-wide resource management (Faux-Nightingale et al., 2024). When crisis standards become routine, there emerges a significant risk of compartmentalisation and ethical numbness rather than reflective moral agency. Villanueva and Bennett (2021) have examined how crisis resource allocation practices, developed for genuinely exceptional circumstances, become normalised in ways that undermine ethical deliberation.

Organisational culture and crisis response

Organisational responses critically shape whether corridor care becomes a toxic “normalised crisis” or remains a contested, temporary deviation from acceptable practice. Research has identified distinct cultural patterns that either exacerbate or ameliorate staff distress under sustained pressure.

Cultures characterised as task-driven, top-down, and rule-heavy, with poor communication and absent visible leadership, are associated with staff feeling abandoned, disrespected, and “othered” (Yang et al., 2025; Maple et al., 2024; Abrams et al., 2024; Thude et al., 2021). In such environments, organisational communication occurs primarily through email directives and formal policy documentation rather than relational engagement. Staff experience biopolitical control mechanisms—rigid rules governing breaks, movement, and behaviour—as manifestations of organisational non-compassion that signal their replaceability and peripheral status (Abrams et al., 2024).

Conversely, cultures that deliberately prioritise staff mental health, relational leadership, and psychological safety demonstrate capacity to buffer crisis conditions (Maple et al., 2024; Thude et al., 2021; Petitta and Martínez-Córcoles, 2022). Several key elements characterise these protective organisational cultures:

Visible, relational leadership emerges as a consistent protective factor. Managers who maintain presence on wards, listen actively to staff concerns, validate the limits of what can be achieved under crisis conditions, and defer to frontline expertise create environments where staff feel supported rather than abandoned (Thude et al., 2021; Maple et al., 2024). This visibility carries symbolic significance beyond its practical utility, communicating that organisational leaders share in the challenges faced by frontline workers.

Dedicated spaces and practices of care demonstrate organisational compassion in tangible forms. Rest and recuperation areas, access to psychological support services, and concrete acts of care directed toward staff wellbeing communicate that workers are valued as persons rather than merely as productive units (Abrams et al., 2024; Maple et al., 2024). These provisions represent investment in staff wellbeing that transcends minimal legal compliance.

Inclusive communication and shared sense-making practices enable staff to participate meaningfully in understanding and responding to crisis conditions. Faux-Nightingale et al. (2024) identified how corridors and shared spaces can serve as sites for two-way “corridor conversations” that gauge mood and wellbeing, rather than functioning only as overflow care locations. This reconfiguration of spatial purpose represents creative adaptation to crisis conditions that preserves relational dimensions of organisational life.

Mindful organising and organisational resilience

The concept of mindful organising offers theoretical resources for understanding how healthcare organisations can maintain effectiveness under crisis conditions. Petitta and Martínez-Córcoles (2022) developed a conceptual model linking mindful organising to effective safety and crisis management, emphasising the role of organisational culture in enabling collective vigilance and adaptive response.

Mindful organising encompasses several interrelated practices: collective attention to weak signals indicating emerging problems, openness to reporting difficulties without fear of blame, and capacity for rapid adaptation based on frontline intelligence. These practices require cultural foundations that tolerate uncertainty, encourage speaking up, and treat errors as learning opportunities rather than occasions for punishment (Petitta and Martínez-Córcoles, 2022; Roos et al., 2025; Thude et al., 2021).

Roos et al. (2025) conducted longitudinal research examining healthcare workers’ coping strategies and organisational resilience processes during the COVID-19 pandemic’s first year. Their findings highlighted the interdependence between individual coping and organisational conditions, demonstrating that protective coping strategies function most effectively within supportive organisational contexts. This research underscores the limitations of interventions focused solely on individual resilience without addressing organisational factors.

Multi-level coping strategies

Staff coping with normalised crisis conditions operates across multiple levels, from individual psychological strategies through team-based mutual support to organisational-level responses.

At the individual level, problem-solving approaches and positive meaning-making represent common and generally adaptive strategies. Staff construct narratives of “doing the best possible in impossible circumstances” that maintain professional identity and psychological equilibrium despite objectively inadequate conditions (Roos et al., 2025; Yang et al., 2025). Self-compassion emerges as a potentially valuable resource, though research suggests this practice remains unfamiliar to many healthcare workers and requires explicit organisational permission to be adopted (Abrams et al., 2024).

Team-based coping through informal solidarity and mutual support enables staff to navigate crisis conditions collectively. Research across corridor care, COVID-19 wards, and nursing home settings identifies “family-like” cultures that help staff “make sure we make it through” despite feeling abandoned by wider organisational systems (Yang et al., 2025; Faux-Nightingale et al., 2024). These peer relationships provide emotional sustenance, practical assistance, and moral validation that formal support structures may fail to deliver. Enhancing team autonomy and communication can mitigate stress and conflict in crowded, pressured environments (Robertson, Ryan and Talpur, 2024).

Organisational-level responses present more ambiguous implications. Policies that codify corridor care and establish “temporary escalation spaces” risk institutionalising crisis rather than addressing underlying capacity and systemic failures (Sheather and Phillips, 2025; Chadwick, 2025; Wise, 2025). Such formalisation may provide short-term operational benefits whilst embedding ethically problematic practices as permanent features of healthcare delivery. Some staff respond to sustained crisis through emotional withdrawal or avoidance—strategies associated with higher-risk situations and weaker organisational resilience (Roos et al., 2025; Yang et al., 2025).

The risk of ethical normalisation

The literature reveals significant concern regarding the normalisation of ethically problematic practices. When crisis standards become routine, the moral urgency that initially accompanied their adoption dissipates. Staff may develop what might be termed “ethical numbness”—a diminished sensitivity to conditions that would previously have provoked moral distress (Faux-Nightingale et al., 2024; Villanueva and Bennett, 2021).

This normalisation carries systemic implications beyond individual psychological harm. As substandard conditions become accepted as normal, the pressure for systemic reform diminishes. Corridor care transforms from a visible symptom of system failure demanding urgent response into an unremarkable feature of everyday practice. The ethical violation becomes invisible precisely because it is ubiquitous.

Professional bodies and regulatory authorities face particular challenges in this context. Ethical guidance predicated on corridor care as genuinely temporary and exceptional loses purchase when such conditions become permanent features of healthcare delivery. The gap between aspirational professional standards and operational reality creates what might be termed an “ethics-practice gulf” that staff must navigate daily (Sheather and Phillips, 2025).

Discussion

Addressing the research objectives

This synthesis has examined the complex interrelationships between ethical tensions, organisational culture, and coping strategies within normalised crisis conditions. The findings address each research objective whilst revealing the multifaceted nature of staff experiences under sustained pressure.

Regarding the first objective—examining ethical tensions and moral distress—the evidence demonstrates that corridor care generates significant moral distress through systematic prevention of ethical care delivery. Staff recognise the gap between professional standards and achievable practice, experiencing this recognition as psychologically damaging. The progression from moral distress to moral injury represents a concerning trajectory with implications for workforce sustainability and care quality.

The second objective—analysing organisational culture’s influence—revealed stark contrasts between toxic and supportive cultural patterns. Bureaucratic, top-down cultures characterised by absent leadership and poor communication exacerbate staff distress, whilst relational, visible leadership and dedicated wellbeing provisions offer protective effects. This finding carries significant implications for healthcare management practice and leadership development.

The third objective—identifying multi-level coping strategies—demonstrated the importance of distinguishing individual, team-based, and organisational responses. Whilst individual problem-solving and meaning-making strategies offer valuable resources, their effectiveness depends substantially upon supportive organisational contexts. Team-based solidarity provides crucial buffering but cannot substitute for adequate systemic resources.

The fourth objective—evaluating cultural characteristics—identified specific features of protective organisational cultures: visible leadership, psychological safety, shared decision-making, and dedicated wellbeing provisions. These characteristics represent actionable targets for organisational development interventions.

The fifth objective—synthesising recommendations—emerges from integration of the preceding findings and is addressed in the concluding section.

Critical analysis of key findings

The transformation of corridor care from emergency measure to normalised practice represents a significant failure of healthcare governance. The evidence suggests this normalisation occurs gradually, through incremental accommodation rather than deliberate policy choice. Each small expansion of acceptable practice establishes new baselines from which further expansion becomes possible. Understanding this mechanism of normalisation is essential for developing effective resistance strategies.

The relationship between organisational culture and staff coping emerges as bidirectional and dynamic. Supportive cultures enable effective coping, but effective coping also contributes to cultural maintenance and development. This positive feedback loop suggests that early intervention to establish supportive cultural patterns may generate sustained benefits. Conversely, toxic cultures may generate self-reinforcing cycles of distress, withdrawal, and further cultural deterioration.

The distinction between adaptive and maladaptive coping strategies requires careful interpretation. Emotional withdrawal, whilst associated with poorer outcomes, may represent a rational response to genuinely impossible conditions rather than individual psychological deficiency. Pathologising such responses risks obscuring the organisational and systemic failures that generate them. Effective intervention must address root causes rather than merely treating symptoms.

Implications for healthcare leadership

Healthcare leaders face significant challenges in navigating normalised crisis conditions ethically. The evidence suggests that accepting crisis conditions as permanent features of healthcare delivery carries long-term costs that outweigh short-term operational convenience. Leaders must resist the normalisation of substandard practice whilst simultaneously supporting staff forced to work within inadequate conditions.

Visible, relational leadership emerges as a consistent protective factor across multiple studies. Leaders who maintain ward presence, engage in genuine dialogue with frontline staff, and acknowledge the limits of what can be achieved under current conditions create environments where staff feel valued and supported. This visibility carries symbolic significance: it communicates that leaders share in the challenges faced by workers rather than observing from comfortable distance.

Investment in staff wellbeing provisions—rest areas, psychological support, flexible working arrangements—represents both ethical obligation and operational necessity. Staff who feel cared for demonstrate greater resilience, reduced turnover intention, and maintained engagement with organisational goals. These provisions should be conceived as core operational requirements rather than discretionary benefits.

Theoretical implications

This synthesis contributes to theoretical understanding in several domains. The concept of “normalised crisis” requires further development to capture the specific dynamics of healthcare settings where crisis conditions become permanent operational features. Existing crisis management literature typically presupposes temporary disruption followed by return to normal operations; healthcare contexts increasingly challenge this assumption.

The relationship between moral distress, moral injury, and burnout requires continued theoretical refinement. These concepts overlap but are not synonymous; understanding their interrelationships is essential for developing targeted interventions. Moral injury, in particular, may carry long-term implications that differ qualitatively from burnout, requiring distinct therapeutic responses.

Organisational culture research would benefit from greater attention to healthcare-specific dynamics. The ethical dimensions of healthcare work—the commitment to patient welfare, the significance of care relationships, the professional obligations of clinical roles—create distinctive cultural dynamics that generic organisational theory may inadequately capture.

Limitations of the analysis

Several limitations qualify the conclusions drawn from this synthesis. The contemporary nature of corridor care as a research focus means longitudinal evidence remains limited; understanding of long-term trajectories requires continued research as the phenomenon matures. Studies conducted during the COVID-19 pandemic may not generalise fully to post-pandemic contexts, where crisis conditions lack the exceptional framing that pandemic circumstances provided.

The literature synthesis methodology, whilst appropriate for the research objectives, carries inherent limitations. The analysis depends upon the quality and comprehensiveness of existing research; gaps in the evidence base necessarily constrain the conclusions that can be drawn. Future primary research should address identified gaps, particularly regarding the long-term trajectories of staff working under normalised crisis conditions.

Conclusions

This dissertation has examined how healthcare staff cope with “normalised crisis” conditions, with particular focus on the intersection of ethical tensions, organisational culture, and adaptive strategies. The analysis reveals that corridor care in the NHS has transitioned from emergency measure to routine practice, generating significant moral distress and moral injury among staff unable to deliver care meeting professional ethical standards.

Organisational culture emerges as a critical mediating variable determining whether crisis conditions become toxic or remain contested. Cultures characterised by visible leadership, psychological safety, and genuine investment in staff wellbeing buffer the adverse effects of crisis conditions, whilst bureaucratic, top-down cultures exacerbate distress and promote maladaptive coping responses. This finding carries direct implications for healthcare leadership practice and organisational development priorities.

Staff coping operates across multiple levels—individual, team-based, and organisational—with effectiveness at each level depending substantially upon supportive conditions at other levels. Individual resilience strategies, whilst valuable, cannot compensate for absent organisational support. Team-based solidarity provides crucial buffering but requires enabling conditions that organisations must actively cultivate.

The normalisation of crisis conditions carries profound ethical implications that extend beyond immediate staff and patient welfare. When substandard practices become accepted as normal, pressure for systemic reform diminishes, and ethically problematic conditions become invisible through their very ubiquity. Resisting this normalisation represents an ethical imperative for healthcare leaders, professional bodies, and policymakers.

Recommendations for practice

Healthcare organisations should prioritise visible, relational leadership that maintains genuine engagement with frontline staff experiences. Investment in dedicated wellbeing provisions—rest areas, psychological support services, and flexible working arrangements—should be conceived as core operational requirements rather than discretionary benefits.

Professional bodies should develop guidance that acknowledges the reality of sustained crisis conditions rather than presupposing genuinely temporary escalation. This guidance should support staff in maintaining ethical sensitivity whilst navigating constrained circumstances, without normalising fundamentally unacceptable practices.

Policymakers must address the systemic capacity failures that generate corridor care rather than codifying temporary escalation spaces as permanent solutions. Policy responses that institutionalise crisis conditions risk embedding substandard practices whilst deflecting attention from necessary structural investment.

Directions for future research

Future research should examine the long-term trajectories of staff working under normalised crisis conditions, employing longitudinal designs that capture evolving experiences over extended periods. Investigation of interventions designed to support staff wellbeing and organisational culture should employ rigorous evaluation methodologies to identify effective approaches.

Theoretical development should continue to refine understanding of the relationships between moral distress, moral injury, and burnout, attending to the distinctive features of healthcare contexts. Comparative research examining normalised crisis conditions across different healthcare systems and national contexts would illuminate the role of systemic factors in shaping staff experiences.

Research examining patient experiences of corridor care should complement the staff-focused literature synthesised in this dissertation. Understanding how patients perceive and are affected by corridor care is essential for comprehensive assessment of this phenomenon’s implications.

In conclusion, staff cope with “normalised crisis” through improvisation, solidarity, and personal resilience, but without organisational cultures of care and ethical resistance, these conditions risk entrenched moral injury, burnout, and further normalisation of ethically unacceptable practices. Sustainable healthcare delivery requires fundamental cultural transformation rather than policy accommodation of substandard conditions.

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To cite this work, please use the following reference:

Rahman, A., 17 January 2026. Ethics and organisational culture: how healthcare staff cope with “normalised crisis” conditions. [online]. Available from: https://www.ukdissertations.com/dissertation-examples/nursing/ethics-and-organisational-culture-how-healthcare-staff-cope-with-normalised-crisis-conditions/ [Accessed 23 January 2026].

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