already may have made as many changes as you possible can, and you are still feeling the moral distress of knowing that you are not delivering the standard of care you believe is necessary. You may also realize that your co-workers are also already doing as much as they can, and you don't want to overburden them further. You KNOW your own  profession and know what is required, and may believe that you are not being true to your profession and personal values by not being able to do more. Maybe you experience the tension between your professional standards and your lack the power to make necessary changes in your workplace and role. You may even have taken steps to be heard, and been provided with reasons why 'the budget does not allow for hiring more staff or providing more resources'. You may be experiencing some moral distress because of all this.