Moral distress, advocacy and burnout: theorizing the relationships

Int J Nurs Pract. 1999 Mar;5(1):8-13. doi: 10.1046/j.1440-172x.1999.00143.x.


Burnout is a major contributor to shortages of experienced nurses. The research literature shows a correlation between moral distress and burnout in critical care nurses. This paper reports on part of an interpretive interactionist study concerning nurses' experiences of moral distress which prompted attempts to advocate for vulnerable patients. One critical incident is used as an example of the qualitative findings of the study. In this paper, we theorize about what happened when nurses advocated for their patients by challenging medical treatments which the nurses believed to be both inappropriate and to contributing to patient suffering. When attempts at advocacy were unsuccessful, the nurses experienced intensified moral distress, frustration and anger. Being an unsuccessful advocate resulted in nurses being relocated within the hospital, nurses being scapegoated and/or burning out. The theoretical links which this paper makes between advocacy, moral distress and burnout are supported by empirical data from the study.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Burnout, Professional / etiology
  • Burnout, Professional / psychology*
  • Critical Care / methods
  • Critical Care / psychology*
  • Ethics, Nursing*
  • Female
  • Humans
  • Male
  • Medical Futility
  • Morals*
  • Nursing Methodology Research
  • Nursing Staff, Hospital / psychology*
  • Nursing Staff, Hospital / supply & distribution
  • Nursing Theory*
  • Patient Advocacy*
  • Physician-Nurse Relations
  • Power, Psychological
  • Queensland
  • Resuscitation Orders
  • Surveys and Questionnaires