Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital

J Nurs Manag. 2008 Apr;16(3):360-73. doi: 10.1111/j.1365-2834.2007.00798.x.


Aim: To determine the prevalence and contributing factors of moral distress in medical and surgical nurses.

Background: Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses.

Method: A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital.

Results: The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients.

Conclusion: Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress.

Implications for nursing management: Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.

MeSH terms

  • Acute Disease / nursing
  • Adult
  • Aged
  • Analysis of Variance
  • Attitude of Health Personnel*
  • Burnout, Professional / epidemiology
  • Burnout, Professional / etiology
  • Burnout, Professional / psychology*
  • Conflict, Psychological
  • Cross-Sectional Studies
  • Female
  • Humans
  • Interprofessional Relations / ethics*
  • Least-Squares Analysis
  • Male
  • Middle Aged
  • Morals*
  • Nursing Methodology Research
  • Nursing Staff, Hospital / ethics*
  • Nursing Staff, Hospital / organization & administration
  • Nursing Staff, Hospital / psychology*
  • Perioperative Nursing / ethics
  • Perioperative Nursing / organization & administration
  • Prevalence
  • Prospective Studies
  • Qualitative Research
  • Southwestern United States / epidemiology
  • Surveys and Questionnaires