Registered nurses' perceptions of moral distress and ethical climate

Nurs Ethics. 2009 Sep;16(5):561-73. doi: 10.1177/0969733009106649.


Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley's Moral Distress Scale and Olson's Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses' workplaces for the benefit of both nurses and patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • British Columbia
  • Burnout, Professional / diagnosis
  • Burnout, Professional / psychology*
  • Clinical Competence
  • Cross-Sectional Studies
  • Female
  • Health Facility Environment* / ethics
  • Health Facility Environment* / organization & administration
  • Humans
  • Interprofessional Relations
  • Male
  • Middle Aged
  • Morals*
  • Nursing Methodology Research
  • Nursing Staff, Hospital* / ethics
  • Nursing Staff, Hospital* / organization & administration
  • Nursing Staff, Hospital* / psychology
  • Organizational Culture
  • Qualitative Research
  • Regression Analysis
  • Severity of Illness Index
  • Social Support
  • Surveys and Questionnaires
  • Workplace / organization & administration
  • Workplace / psychology*