Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses

Nurs Forum. 2011 Oct-Dec;46(4):256-68. doi: 10.1111/j.1744-6198.2011.00237.x.


Aim: The purpose of this study was to examine how nurses' moral distress, education level, and critical reflective practice (CRP) related to their work engagement. The study is relevant to nursing, given registered nurse (RN) documented experiences of job-related distress and work dissatisfaction, and the nursing shortage crisis. A better understanding of factors that may enhance RN work engagement is needed.

Methods: A non-experimental, descriptive, correlational design was used to examine the relationships among four variables: moral distress, education level, CRP, and work engagement. The sample included 28 intensive care unit RNs from three separate ICUs in a 355-bed Southwest magnet-designated hospital.

Results: There was a positive direct relationship between CRP and work engagement, a negative direct relationship between moral distress and work engagement, and CRP and moral distress, together, explained 47% of the variance in work engagement. Additionally, in the neonatal intensive care unit, a positive direct relationship between increased educational level and CRP was identified, with a suggested negative relationship between increased education level and moral distress.

Implications: Strategies to promote CRP and reduce moral distress are recommended, to promote RN work engagement. Additionally, further study on the role of education in nurses' work engagement is recommended.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Critical Care* / ethics
  • Critical Care* / psychology
  • Educational Status
  • Female
  • Humans
  • Job Satisfaction*
  • Male
  • Middle Aged
  • Morals*
  • Nursing Methodology Research
  • Nursing Staff, Hospital / psychology*
  • Nursing Staff, Hospital / statistics & numerical data
  • Southwestern United States
  • Stress, Psychological*
  • Young Adult