Moral distress among healthcare professionals: report of an institution-wide survey

J Nurs Scholarsh. 2015 Mar;47(2):117-25. doi: 10.1111/jnu.12115. Epub 2014 Nov 29.


Purpose: Moral distress is a phenomenon affecting many professionals across healthcare settings. Few studies have used a standard measure of moral distress to assess and compare differences among professions and settings.

Design: A descriptive, comparative design was used to study moral distress among all healthcare professionals and all settings at one large healthcare system in January 2011.

Methods: Data were gathered via a web-based survey of demographics, the Moral Distress Scale-Revised (MDS-R), and a shortened version of Olson's Hospital Ethical Climate Scale (HECS-S).

Findings: Five hundred ninety-two (592) clinicians completed usable surveys (22%). Moral distress was present in all professional groups. Nurses and other professionals involved in direct patient care had significantly higher moral distress than physicians (p = .001) and other indirect care professionals (p < .001). Moral distress was negatively correlated with ethical workplace climate (r = -0.516; p < .001). Watching patient care suffer due to lack of continuity and poor communication were the highest-ranked sources of moral distress for all professional groups, but the groups varied in other identified sources. Providers working in adult or intensive care unit (ICU) settings had higher levels of moral distress than did clinicians in pediatric or non-ICU settings (p < .001). Providers who left or considered leaving a position had significantly higher moral distress levels than those who never considered leaving (p < .001). Providers who had training in end-of-life care had higher average levels of moral distress than those without this training (p = .005).

Conclusions: Although there may be differences in perspectives and experiences, moral distress is a common experience for clinicians, regardless of profession.

Clinical relevance: Moral distress is associated with burnout and intention to leave a position. By understanding its root causes, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care, staff satisfaction, and retention.

Keywords: Moral distress; comparative study; ethical climate; interprofessional.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Attitude of Health Personnel*
  • Delivery of Health Care / ethics*
  • Female
  • Humans
  • Intensive Care Units
  • Job Satisfaction
  • Male
  • Medical Staff, Hospital / psychology*
  • Middle Aged
  • Morals*
  • Stress, Psychological / etiology*
  • Terminal Care
  • Workplace / standards
  • Young Adult