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Open Access Publications from the University of California

Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center.

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Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units.


The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress.


A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress.


The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress.

Linking evidence to action

Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions.

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