Moral Distress in Nurse Leaders – A Scoping Review of Literature

• Published in: Nursing outlook 2023-09, Vol.71 (5), p.102026-102026, Article 102026
• Main Authors: Edwin, Hephzibah Sophie, Trinkoff, Alison M., Mills, Mary Etta
• Format: Article
• Language: English
• Subjects: Healthcare Manager; Moral Distress; Nurse Administrator; Nurse Director; Nurse Executive; Nurse Leader; Nurse Manager; Nurse Middle Manager; Psychological Distress
• ISSN: 0029-6554; 1528-3968
• DOI: 10.1016/j.outlook.2023.102026

Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles - two quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures - the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress. •Moral distress is negative self-directed emotions resulting from being constrained in taking the right moral action.•The complex healthcare environment contributes to overwhelming job demands exacerbating the moral distress in nurse leaders.•Irrespective of leadership positions, moral distress affects one’s physical, emotional, and professional well-being and increases the intention to quit.•Policies guiding recognition of moral distress in nurse leaders are crucial to promote workforce retention.•Organizational efforts with targeted interventions are imperative to address moral distress in nurse leaders.