Moral Distress

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Moral Distress

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Moral Distress in Nursing: What You Need to Know

Moral distress is a complex and challenging problem that can have a significant negative impact on the healthcare team — from hindering our ability to advocate for patients to leaving our job or the profession. During a crisis or disaster, the frequency and severity of moral distress increase. Acknowledging and addressing moral distress is essential to preserving our integrity.

Moral distress occurs when you know the ethically correct action to take but you are constrained from taking it. Whether stemming from internal or external factors, moral distress profoundly threatens our core values. It is distinct from other forms of distress experienced by nurses, such as burnout and compassion fatigue, and is especially prevalent among nurses caring for critically ill patients.

One of the key difficulties in addressing moral distress is first recognizing it. It may be experienced in the form of physical, emotional and/or psychological symptoms, including headaches, palpitations, gastric upset, anger, guilt, frustration, withdrawal and depression.

The causes of moral distress vary among individuals. Common triggers include end-of-life care, inadequate staffing, value conflicts, challenging team dynamics and duty conflicting with safety concerns, among others.

If you suspect you may be experiencing moral distress, it is important to identify, assess and address it – and to seek assistance in working through it. AACN is committed to supporting nurses with moral distress and offers resources to help.

Recognizing Moral Distress … and What to Do About It

There are four key components to addressing moral distress.

Determine What You Are Experiencing

Distinguish between moral distress, burnout and compassion fatigue. All three cause distress but involve different mitigation strategies.

Gauge the Severity of Your Distress

Familiarize yourself with common symptoms, and rate your distress from 1 to 10 to help you prioritize mitigation efforts.

Identify the Causes and Constraints

Recognize the situations and factors that contribute to your moral distress. Use this knowledge to guide your next steps.

Take Action to Help You Move Forward

Consider all options for addressing your moral distress. What resources do you have personally? What’s available in your unit or organization?

Understanding Moral Distress: An Expert Perspective

One of the biggest challenges in overcoming moral distress is recognizing the condition in ourselves. Longtime critical care clinical nurse specialist Natalie Correll-Yoder, a national expert and frequent presenter on moral distress, helps nurses, other healthcare staff and organizations identify and address this challenging issue. Her video interview offers guidance for nurses grappling with moral distress. Topics include:

What Is Moral Distress? | Effects of Moral Distress | Support for Moral Distress | The Importance of Self-Care

There's still a lack of recognition of what moral distress is. A lot of times nurses are feeling these symptoms or emotions, and they don't know what it is. They can't put a name to it.
Natalie Correll-Yoder, MN, RN, CCRN, CCNS

Key Resources

Managing moral distress requires an understanding of its causes, symptoms and solutions. Whether you are experiencing moral distress yourself or want to support someone who is, these featured resources from AACN can help.

Moral Distress in Times of Crisis – AACN Position Statement

While our front-line providers care for patients and families during the COVID-19 pandemic, hospitals must vigilantly identify and provide resources to mitigate the harmful effects of moral distress.

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Moral Distress in a Crisis: What, Why and How to Cope

Challenges posed by COVID-19 further complicate the ethical decisions nurses face, resulting in a greater intensity and frequency of moral distress. This podcast conversation explores causes, impact and mitigation of moral distress.

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Facing Moral Distress During the COVID-19 Crisis

The COVID-19 crisis creates unprecedented challenges for healthcare professionals on the front lines of care. This blog reviews the causes and symptoms of moral distress, and offers solutions.

Creating Resiliency and Improving Retention Among Nurses

Explore how Massachusetts General Hospital nurses who participated in AACN’s Clinical Scene Investigator(CSI) Academy nurse successfully promoted resilience in an environment prone to moral distress.

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Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community

Article authors differentiate between mattering, moral distress and secondary trauma in relation to burnout syndrome, and discuss healthcare organizations as moral communities obligated to addressing these “costs of care.”

Additional Resources

Explore AACN’s full collection of resources for recognizing, evaluating and overcoming moral distress. This compilation includes journal articles, webinars, recorded conference sessions and other materials to support you and your colleagues in resolving moral challenges.