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Impact of moral distress on early career nurses: an integrative review
  1. Natalie Finch
  1. School of Nursing and Healthcare Leadership, University of Bradford, Bradford, UK
  1. Correspondence to Natalie Finch, School of Nursing and Healthcare Leadership, University of Bradford, Bradford, UK; nfinch1{at}

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This is a summary of Loyd et al.1

Background and purpose

  • ‘Moral distress’ is described by Jameton as ‘…aris[ing] when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’ (p. 6).2

  • Moral distress may cause nurses to question their career choice, and to feel disempowered and unhappy in their work. This may have a negative impact on the physical and mental well-being of nursing staff, leading to burnout and high staff turnover.

  • Nurses in the first 5 years of their career (early career nurses) may be particularly at risk of experiencing moral distress as they make the stressful and challenging transition from student to qualified practice.

  • The purpose of the review is to synthesise the literature regarding moral distress in the first 5 years of qualified practice.


Results and areas for future research

  • Eight reports met the criteria for this review, seven of which were qualitative and one which was a mixed-methods study.

  • Sample sizes of included studies ranged from 50 to 816 participants, practicing in Canada, Germany, Iran, Japan and the USA.

  • Findings across the studies relating to moral distress and years of practice were conflicting, highlighting the need for further research.

  • Increase in moral distress related to higher level of education were noted in two studies, but not observed or reported in others.

  • One study found that nurses youngest in age reported the highest levels of moral distress, while one study found no relationship between age and moral distress.

  • The variance in all findings suggests that further research into the links between moral distress and levels of education, years of practice and age of the nurse is warranted.

Take home messages

  • While the studies included in this review include some inconsistencies in findings, there is evidence of the experience of moral distress in early career nurses worthy of further consideration.

  • Those involved with nurse education and career support should be aware of the existence of moral distress and consider ways to incorporate education and support for this experience into curricula and early career development plans.

  • Further research should take place which considers not only the education level, years of practice and age of the nurse, but also the impact of the area of clinical practice and the country of practice to understand the impact of the clinical background and the wider systems on the experience of moral distress in early career nurses. This would allow for the development and application of appropriate interventions to mitigate and minimise the impact of moral distress.



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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.