Date of Award

Spring 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Nursing

Degree Name

Other

First Advisor

Cathleen Colleran

Second Advisor

Andrew Smith

Abstract

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High turnover and high nurse patient ratios have a direct impact on quality outcomes and patient satisfaction. Nurse leaders can have a positive impact on moral distress in acute care nurses through recognition and intervention when moral distress is present.

Methods: Nurse leaders (unit nurse managers, nursing directors, clinical nurse educators, clinical nurse educators) were provided with 8 weeks of moral distress education including in person presentations and emailed resources based on the transformational leadership principles. The plan, do, study, act method was used as an improvement structure for this quality improvement project. Baseline knowledge and comfort assessments in recognizing and responding to moral distress were administered via a secure online survey. Nurse leader thriving was measured using a validated thriving assessment tool administered via online survey.

Intervention: An 8-week intervention was designed to educate nurse leaders on recognizing and responding to moral distress using available best practices and resources. The initial presentation was based on the American Association of Critical Care Nurses (AACN) Moral Distress Toolkit and included background information on what moral distress, compassion fatigue, burnout, and trauma look like in acute care nurses and how nurse leaders and respond appropriately.

Results: Nurse leaders reported a statistically significant increase in comfort in both recognizing and responding to moral distress. Nurse leader knowledge on recognizing and responding to moral distress improved slightly but the results were not statistically significant. Nurse leaders reported an increase in emotional thriving over the course of the intervention, but causation was unable to be verified. Unanticipated anecdotal benefits such as the development of further moral distress reduction programs because of the intervention were plentiful.

Conclusion: Providing a lengthy and varied educational intervention on moral distress improved nurse leaders’ comfort with recognizing and responding to moral distress. An increase in emotional thriving was seen, but a lack of qualitative data associated with the intervention eliminated the ability to connect the emotional thriving with the intervention. Participants reported myriad unmeasured benefits of the intervention.

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