Moral reckoning in nursing.

Analysis of qualitative data resulted in an original substantive grounded theory of moral reckoning in nursing, a three-stage process. After a novice period, the nurse experiences a stage of ease in which there is comfort in the workplace and congruence of internal and external values. Unexpectedly, a situational bind occurs in which the nurse's core beliefs come into irreconcilable conflict with external forces. This compels the nurse into the stage of resolution, in which he or she either gives up or makes a stand. The nurse then moves into the stage of reflection in which he or she lives with the consequences and iteratively examines beliefs, values, and actions. The nurse tries to make sense of experiences through remembering, telling the story, and examining conflicts. This study sets the stage for further investigation of moral distress. The theory of moral reckoning challenges nurses to tell their stories, examine conflicts, and participate as partners in moral decision making.