Moral distress in clinical practice: implications for the nurse administrator.

The purpose of this paper is to describe the experience and effect of moral distress in clinical practice and to present the implications of this phenomena for nurse administrators. Findings from three recent investigations provide the descriptive data for this paper. Nurses in clinical practice are frequently confronted with situations which challenge personal moral beliefs. Life and death events, sudden unexpected emergencies and professional role conflict have been identified as some examples of the kinds of situations that are most difficult to cope with. Feelings of emotional distress may occur as a result of participation in a patient care situation which involves an ethical issue. Personal and professional wholeness may be significantly compromised by the ineffective resolution of such issues. Moral distress may affect the nurse's ability to care for the patient and may require a significant period of resolution. Moral distress has been identified as one reason that nurses choose to leave their jobs and occasionally to leave the profession. Implications for the nurse administrator include a responsibility to be aware and supportive of the nurse in this situation. Commitment to developing effective strategies to assist nurses to cope successfully with the ethical dimension of clinical practice is an important management concern.