Addressing moral distress in nurse managers through facilitated ethical discussions

BACKGROUND: Moral distress among nurse managers contributes to burnout, disengagement, and turnover, with significant organizational and financial consequences. Despite growing recognition of this issue, few evidence-based interventions specifically address moral distress in this leadership population. PURPOSE: This evidence-based practice initiative evaluated the impact of facilitated ethical discussions on moral distress and intent to leave among nurse managers at a community hospital. METHODS: A pretest-posttest design was used with a convenience sample of 10 nurse managers at a Magnet®-recognized, 180-bed community hospital. Participants attended four monthly facilitated ethical discussions grounded in the Unit-Based Ethics Conversations model. Moral distress was measured before and after the intervention using the Moral Distress-Appraisal Scale. Intent to leave was assessed using a single-item Likert-scale measure. RESULTS: Mean moral distress scores decreased from 16.8 to 14 following the intervention, representing a medium effect size (0.64). Although intent to leave didn't change, all nurse managers remained in their roles postimplementation. Most participants indicated that they would recommend facilitated ethical discussions to peers. CONCLUSIONS: Facilitated ethical discussions may reduce moral distress and support nurse manager retention. This low-cost intervention demonstrates potential clinical and financial benefits and warrants continued use and broader implementation among nursing leadership.