When Ethics Hurts: The Causes and Impact of Moral Distress on Emergency Department Nurses: A Scoping Review

AIM: To explore the extent and range of published research on the nature of moral distress in emergency nurses. DESIGN: Scoping review. METHODS: The review followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were undertaken with a date limit of 2015-2025. Reference lists of included papers were also screened. Two reviewers independently screened and extracted data, with disagreements resolved through discussion or third-party review. DATA SOURCES: Searches were undertaken in August 2025 in CINAHL, MEDLINE, Scopus, and PsycINFO. RESULTS: Included studies were across diverse international settings with sample sizes ranging from 169 and 390. Thematic analysis identified four overarching themes: factors contributing to moral distress; situational triggers; the impact of moral distress; and interventions and support strategies. CONCLUSION: The scoping review identified moral distress as a complex phenomenon that undermines nurse well-being, reduces professional satisfaction, and compromises care delivery. Common causes include organisational constraints and the depersonalisation of care, with demographic and contextual factors shaping experiences. Most studies focused on describing the experience of moral distress. Few studies considered evaluating interventions or organisational supports. No longitudinal studies were identified, and variation in tools limited comparability. Future research should focus on interventions and longitudinal designs to investigate how moral distress evolves in the emergency nurse population over time and across various stages of practice. IMPLICATIONS: Establishing evidence-based strategies to mitigate moral distress is essential for supporting emergency nurses and reducing attrition. IMPACT: This study mapped the literature on moral distress in emergency nurses over the last 10 years. It found that most research focuses on measuring moral distress rather than on interventions to prevent or mitigate it. The review will inform nurse leaders, researchers, educators, and policymakers seeking strategies to further support their staff. REPORTING METHOD: This review adhered to the Joanna Briggs Institute guidelines for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. PROTOCOL REGISTRATION: The protocol is registered with Open Science Framework and will be publicly accessible following embargo release in January.