“They leave crying”: An exploration of moral distress in nurses facing workplace violence

Background Workplace violence (WV) is unfortunately common in healthcare environments and leads to difficult ethical choices for nurses who must decide how to provide for patients’ care needs while also navigating a risk of being harmed. When safety takes priority over care, nursing values such as non-abandonment and duty to care cannot be fulfilled, and moral distress results. Research question This study examined how moral distress is experienced when nurses encounter WV, to better understand the implications of these ethically fraught situations. Design, Participants & Context We conducted a secondary qualitative analysis using conventional inductive content analysis of interview transcripts related to nurses’ experiences of WV from 36 nurses working in a range of settings across Canada. Ethical considerations The study was approved by the University of Manitoba Fort Garry Campus Research Ethics Board (HE2023-0102). Findings Violence from patients is a significant moral event, creating moral distress for nurses. We identified three themes: Moral Compromise : angst related to the inability to meet patient needs, the impact of causing trauma to the patient, and being part of dignity-compromising care; Disengagement : decreased tolerance, restrictive boundaries, and leaving the situation; and Structural Influences : watching colleagues suffer, lack of options for violence prevention, and the impact of supervisor support. Conclusion This study provides critical insights into the ways that nurses experience WV-related moral distress, including the contextuality of the duty to care, opportunities to reframe the concept of abandonment to allow for withdrawal when needed to mitigate risk and moral distress, and the key role of institutions in the production of moral distress. The impact of moral distress experienced by nurses when facing WV and the profound ethical and professional consequences of violent interactions for nurses are a clear call for measures to address both the antecedent behaviors and the resulting distress.