The Relationship Between Moral Distress and Quiet Quitting in Intensive Care Nurses: The Mediating Role of Moral Injury

Background Intensive care nurses encounter numerous ethical problems in clinical practice. When these morally challenging situations remain unresolved, they may lead to moral distress and moral injury among nurses and may ultimately result in quiet quitting behaviours. Studies examining the relationships among moral distress, moral injury and quiet quitting among intensive care nurses within a comprehensive model are limited. Aim This study aimed to examine the relationships among moral distress, quiet quitting and moral injury among intensive care nurses. Study Design The study employed a cross‐sectional correlational design. It was conducted between 1 April and 31 October 2025 among intensive care nurses working in a university hospital in Türkiye. The data were collected using the Nurse Introductory Information Form, the Moral Distress‐Appraisal Scale, the Moral Injury Symptom Scale–Healthcare Professional, and the Quiet Quitting Scale. The relationships among moral distress, moral injury, and quiet quitting were examined using the Pearson correlation coefficient. The statistical significance of the mediating effects was evaluated using 95% confidence intervals from 5000 bootstrap samples. Results The study included 138 intensive care nurses. A moderate positive relationship was found between moral distress and moral injury among intensive care nurses ( r = 0.524, p < 0.001). In addition, a low but statistically significant positive relationship was identified between quiet quitting and both moral injury ( r = 0.258, p < 0.001) and moral distress ( r = 0.201, p < 0.001). The mediation analysis revealed that moral injury played a full mediating role in the relationship between moral distress and quiet quitting (B = 0.083; 95% CI [0.003, 0.170]). Conclusion This study demonstrates that the relationship between moral distress and quiet quitting among intensive care nurses operates through moral injury. The findings indicate that moral injury constitutes a key mechanism that negatively affects nurses' professional engagement and organisational commitment. In this context, quiet quitting may be seen as an outcome arising from unresolved ethical problems. Strengthening ethical support mechanisms to prevent moral injury is therefore important for the professional sustainability of nurses. Relevance to Clinical Practice These findings highlight the clinical importance of recognising and addressing moral distress and moral injury among intensive care nurses, as early interventions targeting these ethical challenges may help reduce quiet quitting tendencies and support sustained professional engagement. Accordingly, strengthening ethical support mechanisms and improving working conditions may foster a more supportive clinical environment and help sustain nurses' engagement in intensive care practice.