Moral Distress and Turnover Intention Among Nurses in Saudi Arabia: A Cross-Sectional Study

Background/Objectives: Moral distress is a common ethical challenge among nurses working in high-acuity clinical settings and is often associated with turnover intention. However, evidence regarding this relationship among nurses in Saudi Arabia remains limited. This study examined the relationship between moral distress and turnover intention to identify factors associated with turnover intention among nurses. Methods: A cross-sectional study was conducted among 160 registered nurses working in intensive care, oncology, and emergency departments in Saudi Arabia. Three instruments were used for data collection: a sociodemographic questionnaire developed by the research team, the Measure of Moral Distress for Healthcare Professionals, and the Turnover Intention Scale. Results: Nurses working in intensive care and oncology units reported significantly higher moral distress than those working in emergency departments (F = 5.979, p = 0.003). Female nurses reported significantly higher moral distress than male nurses (t = 1.980, p = 0.049). Pearson’s correlation analysis revealed a significant positive association between moral distress and turnover intention (r = 0.332, p < 0.001). Multiple linear regression analysis, controlling for sex, nationality, educational level, department, and years of clinical experience, revealed that moral distress remained significantly associated with turnover intention (β = 0.367, p < 0.001); the model explained 15.0% of the variance in turnover intention (R2 = 0.150; adjusted R2 = 0.116). Conclusions: Nurses experiencing higher levels of moral distress reported greater turnover intention, and this association remained significant after adjustment for selected sociodemographic characteristics. Healthcare organizations may consider strategies to address moral distress, such as fostering supportive ethical work environments, strengthening ethical leadership, and promoting nurses’ well-being, to support workforce retention. However, the cross-sectional design and convenience sampling limit causal inference and the generalisability of these findings.