The Lived Experience of Moral Distress in Nursing Academe

Background:  Practice dilemmas, labeled as moral distress, have appeared in the nursing literature as a topic of discussion and concern for over 30 years. Less extensively documented has been the occurrence of moral distress in nursing education. As Ganske (2010) has noted, anecdotal reports of moral distress are frequent heard in schools of nursing and higher education, but research and literature exploring the depth and breadth of moral distress in academe is scant. These gaps make development of supportive structures, policy, and interventions impossible. 

Situations noted to lead to ethical dilemmas in nursing education have been termed “seeds of moral distress;” namely, academic dishonesty, grade inflation, incivility, poor clinical performance, and unprofessional behaviors. Several authors have speculated on why moral distress in nursing education has received so little attention.  Unsurprisingly, opinions center on nursing’s unique characteristic of caring; where nurse educators are unable to separate their educator role from that of their care provider role. While some dialogue has centered on the need to remain cognizant of the separate roles of nurse-as-caregiver and nurse-as-educator, even less attention has been given to the reluctance of educators to act on their ethical concerns, despite an established code of ethics for nurse educators. 

Methodology:  The purpose of this phenomenological investigation was to describe the lived experience of nurse educators who self-identified as having experienced moral distress in their role as an educator.  Hour-long phenomenologic interviews were conducted with 10 current and former nursing faculty members who met the inclusion criteria. Criteria for study inclusion consisted of: Possess a Master’s degree in nursing and have been employed as a nurse educator for more than 12 months.  Data analysis was ongoing utilizing Giorgi’s approach.

Findings: Three themes emerged from the analysis. Environmental turmoil, violation of ethical comportment, and physical & emotional symptomology were the thematic categories which accounted for the deleterious effects of moral distress. Participants in this study expressed that conflicts in the academic environment leading to feelings of moral distress were those that violated the participants’ personal and/or professional ethics, values, and morals. Participants experiencing moral distress often experienced common physical symptoms and/or emotional responses. Physical symptoms expressed by participants were increased heart rate, tension, insomnia, and gastrointestinal disturbances. Emotional responses included feelings of helplessness, hopelessness, guilt, anger, sadness, and frustration.

While most respondents in this study identified negative physical and emotional responses to moral distress, several participants also identified a feeling of strength. This strength developed after the incident creating the moral distress had been resolved or the faculty member had chosen to leave their position.  Practice and policy recommendations elicited from the research data call for administrative leadership which proactively supports reviews of morally distressing situations in academe, incorporation of the AACN Four “As” in academic environments, mentoring relationships among new and experienced faculty, as well as well-defined policies to guide faculty.