Methods: A mail questionnaire was randomly distributed to western United States perioperative registered nurses yielding a 30 % response rate (N = 146).
Results: Fear of reprisal and retaliation were positively correlated with moral distress (p = .000). Significant negative correlations occurred between fear of reprisal and retaliation and (a) peer support (p = .000), (b) the institutions response to ethical concerns (p = .003), (c) institution punishment of reporters (p = .015), (d) level of moral courage exhibited when not in the best interest of the patient (p = .037), and (e) level of moral courage in speaking up when risks are known (p = .038). The level of moral courage needed to overcome being silent showed positive correlations with (a) frequency of immediate reporting of ethical issues to administration (p = .000), (b) questioning a provider when not in the best interest of the patient (p = .000), and (c) frequency of speaking up regarding ethical issues (p = .000). Sufficient performance of the MCQN Likert-type scale showed contrast of scale scores to reflect variance; Cronbach’s alpha measured 0.86.
Conclusion: Findings indicate the moral courage model performance was robust. Perioperative nurses reported high moral courage in situational threats to patient safety. Significant findings clustered influencing factors of fear, previous experience, peer support, and institutional culture. Supportive nursing management and administration promote perioperative nurses’ exhibition of moral courage. Themes emerged in qualitative data: (a) nurse leaders who exhibited moral courage and supportive of moral courage increased staff nurses’ speaking up with moral courage; (b) Nurses reported non-supportive nurse leaders created moral distress, job dissatisfaction, nurses leaving the job or profession, and fear of reprisal and retaliation. Future research is indicated for supportive nursing management and policy creation promoting moral courage. Nurse educators should support moral courage throughout the curriculum building a sturdy foundation for the novice nurse.