A Mixed Methods Study of Moral Distress Among Frontline Nurses During the COVID-19 Pandemic

Objective: The study's purpose was to develop an understanding of factors affecting moral distress among nurses during the COVID-19 pandemic. Method: California-licensed, registered nurses who cared for COVID-19 patients for at least 3 months were recruited for an explanatory concurrent mixed methods study. Data are derived from the first of two surveys administered 3 months apart, including open-ended questions. Results: Variables with significant bivariate correlations were included as simultaneous predictors in a linear regression model predicting moral distress. The overall model was significant, explaining a substantial portion of the variance in moral distress, but results showed only organizational support and institutional betrayal uniquely predicted moral distress. Three qualitative themes were identified: Ethical Violations in Care, Institutional Betrayal, and Traumatic Strain. The impacts of organizational support and institutional betrayal on nurses' moral distress are important findings in both datasets. Conclusions: Findings provide insights into how nurses' experiences affected their feelings about work. Participants indicated feeling disregarded by management and institutional structures, indicating potential means of slowing the rates at which nurses plan to leave bedside practice.