Lorretta Krautscheid, George Fox University – What Can Be Done About Moral Distress?

On George Fox University Week: What is causing moral distress among student nurses and health care workers?

Lorretta Krautscheid, associate professor in nursing, explains.

Lorretta Krautscheid, PhD, MS, RN, CNE is an Associate Professor in Nursing.  Her scholarship has centered on teaching strategies to promote ethically informed, evidence-based, theory-guided practice.  Lorretta has presented and published research on moral distress among undergraduate nursing students, relationships between resilience protective factors and moral distress, educational strategies supporting moral resilience, and trusting and deference behaviors among post-licensure nurses. Lorretta serves on the American Nurses Association Moral Resilience Panel: Advisory Committee and is a consultant for the Nurse Executive Center Advisory Board regarding transition to practice programs.

What Can Be Done About Moral Distress?


There is a persistent and growing need to educate and retain nurses who are prepared to address patient care needs within complex health care systems. Approximately 17% of newly registered nurses leave the profession within the first year of practice.  Moral distress contributes to this dilemma. Moral distress is defined as feeling constrained from acting upon one’s ethical knowing. It is associated with powerlessness, compassion fatigue, apathy, and burnout.  My research focuses on identifying factors causing moral distress among nursing students and implementing curriculum promoting moral agency.

This work is important because students who develop moral distress in nursing school have an increased risk for becoming apathetic – new nurses reported “going along to get along” in the workplace.  In a national three-site study, student nurses reported moral distress when they witnessed daily dilemmas such as compromised infection control, unsafe medication administration practices, and inadequate resources to alleviate human suffering.  These situations were pervasive across workplace settings. The findings resulted in curricular strategies to promote resilience.

We taught ethical decision making and conflict communication strategies in the classroom and rehearsed in simulation labs.  We also provided education for nurses working with our students in clinical settings.  We emphasized resilience protective factors such as social support, goal efficacy, and communication techniques. 

My later research revealed statistically significant relationships. When social support was high, moral distress was low. When perceived goal-efficacy was high, moral distress was low. We believe resilience empowers students to advocate during ethical dilemmas. The goal is for students to engage resilience protective factors in clinical practice, resulting in workforce retention and quality patient care.