Relationships Among Moral Distress, Level of Practice Independence and Intent to Leave of Emergency Department Nurse Practitioners

Purpose: This study investigated relationships among moral distress, level of practice independence and intention to leave of emergency department nurse practitioners (ED NPs).
Methods: This quantitative, cross-sectional, correlational study used a survey methodology. A convenience sample of 236 ED NPs was recruited through a mailed survey of ED NPs in an international nursing specialty association. The participants completed instruments regarding moral distress using the Moral Distress Scale-Revised (MDS-R), level of practice independence using the Dempster Practice Behavior Scale (DPBS) and intent to leave the clinical position through self-report.
Findings: The MDS-R was a significant predictor of intention to leave in ED NPs. The DPBS did not yield significance for intention to leave and was noted to have a slight negative but non-significant relationship with the MDS-R in that when the MDS-R scores were higher, the DPBS scores were lower. Both male and female MDS-R scores were higher if the respondent revealed they were considering leaving or left their position than when they were not considering leaving. Respondents found poor patient care due to poor staff communication and working with incompetent coworkers as the most morally distressing situations in their practice.
Discussion: Findings support the MDS-R is a valid and reliable instrument in measuring moral distress. This study further validates that moral distress is a significant indicator of one’s intent to leave their position. Examining the root causes of moral distress in ED NPs and developing interventions to alleviate moral distress may be effective in keeping highly trained ED NPs in their clinical position.