Moral distress: Exploring the experiences of rural clinic nurses

Background: Moral distress can negatively impact nurses, patients, and the healthcare system and has been well-documented in high-acuity care environments. Levels of moral distress and experiences of moral distress have been reported as high and severe among nurses in high-acuity care environments; however, the levels and experience of moral distress are unknown in rural clinic nurses. Research Question/Aim/Objectives: This study sought to gain a broader understanding of moral distress in nurses working in rural clinic settings. The aims were (1) Determine the level of moral distress among rural clinic nurses; (2) Examine the relationships of moral distress levels, demographic characteristics, and work experience variables of rural clinic nurses; (3) Identify themes regarding the perceived experiences of moral distress of nurses working in rural clinics; (4) Explore how aspects of rural practice impact moral distress for rural clinic nurses. Research Design: Convergent mixed methodology gathered quantitative and qualitative data in parallel, employed correlation and thematic analysis, respectively, then data were merged. Participants and Research Context: Informed by Rural Nursing Theory, a consecutive sample of 52 nurses across four states were surveyed using the Measure of Moral Distress for Healthcare Professionals and narrative questions. Ethical Considerations: The healthcare system and University IRBs granted exempt status. Findings/Results: The mean moral distress was 74.7 (SD = 76.8), range was 0 to 246, and no significant relationships were found between moral distress, demographics, or work experience variables. Four main themes were identified: (1) Lack [of something] Leads to Moral Distress (2) Barriers to Patient Care and Adherence (3) Inappropriate Healthcare Utilization (4) Care and Practice Factors that Lead to Moral Distress. Conclusions: Rural clinic nurses experience moral distress for reasons unique to rural practice, while other triggers are shared with urban nurses. Further research is warranted on sources of moral distress for rural clinic nurses.