Moral resilience among nurses: A systematic review and meta-analysis

BackgroundMoral resilience enables nurses to navigate ethical challenges and mitigate moral distress, supporting well-being and high-quality care.AimTo synthesize evidence on the level of moral resilience among nurses and identify potential moderating factors.MethodsA systematic review and meta-analysis were conducted across nine electronic databases from inception to December 2024, updated in August 2025. Observational studies reporting quantitative data using the Rushton Moral Resilience Scale (RMRS) were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analysis, subgroup analyses, and meta-regression were used to pool data and explore heterogeneity.Ethical considerationsEthical approval was not required as the review synthesized publicly available data.ResultsTwenty-four cross-sectional studies comprising 9510 nurses from seven countries were included. The pooled mean moral resilience score was 2.88 (95% CI: 2.78-2.99), indicating a moderate level. Subscale means were: response to moral adversity 2.66 (95% CI: 2.45-2.87), relational integrity 2.79 (95% CI: 2.62-2.96), personal integrity 2.95 (95% CI: 2.80-3.11), and moral efficacy 3.19 (95% CI: 3.06-3.32). Clinical department and employment type significantly moderated moral resilience.ConclusionsNurses globally demonstrate moderate moral resilience, with the lowest capacity in responding to moral adversity. Targeted training and systemic support are needed, particularly for high-stress departments and non-permanent staff, to enhance ethical practice and safeguard nurse well-being.