Get in Line: A Hermeneutic Phenomenological Study Exploring Moral Distress in UK Pre-Registration Student Nurses

Moral distress among student nurses remains underexamined in clinical education in the United Kingdom, despite concern about its effects on well-being, retention and professional identity. International evidence shows moral distress is a growing challenge, yet little is known about how it shapes identity formation during preregistration training.

This hermeneutic phenomenological study explored how student nurses experience and interpret moral distress during clinical placements and how these experiences influence developing professional identity, while offering internationally relevant insight into early ethical learning.

Thirty final-year student nurses took part in 1-to-1 reflective discussions within a routine placement debrief activity. Data were analyzed using van Manen's hermeneutic approach, involving prolonged engagement, iterative interpretation, reflexive journalling and peer dialogue to support rigor. Analysis was manual and aligned with hermeneutic tradition.

Three themes were identified. Students often recognized ethical concerns but felt unable to act because of uncertainty and limited authority. They then encountered workplace expectations that discouraged speaking up, shaped by supervision structures, hierarchy, and organizational pace. Through reflection, students described moral distress as influencing the nurse they hoped to become, indicating its developmental potential. These findings offer an original account of moral distress as a formative influence on identity development with relevance for global nursing education.

Moral distress functions as an emotional burden and a developmental experience. When supported through relational supervision and ethical dialogue, it can strengthen ethical awareness and identity formation. The findings have relevance for education, workforce well-being, and psychologically safe learning environments.