Occupational Moral Injury and Professional Quality of Life Among a Group of Greek Nurses: A Cross-Sectional Study

Background: Occupational moral injury is associated with nurses' psychological well-being, yet evidence linking it to professional quality of life remains limited, and no validated Greek version of the Occupational Moral Injury Scale (OMIS) has been available. Methods: A cross-sectional study was conducted among 301 nurses from two public hospitals in Greece. Using convenience sampling, 350 questionnaires were distributed, yielding an 86.0% response rate. Participants completed the Occupational Moral Injury Scale (OMIS) and the Professional Quality of Life Scale Version 5 (ProQOL-V). The OMIS was translated and culturally adapted into Greek through a forward-backward translation process, and its validity and reliability were assessed using confirmatory factor analysis and internal consistency testing. Results: The Greek OMIS demonstrated excellent internal consistency (Cronbach's α = 0.95). CFA provided preliminary support for the proposed factorial structure, although model fit indices indicated a marginal-to-moderate fit (CFI = 0.887, TLI = 0.866, SRMR = 0.070 and GFI 0.902). Participants reported relatively high compassion satisfaction (M = 37.30, SD = 7.35) and moderate levels of burnout (M = 23.36, SD = 5.06) and secondary traumatic stress (M = 22.13, SD = 7.28). Betrayal was negatively associated with compassion satisfaction (r = -0.151, p = 0.009) and positively associated with burnout (r = 0.427, p < 0.001) and secondary traumatic stress (r = 0.366, p < 0.001). Regression analyses showed that dimensions of moral injury were associated with burnout, secondary traumatic stress, and compassion satisfaction, with betrayal showing the strongest associations. Conclusions: Occupational moral injury was associated with poorer professional quality of life, underscoring the need for organizational support, ethical resources, and clinical supervision to promote healthcare professionals' well-being and resilience.