Exploring the Views and Experiences of Moral Distress Among Newly Graduated Registered Nurses in Saudi Arabia: A...

Background: Moral distress is a significant concern in nursing, particularly among newly graduated registered nurses transitioning into professional practice. Limited experience, high workloads, and exposure to ethically challenging situations may negatively affect well-being and contribute to early-career attrition. Evidence on how NGRNs experience and manage moral distress globally and in Saudi Arabia remains limited, and the role of healthcare organisational factors in shaping this phenomenon is not yet well understood. Aim: This study aims to examine the experiences of NGRNs regarding moral distress in adult tertiary care hospitals in Saudi Arabia, focusing on contributing factors, coping strategies, and organisational influences. Methods: A mixed-methods sequential explanatory design will be used. In the quantitative phase, NGRNs will complete the Measure of Moral Distress-Healthcare Professionals (MMD-HP) and a demographic questionnaire. Data will be analysed using descriptive and inferential statistics to assess levels of moral distress and associations with intention to leave. The qualitative phase will involve semi-structured interviews with NGRNs and focus groups with nursing managers, which will be analysed using reflexive thematic analysis. Integration will occur at the data collection and interpretation stages. The study is guided by Bronfenbrenner's Ecological Systems Theory. Ethical approval has been obtained from Queen's University Belfast and the Najran Health Cluster. Expected Impact: The study is expected to provide a comprehensive understanding of moral distress among NGRNs and inform the development of targeted organisational strategies to support Registered Nurse wellbeing, retention, and quality of care.