Moral Injury, Glass ceiling, and Nurses' Mental Well-Being

BackgroundNurses' mental well-being is shaped by organizational justice, professional growth opportunities, and ethically supportive work cultures. Perceived glass ceiling barriers may restrict professional advancement and create value conflicts that contribute to moral injury. However, the mechanisms linking structural career constraints to nurses' mental well-being remain insufficiently explored. This study integrates organizational ethics and psychological perspectives to provide insight into how moral injury may explain this relationship.Research Question/Aim/ObjectivesThis study examined the associations among glass ceiling syndrome, moral injury, and nurses' mental well-being, and investigated the mediating role of moral injury in the association between glass ceiling syndrome and mental well-being.Research DesignA descriptive correlational cross-sectional design was used. Data were analyzed using descriptive statistics, Pearson correlations, multivariable regression, and structural equation modeling.Participants and Research ContextThe study included 318 nurses from six public, university, and private hospitals in Cairo. Data were collected using a structured self-administered questionnaire, the Glass Ceiling Questionnaire, the Moral Injury Symptom Scale-Healthcare Professionals Version, and the Warwick-Edinburgh Mental Well-being Scale.Ethical ConsiderationsEthical approval was obtained from the relevant ethics committee. Written informed consent was obtained from all participants. Participation was voluntary, anonymous, and confidential.Findings/ResultsGlass ceiling syndrome was positively associated with moral injury and negatively associated with nurses' mental well-being. Moral injury was also negatively associated with mental well-being. In multivariable regression, moral injury showed the strongest negative association with mental well-being (β = -0.32, p < .001), followed by glass ceiling syndrome (β = -0.19, p < .001). The mediation model showed acceptable to good fit. Moral injury demonstrated a significant mediating effect in the association between glass ceiling syndrome and mental well-being (β = -0.24, 95% CI [-0.34, -0.14], p = .001). The mediating effect accounted for 53.3% of the total association estimated within the proposed model.ConclusionsGlass ceiling barriers and moral injury were associated with poorer nurses' mental well-being. The findings highlight the importance of equitable career advancement, ethical leadership, transparent promotion systems, and structured moral support in fostering healthier nursing work environments. This study provides new insights into the ethical and psychological pathways through which organizational barriers may influence nurses' well-being and offers evidence to inform future leadership strategies, educational initiatives, and intervention research.