Examining Moral Distress and Turnover Intention in Newly Licensed Nurses: A Cross-Sectional Study

To examine moral distress and turnover intention among newly licensed nurses in the acute care setting.

Cross-sectional.

We used purposive sampling to recruit newly licensed nurses working in the acute care setting in a multistate healthcare organisation. Participants completed a demographic survey, the Measure of Moral Distress for Healthcare Professionals and the Turnover Intention Scale-6 between May 2025 and June 2026. Data were analysed using descriptive statistics, independent t-tests, one-way analysis of variance and multiple linear regression.

Of 203 nurses, 194 were registered nurses and nine were licensed practical nurses working in Medical Surgical/Stepdown (43%), Critical Care/Emergency Department (48%) and Procedural/Surgical/Other (9%) units. Moral distress and turnover intention scores in the Medical Surgical/Stepdown departments were significantly higher than the other two groups. We found that moral distress was associated with turnover intention, controlling for department and nursing credential.

Moral distress is an important factor in turnover intention among newly licensed nurses. Organizational initiatives and early interventions that reduce moral distress may lower turnover intention and improve wellbeing. Differences in moral distress and turnover among departments and nurse credentials call for further investigations to develop department-specific interventions.

This study has global implications for nursing leaders and educators to assess moral distress as a potential indicator for turnover intention. New nurse attrition continues to challenge healthcare organisations, and interventions that support new nurses are recommended. With the growth of the nursing workforce, opportunities to assess and implement interventions for moral distress can occur within nurse residency programs. This study broadens the evidence base by including licensed practical nurses in acute care. By analysing data on moral distress and turnover intention early in nurses' careers, nurse educators and leaders are provided with a unique perspective into the transition to practice period. Healthcare organisations can implement strategies to recognise and assess moral distress to bolster efforts to support the nursing workforce and retention initiatives.

These findings contribute to the gap in the literature on moral distress and turnover among new nurses, underline the complexities of the acute care environment and highlight the need for specialty tailored interventions. This study provides insight into initiatives that can support global nursing workforce sustainability.

STROBE.

No patient or public contribution. Patients nor the public were involved in this research.