ArticleBMC nursing2023
The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey.
Article in BMC nursing, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Pooled it
- Moral distress and moral injury in healthcare: A review and instrument analysis.Journal of health psychology · 2026Review
- Workplace indicators and well-being among oral health professionals in HRSA-funded health centres.Health affairs scholar · 2026Article
- The Marginalization of Spiritual Dimensions in Nursing Moral Injury Research: A Bibliometric Analysis, 2018-2025.Journal of religion and health · 2026Article
- State Abortion Laws and Moral Distress in a National Sample of Obstetrician-Gynecologists.JAMA network open · 2026Article
- Linking Work Environment to Turnover Intention: The Mediating Role of Moral Distress Among Emergency Nurses.Nursing reports (Pavia, Italy) · 2026Article
- Predictors of Moral Distress Among Nurses: A Cross-Sectional Study.International journal of environmental research and public health · 2026Article
- Measuring moral distress in Swedish maternal and neonatal healthcare: validation of an adapted MDS‑R and development of a criterion‑based index.Scientific reports · 2026Article
- Collective voices, healthier outcomes: the union effect in American Healthcare.npj health systems · 2026Review
- Global Research Across Countries on Moral Distress and Moral Injury Among Health Care Professionals (2006-2025): A Bibliometric Study of Ethical and Health-Related Research Trends.Journal of religion and health · 2026Article
- Understanding ethical encounters in a hospital setting: a qualitative study.BMC medical ethics · 2026Article
- Nurses' experiences of moral suffering: A qualitative interview study.Nursing ethics · 2026Article
- Trauma-informed care in early intervention: Providers' barriers, boundaries, and needs.Infant mental health journal · 2026Article
- The Relationship Between Guilt Feeling and Job Stress in Oncology Nurses: A Cross-Sectional Study.Health science reports · 2026Article
- Article
- Centering What Matters: Aligning Action with Individual and Community Health Goals: Commission on Investment Imperatives for a Healthy Nation.NAM perspectives · 2026Review
- Emotional Exhaustion, Moral Sensitivity, and Happiness Among Nurses in Cardiac Wards: A Multicenter Cross-Sectional Study.Journal of nursing management · 2026Article
- Fostering Spiritually Supportive Work Environments in Healthcare: Leadership Recommendations From a Narrative Review.Journal of nursing management · 2026Review
- Burnout in practice: A qualitative study of the impact of organizational factors on burnout and patient care among VA mental health providers.Qualitative research in medicine & healthcare · 2025Article
- From Burnout to Resilience: Addressing Moral Injury in Nursing Through Organizational Innovation in the Post-Pandemic Era.Healthcare (Basel, Switzerland) · 2025Review
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundPrevious research suggests that moral distress contributes to burnout in nurses and other healthcare workers. We hypothesized that burnout both contributed to moral distress and was amplified by moral distress for hospital workers in the COVID-19 pandemic. This study also aimed to test if moral distress was related to considering leaving one's job.
methodsA cohort of 213 hospital workers completed quarterly surveys at six time-points over fifteen months that included validated measures of three dimensions of professional burnout and moral distress. Moral distress was categorized as minimal, medium, or high. Analyses using linear and ordinal regression models tested the association between burnout and other variables at Time 1 (T1), moral distress at Time 3 (T3), and burnout and considering leaving one's job at Time 6 (T6).
resultsMoral distress was highest in nurses. Job type (nurse (co-efficient 1.99, p < .001); other healthcare professional (co-efficient 1.44, p < .001); non-professional staff with close patient contact (reference group)) and burnout-depersonalization (co-efficient 0.32, p < .001) measured at T1 accounted for an estimated 45% of the variance in moral distress at T3. Moral distress at T3 predicted burnout-depersonalization (Beta = 0.34, p < .001) and burnout-emotional exhaustion (Beta = 0.38, p < .008) at T6, and was significantly associated with considering leaving one's job or healthcare.
conclusionAspects of burnout that were associated with experiencing greater moral distress occurred both prior to and following moral distress, consistent with the hypotheses that burnout both amplifies moral distress and is increased by moral distress. This potential vicious circle, in addition to an association between moral distress and considering leaving one's job, suggests that interventions for moral distress may help mitigate a workforce that is both depleted and burdened with burnout.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.