ORCID ID
Graduation Date
Spring 5-9-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Programs
Nursing
First Advisor
Lynnette L. Stamler, Ph.D., D.Litt.
Second Advisor
Sue Schuelke, Ph.D.
Abstract
New graduate nurse attrition rates are elevated in the context of the nursing workforce shortage and a rapidly evolving healthcare environment. One contributing factor may be moral distress occurrences experienced by new graduate registered nurses. These challenging situations for new graduate nurses are an underdeveloped area in the literature. To better understand what is occurring in the first year of nursing practice, a three-phase research study was conducted. In the first phase, an integrative review of early career nurses and moral distress was conducted. Results revealed varying reports of moral distress in new graduate nurses with inconsistencies related to experience, age, and education level. Drastic changes in healthcare during and following the COVID-19 pandemic prompted inquiry into new graduate nurses’ definitions of moral distress. In phase two of the research, a qualitative, descriptive research study was conducted with a deductive comparison between new graduate nurses and literature definitions of moral distress. Results revealed conceptual congruency between the definitions with three additional themes identified: transition to practice challenges, feelings of shame, and wrongdoing associated with inadequacy. The third phase of the research was subsequently conducted to quantify the moral distress problem in new graduate nurses and determine its relationship to their intent to leave their jobs and/or the profession. A descriptive correlational, cross-sectional study was conducted. Results indicated that new graduate nurses experience moral distress at a wide range of levels. There is a significant relationship between new graduate nurse moral distress and those who have left or considered leaving or are considering leaving their positions now due to moral distress. The new knowledge generated in this three-phase research study informs future nursing research, education, and practice to promote professional nursing practice. Research with an expanded sample can promote representation of the moral distress problem and generalizability of the findings. Moral distress nursing education initiatives can be developed, implemented, and investigated in undergraduate and professional development education environments. These education initiatives can inform the preparation of nurses and support their recognition and management of moral distress in their nursing practice environments.
Rights
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Recommended Citation
Loyd, Lauren A., "Understanding Moral Distress in New Graduate Nurses: Evidence to Promote Professional Nursing Practice" (2026). Theses & Dissertations. 1084.
https://digitalcommons.unmc.edu/etd/1084