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Leading the Way

Addressing moral distress and resilience in nursing

ANA joined leading nursing organizations at a State of the Science Symposium in Baltimore, Maryland from August 11 to 12, 2016. Forty-six nurse leaders met in a brainstorming effort to advance strategies and solutions to address the issue of moral distress and resilience in nursing. The summit, held by the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, the American Journal of Nursing, the Journal of Christian Nursing, the American Association of Critical Care Nurses, and ANA, built on the prior recommendations of the National Nursing Ethics Summit held in November 2015.

ANA Board Secretary Patricia Travis, PhD, RN, CCRP, a Maryland Nurses Association member, representedANA at the event, and answers some questions about her experience.

How would you describe your experience?

I was honored to represent ANA, and enjoyed the opportunity to participate and dialogue with world renowned ethicists. The meeting caused me to reflect on my clinical days serving on hospital committee ethics boards that occasionally required immediacy in the discussion and formulation of recommendations regarding complex patient issues and family life choices.

What is the significance of moral distress and how does moral resilience differ?

Moral distress and moral resilience are complex terms. One definition of moral distress is “the pain or anguish affecting the mind, body, or relationships in response to a situation in which a person is aware of a moral problem, acknowledges moral responsibility, and makes a moral judgment about the correct action; yet as a result of real or perceived constraints cannot enact the desired action.” Moral resilience may be defined as “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks” (Rushton et al, 2016).

The ability to deal with ethically adverse situations without having the lasting effects of moral distress or moral residue is the ultimate goal. It requires morally courageous action, identifying essential support systems and resources, and doing the right thing. Research has shown that moral distress can cause some nurses to leave their jobs or the profession. Shifting our thinking from moral distress to building moral resilience has significant implications for states like Maryland, which is projected to experience a shortage of 10,000 or more registered nurses in 2025.

What are the outcomes of the symposium?

Working in small groups, we developed specific recommendations for building resilience in nursing practice, research, education, and policy arenas. Cheryl Peterson, MSN, RN, vice president of ANA nursing programs, served as a facilitator. Laurie Badzek, director of the ANA Center for Ethics and Human Rights, served on the planning committee. A report will be published on the meeting outcomes in early 2017.


Recognizing the importance of all nurses understanding these key concepts, the ANA Center for Ethics and Human Rights is convening the Moral Resilience Professional Issues Panel, with a focus on the voice of the bedside nurse. The goals of the panel are to identify current understandings of moral distress in practicing RNs, and to determine strategies, resources, and goals that will strengthen moral resilience among nurses.

What else do you want ANA members to know?

As a leadership organization representing the nation’s 3.6 million registered nurses, ANA plays a seminal role in all domains of excellence, including education and training in ethics. This is one example of how ANA does the right thing through nursing advocacy.

Selected references

American Nurses Association. Professional issues panels.

Rushton CH, Caldwell M, Kurtz M. Moral distress: A catalyst in building moral resilience. Am J Nurs. 2016;116(7);40-9.

U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce National Center for Health Workforce Analysis. The future of the nursing workforce: National and state level projections, 2012-2025. December 2014.

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