The Relationship between Moral Distress and Nurses' Turnover Intention in Intensive Care Unit Nurses
Background and Aim: Nurses have a very important and prominent role in the health care system, and turnover of nurses in health care system, disrupts the functioning of the organization. There are many factors that can be associated with the turnover of nursing services. The purpose of this study was to investigate the relationship between moral distress and Nurses' Turnover Intention in intensive care unit nurses.
Materials and Methods: This study is a descriptive-correlational study, which was performed using census sampling on 117 nurses working in the intensive care units of Qom hospitals in 2016. Data were collected using the Hinshaw Anticipated Turnover Scale, and the Jamton 30-Questionnaire. Data were analyzed by SPSS software 16 and descriptive statistics and statistical tests of multivariate logistic regression.
Findings: The results showed that there was a significant relationship between moral distress and the Nurses' Turnover Intention in intensive care units nurses (p=0.03, OR: 2.44). The mean score of moral distress in the participants in the study was 137.53 with a standard deviation of 23.14. Also, the mean score of Nurses' Turnover Intention was 3.44 with a standard deviation of 0.948.
Ethical Considerations: This article is the result of an approved research project at Qum University of Medical Science. During the research process, the university's ethical policies were complied with in accordance with the principles of the Helsinki Declaration, including obtaining informed consent from participant.
Conclusion: According to the results of this study, it is necessary for nurses to pay more attention to moral distress and Nurses' Turnover Intention. Therefore, measures should be taken to reduce ethical challenges, moral distress, and subsequently Nurses' Turnover Intention in the clinical setting.
Cite this article as: Taghavi Larijani T, Jodaki K. The Relationship between Moral Distress and Nurses' Turnover Intention in Intensive Care Unit Nurses. Med Ethics J 2020; 14(45): e6.
Hajinabi K, Nasiripoor AA, Zahedkar P, Mehrabian F. Relationship between nurses’ working shifts with human resources productivity. Journal of Holistic Nursing And Midwifery 2013; 23(1): 7-12. [Persian]
Alshutwi S. Workplace support and turnover intention: A preliminary conceptual framework to inform practice and research. J Nurs Health Sci| Volume 2017; 3(2): 1-8.
Arnold E. Managing human resources to improve employee retention. The Health Care Manager 2005; 24(2): 132-140.
Frank FD, Finnegan RP, Taylor CR. The race for talent: Retaining and engaging workers in the 21st century. Human Resource Planning 2004; 27(3): 1-15.
Nardi DA, Gyurko CC. The global nursing faculty shortage: Status and solutions for change. Journal of Nursing Scholarship 2013; 45(3): 317-326.
Hoseini-Esfidarjani SS, Negarandeh R, Janani L, Mohammadnejad E, Ghasemi E. The intention to turnover and its relationship with healthy work environment among nursing staff. Journal of Hayat 2018; 23(4): 318-331. [Persian]
Jones CB. Revisiting nurse turnover costs: Adjusting for inflation. JONA: The Journal of Nursing Administration 2008; 38(1): 11-18.
Fletcher CE. Hospital RNs’ job satisfactions and dissatisfactions. JONA: The Journal of Nursing Administration 2001; 31(6): 324-331.
Taghadosi M, Nabizadeh Gharghozar Z. Intention to Leave of Nurses and Related Factors: A Systematic Review. Scientific Journal of Nursing, Midwifery and Paramedical Faculty 2019; 4(4): 1-14. [Persian]
Hamric AB, Davis WS, Childress MD. Moral distress in health care professionals. The Pharos of Alpha Omega Alpha-Honor Medical Society Alpha Omega Alpha 2006; 69(1): 16-23.
Naboureh A, Imanipour M, Salehi T, Tabesh H. The relationship between moral distress and self-efficacy among nurses in critical care and emergency units in hospitals affiliated to Ahvaz Jundishapur university of medical sciences. Journal of Rafsanjan University of Medical Sciences 2015; 14(6): 443-454. [Persian]
Mahmoodzadeh Z, Ashktorab T, Naeeni SMK. The correlation between Moral Distress and Caring Behaviors of Nurses in Intensive Care Units of Bandar Abbas Hospitals in 2018. Iranian Journal of Medical Ethics and History of Medicine 2019; 12(1): 82-93.
Corley MC. Nurse moral distress: A proposed theory and research agenda. Nursing Ethics 2002; 9(6): 636-650.
Atashzadeh Shorideh F, Ashktorab T, Yaghmaei F, Alavimajd H. Association of ICU nurses’ demographic characteristics and moral distress. Iranian Journal of Medical Ethics and History of Medicine 2013; 5(7): 66-78.
Dehghan Nayeri N, Jalalinia F, Salehi T. Essentials of Nursing Research. Apprasing Evidence for Nursing Practice. Translated by Polit D, Beck C. 5th ed. Tehran: Andishe Rafih Publication; 2015. p.192-193. [Persian]
Motevallian SA, Alizadegan S, Hossein Vaziri M, Khoiee EM, Goushegir SA, Ghoroubi J. Developing the moral distress scale in the population of Iranian nurses. Iranian Journal of Psychiatry 2008; 3(2): 55-58. [Persian]
Hariri G, Yaghmaei F, Shakeri N. Assessment of some factors related to leave in nurses and their demographic charater in educational hospitals of Shahid Behesthi University of Medical Sciences. Journal of Health Promotion Management 2012; 1(3): 17-27. [Persian]
Mohamadzadeh Nojehdehi M, Rafii F, Ashghali-Farahani M, Bahrani N. Comparing nurses’ intention to leave in hospitals of execute/non-execute organizational excellence model. Iran Journal of Nursing 2014; 27(88): 46-55. [Persian]
Nikbakht NA, Salari A, Hosseinpour M, Yekaninejad M. Study the rate of burnout and intention to leave and their relationship among emergency department nurses. IJNR 2014, 9(3): 19-29. [Persian]
Sadeghi M, Ebrahimi H, Abbasi M. The relationship between moral distress and burnout in clinical nurses in the Shahroud city. Iranian Journal of Nursing Research 2016; 11(2): 78-87. [Persian]
Joolaee S, Jalili HR, Rafii F, Hajibabaee F, Haghani H. Relationship between moral distress and job satisfaction among nurses of Tehran University of Medical Sciences Hospitals. Journal of Hayat 2012; 18(1): 42-51. [Persian]
Chiu YL, Chung RG, Wu CS, Ho CH. The effects of job demands, control, and social support on hospital clinical nurses' intention to turn over. Applied Nursing Research 2009; 22(4): 258-263.
Rozo JA, Olson DM, Thu H, Stutzman SE. Situational factors associated with burnout among emergency department nurses. Workplace Health & Safety 2017; 65(6): 262-265.
Van Mol MM, Kompanje EJ, Benoit DD, Bakker J, Nijkamp MD. The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. PloS One 2015; 10(8): e0136955.
Nguyen HTT, Kitaoka K, Sukigara M, Thai AL. Burnout study of clinical nurses in Vietnam: Development of job burnout model based on Leiter and Maslach's theory. Asian Nursing Research 2018; 12(1): 42-49.
Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. Journal of Medical Ethics and History of Medicine 2015; 8(2): 1-7.
Karanikola MN, Albarran JW, Drigo E, Giannakopoulou M, Kalafati M, Mpouzika M, et al. Moral distress, autonomy and nursephysician collaboration among intensive care unit nurses in Italy. Journal of Nursing Management 2014; 22(4): 472-484.
Lawrence LA. Work engagement, moral distress, education level and critical reflective practice in intensive care nurses. Nursing Forum 2011; 46(4): 256-268.
Liou SR. The relationships between collectivist orientation, perception of practice environment, organizational commitment and intention to leave current job among Asian nurses working in the US. [PhD Thesis]. Texas: The University of Texas at Austin, US; 2007.
Sadeghi A, Mohseni Fard J, Poorolajal J. The Correlation between Organizational Culture and Nurses' Turnover Intention in Educational and Therapeutic Centers of Hamadan University of Medical Sciences. Journal of Health Promotion Management 2018; 6(6): 37-45. [Persian]
Dehghani K, Nasiriani K, Mousavi T. Investigating intensive care unit nurses' performance and its adjusting with standard. SSU Journals 2014; 21(6): 808-815. [Persian]
Heland M. Fruitful or futile: Intensive care nurses' experiences and perceptions of medical futility. Australian Critical Care 2006; 19(1): 25-31.
Niederman MS, Berger JT. The delivery of futile care is harmful to other patients. Critical Care Medicine 2010; 38(10): S518-S522.
Epstein EG, Hamric AB. Moral distress, moral residue and the crescendo effect. The Journal of Clinical Ethics 2009; 20(4): 330-342.
Dodek PM, Wong H, Norena M, Ayas N, Reynolds SC, Keenan SP, et al. Moral distress in intensive care unit professionals is associated with profession, age and years of experience. Journal of Critical Care 2016; 31(1): 178-182.
Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive and Critical Care Nursing 2007; 23(5): 256-263.
Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care 2005; 14(6): 523-530.
Vaziri MH, Merghati-Khoei E, Tabatabaei S. Moral distress among Iranian nurses. Iranian Journal of Psychiatry 2015; 10(1): 32-36.
Norman LD, Donelan K, Buerhaus PI, Willis G, Williams M, Ulrich B, et al. The older nurse in the workplace: Does age matter? Nursing Economics 2015; 23(6): 282-289.
Tourangeau AE, Cranley LA. Nurse intention to remain employed: Understanding and strengthening determinants. Journal of Advanced Nursing 2006; 55(4): 497-509.
Hesam M, Asayesh H, Roohi G, Shariati A, Nasiry H. Assessing the relationship between nurses' quality of work life and their intention to leave the nursing profession. Quarterly Journal of Nursing Management 2012; 1(3): 28-36.
Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit‐level nurse practice environment and burnout on nurse‐reported outcomes: a multilevel modelling approach. Journal of Clinical Nursing 2010; 19(11‐12): 1664-1674.
Based on the obtained author agreement upon submission, "Medical Ethics Journal" is the copyright owner of the published material. However, according to Bethesda Statement, all works published in this journal are open access and freely available to anyone on the journal web site without cost under CC BY-NC 4.0. Based on this license, under the condition of proper citation, “Medical Ethics Journal” grants to all users the following rights:
1. Free, irrevocable, worldwide, perpetual access to all published materials.
2. To copy, use, distribute, transmit and display the work.
3. To make and distribute derivative works in any digital medium for any non-commercial purpose under the same license.