Moral Agency and Moral Distress Among Registered Nurses: Novice to Expert

Abstract

In everyday practice, nurses encounter moral dilemmas that can potentially impact patients’ quality of care. A nurse exercising moral agency makes ethical decisions based on core values and moral principles. Moral agency has roots in existential philosophy; it can significantly impact the organizational role of nurses, the healthcare system, and patients. The relationship between a moral agent and the institution in which they practice has been labeled the most challenging moral problem of our century. Moral distress can be precipitated by a diminished sense of moral agency. Understanding moral agency in a bureaucratic system like healthcare is necessary to comprehend ethical issues and moral distress experienced by nurses. In this thesis, I, the researcher, explored moral agency and moral distress as experienced by twenty registered nurses (RNs). The distinctions between Novice and Expert RNs were based on years of experience and the work of Benner (1984). Participants were recruited using purposive sampling and a modified snowball sampling technique and face to face interviews were subsequently conducted. De Groot’s methodology (1964) was used as a framework for the study, interviews as the method of data collection and thematic content analysis was used to analyze data. Findings reveal the organizational factors (understaffing, heavy workloads, and time) limiting nurses’ moral agency and potentially leading to moral distress. The three major themes are “Organizational Context: Factors impeding Moral Agency and leading to Moral Distress among RNs”, “Growth of Moral Agency: How RNs develop voice”, and “Moral Agency and Moral Distress in End of life Care”. The themes also touch on the differences and similarities between Novice and Expert RNs as I anticipated differences based on the work of Benner (1984). This distinction was important as I suggest moral distress and moral agency may be different based on experience. The study suggests RNs strive to be moral agents, but often face limitations in exercising moral agency in their profession. This research makes an original contribution to knowledge in the field of healthcare ethics as it is the first study of its kind on moral agency and moral distress among RNs in Canada.