Moral Distress and Considering Leaving in NICU Nurses: Direct Effects and Indirect Effects Mediated by Burnout and the Hospital Ethical Climate

Abstract

<b><i>Background:</i></b> Moral distress in neonatal intensive care unit (NICU) nurses predicts burnout, the hospital ethical climate, and considering leaving the position. However, the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate remain unexamined in these nurses. <b><i>Objectives:</i></b> The aim of this study was to examine the direct effect of moral distress on considering leaving and the indirect effects mediated by burnout and the hospital ethical climate in NICU nurses. <b><i>Methods:</i></b> This is an observational, multicentre, self-report questionnaire study of NICU nurses currently providing direct newborn care on 6 Level 3–4 NICUs in New South Wales, Australia. <b><i>Results:</i></b> Of the estimated 585 eligible nurses, 136 (23%) participated in the study. Twenty-one percent of the nurses were considering leaving. After controlling for the other predictor variables, moral distress did not predict considering leaving (<i>p</i> = 0.651). Burnout (odds ratio [OR] 4.25, <i>p</i> &#x3c; 0.001) and the hospital ethical climate (OR = 0.29, <i>p</i> = 0.020) were significant predictors of considering leaving. The direct effect of moral distress on considering leaving was not significant, but the indirect effects mediated by burnout (<i>B</i> = 0.32, 95% confidence interval [CI] [0.147–0.611]) and the hospital ethical climate (<i>B</i> = 0.19, 95% CI [0.085–0.382]) were significant. <b><i>Conclusions:</i></b> The support of NICU nurses considering leaving should include preventing and resolving moral distress, managing burnout, and enriching the ethical climate of the hospital. This support may reduce psychological distress in NICU nurses and maintain or enhance the standard of care for sick newborns.