Moral Distress Of Nurses And Effects Of Moral Distress On Job Satisfaction, Burnout And Turnover Intention

Objectives To explore the current situation and influencing factors of moral distress among nurses and to analyze the effects of moral distress on job satisfaction, burnout and turnover intention, in order to provide a theoretical basis for strengthening the management of clinical nurses, improving quality of care and reducing the wastage of nurses.Methods260of clinical registered nurses from different departments in3Grade-Ⅲ Level-A hospitals in Jinan were randomly selected as subjects during February2013to June2013.The questionnaires included five parts:the general information questionnaire, the Chinese version of Moral Distress Scale-Revised (MDS-R), Minnesota Satisfaction Questionnaire (MSQ), Maslach Burnout Inventor (MBI) and turnover intention scale. We used SPSS16.0statistical software for statistical analysis, including descriptive analysis,t test, ANOVA, correlation analysis and multiple linear regression analysis.Results A total of260patients were investigated and252(96.9%) effective questionnaires have been got. Detailed information was as follows:1. The mean score of MDF was(1.06±0.46) points and the mean score of MDI was (1.05±0.63) points. The total score of MDS-R was (38.86±26.26) points. The average scores for each dimension:individual responsibility(12.71±12.33) points, no safeguard the best interests of the patients (8.49±6.20) points, value conflicts (13.30±8.72) points and detriment of the patients (4.35±4.36) points.2. There were significant differences in the level of moral distress among nurses of different demographic characteristics:moral distress scores of nurses with older age, undergraduate education, more work experience, high titles, and monthly income of5000to7000yuan were higher than those with younger age, secondary and tertiary, working years<5years, low titles, and low-income. ICU nurses scored higher than all other departments, and nurses of emergency department scored higher than medicine, surgery, gynecology, and pediatrics nurses.3.The result of multiple linear regression analysis of moral distress showed that first degree, work experience, department, and title went into the regression equation, which explained70.2%of the variables.4. The total score of MSQ was (52.46±10.33) points. The scores for each dimension: intrinsic satisfaction (30.95±6.68) points, extrinsic satisfaction(16.65±3.11)points, and the general satisfaction (4.86±1.71)points. The total score of MBI was (51.54±18.07) points. The mean scores of emotional exhaustion, depersonalization and personal accomplishment were respectively (27.62±7.69),(6.97±6.40) and(16.59±8.95) points. The total score of turnover intention was(14.10±3.85) points. The mean scores of each dimension were respectively (4.67±1.35),(4.52±1.26) and (5.62±0.90) points.5. There was a negative correlation between job satisfaction and moral distress (r=-0.434, P<0.01).Burnout of nurses was positively related to moral distress (r=0.444, P<0.01).Turnover intention of nurses had a positively relationship with moral distress (r=0.715, P＜0.01).6. Multiple linear regression analysis for job satisfaction showed that four variables, including position, no safeguard the best interests of the patients, individual responsibility and detriment of the patients, entered into the regression equation, explaining23.3%of the variable. Multiple linear regression analysis for burnout indicated that individual responsibility, staffing of government affiliated institutions, detriment of the patients, professional title, years of nursing experience and departments entered into the regression equation, explaining44.0%of the variable. Multiple linear regression analysis for turnover intention demonstrated that eight variables, including the conflict of value, individual responsibility, departments (surgery, gynecology, pediatrics), years of nursing experience, position and first degree, entered into the regression equation, explaining64.4%of the variable.Conclusion1. The Cronbach’a coefficient for the Chinese version of MDS-R for nurses was0.939, indicating it has a good reliability, and is suitable for domestic nurses.2. Moral distress of nurses was at mild level. Futile care was the main source for the high frequency and high intensity of moral distress among nurses. So, moral distress should be taken seriously by hospital administrators and the community.3. Moral distress of nurses has a significantly correlation with age, years of nursing experience, education, professional title, position, staffing of government affiliated institutions, monthly income and departments. Nurses with older age, longer working life, highly educated, high titles, high duties, an official in the series, a high income, and working in ICU, experienced more moral distress.4. The higher level moral distress was, the lower the job satisfaction of nurses was. The three factors of moral distress (no safeguard the best interests of patients, individual responsibility and detriment of the patients) explain a large amount of job satisfaction of nurses. The higher level moral distress was, the more serious burnout was. The two factors of moral distress (individual responsibility and detriment of the patients) explain a large amount of burnout of nurses. The higher level moral distress was, the high level turnover intention was. The conflict of value and individual responsibility were the positive predictor of turnover intention, explaining a large amount of turnover intention.