The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study


JOURNAL OF NURSING MANAGEMENT, vol.30, pp.2383-2393, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 30
  • Publication Date: 2022
  • Doi Number: 10.1111/jonm.13780
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE, Psycinfo, Public Affairs Index
  • Page Numbers: pp.2383-2393
  • Keywords: Covid-19, moral distress, nurse managers, nursing, FOCUS
  • Hacettepe University Affiliated: Yes


Aim The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic. Background Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders. Methods It is a descriptive phenomenological study that used content analysis. Results Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress. Conclusion Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic. Implications for Nursing Management Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.