Abstract

Background. Moral distress is a pervasive problem in nursing, contributing to loss of nurses' ethical integrity, dissatisfaction with the work of nursing, and loss of nurses from the workforce. Purpose. The purpose of this research was twofold: to further elucidate the experiences and consequences of professional nurses' moral distress and to formulate a logical, systematic, and explanatory theory of moral distress and its consequences. Methods. This Glasserian grounded theory study utilized volunteer and purposive sampling to recruit a sample of 21 registered nurses. Results. The theory of moral reckoning in nursing illuminates a three-stage process. After a novice period, the nurse experiences a Stage of Ease in which there is comfort in the workplace and congruence of internal and external values. Unexpectedly, a situational bind occurs in which the nurse's core beliefs come into irreconcilable conflict with social norms. This constitutes a critical juncture, forcing the nurse out of the Stage of Ease into the Stage of Resolution, during which the nurse attempts to resolve the conflict by choosing among values. Resolution includes either giving up or making a stand. The nurse then moves into the Stage of Reflection in which beliefs, values, and actions are iteratively examined. The nurse tries to make sense of his or her experiences through remembering, telling the story, examining conflicts, and living with the consequences. Conclusions. The theory reaches further than moral distress, identifying a critical juncture and better explaining a process that includes motivation and conflict, resolution, and reflection