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What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland

Margitta B. Beil-Hildebrand (Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria)
Firuzan Sari Kundt (Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria)
Patrick Kutschar (Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria)
Lorri Birkholz (School of Nursing, Chatham University, Pittsburgh, Pennsylvania, USA)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 23 April 2024

Issue publication date: 19 June 2024

60

Abstract

Purpose

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

Design/methodology/approach

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

Findings

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Originality/value

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

Keywords

Citation

Beil-Hildebrand, M.B., Sari Kundt, F., Kutschar, P. and Birkholz, L. (2024), "What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland", Leadership in Health Services, Vol. 37 No. 3, pp. 377-393. https://doi.org/10.1108/LHS-09-2023-0075

Publisher

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Emerald Publishing Limited

Copyright © 2024, Emerald Publishing Limited

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