Moral distress among nurses in medical, surgical and intensive-care units MAURA LUSIGNANI MSN, RN 1 , MARIA LORELLA GIANN  I MD 2 , LUCA GIUSEPPE RE MSN, RN 3 and MARIA LUISA BUFFON MSN, RN 4,5 1 Associate Professor, Coordinator Course Session, Bachelor in Nursing, Department of Biomedical Sciences for Health, University of Milan, Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico, Milan, 2 Assistant Professor, Department of Clinical Sciences and Community Health, University of Milan, NICU, Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico, Milan, 3 Tutor, Course Session Bachelor in Nursing, Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico, Milan, 4 Nurse, Ospedale C a Foncello, Azienda ULSS 9 and 5 Vice President, Provincial College of Nurses, Treviso, Italy Correspondence Maura Lusignani Department of Biomedical Sciences for Health University of Milan Via Pascal 36 20133 Milan Italy E-mail: maura.lusignani@unimi.it LUSIGNANI M., GIANN  I M. L., RE L. G. & BUFFON M. L. (2016) Journal of Nursing Management Moral distress among nurses in medical, surgical and intensive-care units Aim To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. Background Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. Methods A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. Results The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. Conclusions The present study indicates that nurses experience an overall moderate level of moral distress. Implications for nursing management Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care. Keywords: burnout, ethics, medical care, moral distress, registered nurse, surgical and intensive care Accepted for publication: 14 August 2016 Introduction Scientific and technological advances, the decreased availability of health-care resources, and the increasing numbers of elderly patients admitted to acute care wards (Ministry of Health, Italy 2010, World Health Organisa- tion 2015) and diagnosed with multimorbidity, disability, terminal illness or cognitive impairment that render them care-dependent have led to a need to review approaches to patient care. The care provided to patients on an acute ward is often different from that needed by many elderly patients. The turbulence and complexity of aged care environments (Burston & Tuckett 2012), espe- cially those in which elderly patients require critical care, DOI: 10.1111/jonm.12431 ª 2016 John Wiley & Sons Ltd 1 Journal of Nursing Management, 2016