Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study

Abstract Background Newly graduated nurses are particularly vulnerable to moral distress due to limited experience, low self-confidence, and inadequate ethical knowledge, which impact their ability to make and act on ethical decisions. This study aims to describe their moral distress experiences dur...

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Main Authors: Mustafa Sabri Kovanci, Azize Atli Özbaş
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Nursing
Subjects:
Online Access:https://doi.org/10.1186/s12912-025-02863-x
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author Mustafa Sabri Kovanci
Azize Atli Özbaş
author_facet Mustafa Sabri Kovanci
Azize Atli Özbaş
author_sort Mustafa Sabri Kovanci
collection DOAJ
description Abstract Background Newly graduated nurses are particularly vulnerable to moral distress due to limited experience, low self-confidence, and inadequate ethical knowledge, which impact their ability to make and act on ethical decisions. This study aims to describe their moral distress experiences during the transition to professional practice and identify predictive factors affecting moral distress levels. Methods A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and a semi-structured questionnaire. The analysis was conducted separately and then integrated. In the quantitative part of the study, 205 new nurses with 1–18 months of working experience were recruited, and 25 new nurses were recruited in the qualitative part. Results Gender, type of hospital, experience time, caregiver and manager role level, and subjective perception of levels were significant predictors of moral distress. Qualitative data revealed four main themes: (1) causes of moral distress, (2) effect of moral distress, (3) coping with moral distress, and (4) suggestions for reducing moral distress. Discussion The moral distress experienced by newly graduated nurses may become more pronounced during the transition to professional life. During this period, lack of experience, low self-confidence, and insufficient ethical knowledge can increase moral distress and affect future experiences by making it difficult to make and implement ethical decisions. Conclusions This study showed that individual, organizational, and systemic factors influence moral distress in new graduate nurses. It highlights that ethical challenges in developing professional identity are closely tied to organizational structure and systemic regulations, emphasizing the need for individual support and improvements in education and organizational systems to reduce moral distress. Clinical trial number Not applicable.
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spelling doaj-art-e279aea604ba4cc5972d97ad1cc5cfd22025-08-20T03:06:01ZengBMCBMC Nursing1472-69552025-03-0124111510.1186/s12912-025-02863-xNewly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods studyMustafa Sabri Kovanci0Azize Atli Özbaş1Psychiatric Nursing Department, Faculty of Nursing, Hacettepe UniversityPsychiatric Nursing Department, Faculty of Nursing, Hacettepe UniversityAbstract Background Newly graduated nurses are particularly vulnerable to moral distress due to limited experience, low self-confidence, and inadequate ethical knowledge, which impact their ability to make and act on ethical decisions. This study aims to describe their moral distress experiences during the transition to professional practice and identify predictive factors affecting moral distress levels. Methods A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and a semi-structured questionnaire. The analysis was conducted separately and then integrated. In the quantitative part of the study, 205 new nurses with 1–18 months of working experience were recruited, and 25 new nurses were recruited in the qualitative part. Results Gender, type of hospital, experience time, caregiver and manager role level, and subjective perception of levels were significant predictors of moral distress. Qualitative data revealed four main themes: (1) causes of moral distress, (2) effect of moral distress, (3) coping with moral distress, and (4) suggestions for reducing moral distress. Discussion The moral distress experienced by newly graduated nurses may become more pronounced during the transition to professional life. During this period, lack of experience, low self-confidence, and insufficient ethical knowledge can increase moral distress and affect future experiences by making it difficult to make and implement ethical decisions. Conclusions This study showed that individual, organizational, and systemic factors influence moral distress in new graduate nurses. It highlights that ethical challenges in developing professional identity are closely tied to organizational structure and systemic regulations, emphasizing the need for individual support and improvements in education and organizational systems to reduce moral distress. Clinical trial number Not applicable.https://doi.org/10.1186/s12912-025-02863-xEthicsNursing studentMoral distressNew graduate nurse
spellingShingle Mustafa Sabri Kovanci
Azize Atli Özbaş
Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
BMC Nursing
Ethics
Nursing student
Moral distress
New graduate nurse
title Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
title_full Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
title_fullStr Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
title_full_unstemmed Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
title_short Newly graduated nurses’ experiences of moral distress during transition process: a convergent mixed methods study
title_sort newly graduated nurses experiences of moral distress during transition process a convergent mixed methods study
topic Ethics
Nursing student
Moral distress
New graduate nurse
url https://doi.org/10.1186/s12912-025-02863-x
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