Moral Distress in Nursing: Dealing With Moral Distress

Subject: Nursing
Pages: 1
Words: 341
Reading time:
2 min


Clinical nurses may undergo moral distress when they are in a dilemma between following a physician’s orders and trusting their clinical judgment. The physician continued to instruct the nurse to increase the dosage of morphine to a cancer patient experiencing severe pain. However, the nurse felt compelled not to give more analgesics due to the potentiality of opioids overdose to the patient. As a result, the nurse developed moral distress, which affected service delivery.

Dealing with Moral Distress

Moral distress is when a registered nurse has difficulties following the physician’s orders due to personal ethical dilemmas. However, the American association of critical care nurses drafted the 4 As in solving moral distress. The 4 As have been vital in nursing practice and include ask, affirm, assess and act (Butts & Rich, 2016). First, nurses need to ask themselves if they are genuinely experiencing moral distress. In the situation above, the nurse needs to accept a dilemma between his or her wishes and the physician’s orders. The second step is to affirm the distress is present and check on the professional regulations about the situation. The nurse should recognize that it is an inherent role of the nurse to ensure the patient’s safety and well-being. This can be achieved through functioning as the patient’s advocate.

Third, nurses should assess and analyze the situation from all perspectives, including the patient’s, physician’s, the organization’s, and their point of view. To ensure the patient’s safety, the registered nurse should utilize practical communication skills to avoid injuring the nurse-physician relationship. It is also imperative to seek other colleagues’ and nurse managers’ support to solve this ethical dilemma (Pozgar, 2019). The last step on acting is where the nurse implements the best plan of action for ensuring that the patient’s safety is upheld. In doing what is morally right, the nurse maintains moral integrity and authenticity. Finally, the nurse should strive to address any differences that may arise with the physician. Therefore, moral distresses are common occurrences in nurses’ practice, and effective management promotes emotional stability.


Butts, J. B., & Rich, K. L. (2016). Nursing ethics: Across the curriculum and into practice (4th ed.). Jones & Bartlett Learning.

Pozgar, G. D. (2019). Legal and ethical issues for health professionals (5th ed.). Jones & Bartlett Learning.