Nurses working during the Covid-19 pandemic in Wales experienced high levels of moral distress, strongly associated with depression and linked to intentions to leave the profession, finds a new study led by Cardiff University.
The research, funded by the Burdett Trust for Nursing, surveyed 287 registered nurses and nursing students between October 2021 and April 2022. The findings highlight the lasting psychological impact of pandemic working conditions and underline the urgent need for targeted mental health support across the nursing workforce.
Dr Tessa Watts, Emerita Reader at Cardiff University's School of Healthcare Sciences, who led the research said: "Moral distress occurs when healthcare professionals feel unable to act in accordance with their ethical values – this can be due to organisational or environmental constraints."
During the pandemic, nurses frequently faced situations that conflicted with their professional commitment to patient care, including shortages in staffing and protective equipment.
The study found that:
- Moral distress was significantly associated with depression.
- Nurses who had been redeployed reported higher distress.
- Distress was higher among nurses with 2–6 years' experience who had cared for more than 40 COVID-19 patients.
- Those experiencing greater distress were more likely to consider leaving nursing.
- 41 participants met criteria consistent with PTSD or complex PTSD.
- 17% reported symptoms consistent with Long Covid.
The study found that three-quarters of participants intended to remain in the profession, but over one in five were unsure about their future in nursing, raising concerns about workforce sustainability.
Dr Anna Marguerite Sydor, Senior Lecturer at Cardiff University who was part of the research team, said: "Exceptional workforce pressures during the pandemic created conditions where nurses were repeatedly exposed to ethically distressing situations."
Our findings show that the psychological legacy of Covid-19 has not disappeared. Many nurses are still carrying the impact, and without meaningful intervention, we risk losing skilled professionals from an already stretched workforce.
"Registered nurses are the backbone of the healthcare system. They are vital to enhancing patients' health outcomes and safety. Experiences of working under intense, sustained pressure at the height of the Covid 19 pandemic heightened our awareness of the problem of moral distress among registered nurses.
"Our findings reported in this paper have relevance for moral distress continues to impact registered nurses every day.
"Inadequate staffing and skill mix mean registered nurses continue to work in exceptionally challenging environments. Demands and expectations can undermine patient outcomes and safety and conflict with core personal and professional values, affecting registered nurses' physical health, wellbeing and retention," added Dr Watts.
With a duty of care towards their staff, organisations need to take moral distress seriously.
The researchers stress that independent, accessible psychological support and organisational reforms are essential. They recommend renewed focus on staff wellbeing, improved pandemic preparedness, and normalising help-seeking among healthcare workers. Lessons learned from COVID-19 should inform long-term workforce planning rather than being treated as temporary emergency measures.
The team is calling for further research into interventions that reduce moral distress and for healthcare leaders to involve frontline staff in designing future preparedness strategies.
The study, Moral distress among nurses during the COVID-19 Pandemic: a cross-sectional survey , was published in Nursing Open.
