Healthy Nurses Building Moral Resilience

 In Moral Resilience

As nurses we need to aim focus on being morally resilient to any ethical challenges that arise as we care for the people we serve. This requires us to have a conscious awareness of our own views. Moral resilience is defined as the capacity of a person to sustain, restore or deepen their integrity in response to moral complexity, confusion, distress, or setbacks. It is founded on our self- knowledge of and commitment to our values and intentions (Rushton, 2016).

As we aim to develop strategies that assist us in developing our moral resilience, our mind and hearts will be open to enrichment. We will learn to find true meanings to situations we don’t understand. Moral distress must also be recognized by organizations and built into structures in order to support all clinicians. Development of moral resilience will allow for team members to respond and practice in a way that reflects integrity and true intentions.

There are several ways that organizations can assist in cultivating moral resilience.  Many interventions will aim focus on fostering a supportive and ethical culture, which will preserve the clinician’s integrity.

“What is our needful thing? To have high principles at the bottom of it all. Without this, without having laid our foundation, there is small use in building up our details. This is as if you were to try to nurse without eyes or hand…If your foundation is laid on shifting sand, you may build your house, but it will tumble.” –Florence Nightingale (Ulrich, 1992).

Prevention from carrying out the correct action in an ethical situation can have a negative impact on the health of individuals and organizations. The lasting effects of moral distress “reactive distress” is now referred to as “moral residue” (Epstein & Hamric, 2009). After repeated incidents, the accumulation of moral residue can erode our moral courage. (Epstein & Hamric, 2009).

As healthy nurses, a major way we can help to build moral resilience in our work environments is by opening up a dialogue with peers about the existence of moral distress and moral residue. It is amazing how a conversation about this topic can get colleagues talking about times when they felt prevented from intervening in ethically questionable situations. Discussing these barriers to patient advocacy can help nurses to open up about the psychological burden of moral distress and make a pathway for collaboration in the future.

Should a colleague come to us in the midst of a problem, we can help them to exercise moral courage by leading them to think it through with the following steps (Lachman, 2010):

  1. What is the risk you want to take?
  2. What is the situational fear you experience?
  3. What is the outcome you want to achieve and what will you need to do to achieve it?
  4. Identify the resources available to you at this time.
  5. Take action.

Here is an excellent resource for education on moral distress:

The Moral Distress Education Project (University of Kentucky Program for Bioethics)

**Also, use your ANA resources! Consult the ANA Code of Ethics with Interpretive Statements, which is conveniently available online.


  • Epstein, E. G., & Hamric, A. B. (2009). Moral Distress, Moral Residue, and the Crescendo Effect. The Journal of Clinical Ethics20(4), 330–342.
  • Lachman, V.D., (2010) “Strategies Necessary for Moral Courage” OJIN: The Online Journal of Issues in Nursing 15, No. 3, Manuscript 3. DOI: 10.3912/OJIN.Vol15No03Man03
  • Rushton, C. H. (2016). Building moral resilience to neutralize moral distress. American Nurse Today, 11(10).
  • Ulrich, B. T. (1992). Leadership and Management According to Florence Nightingale. Norwalk, CT: Appleton & Lange

Wishing you all the best,

Kiki Magno, MSN, RN, BC, Lisa Ertle, BA, RN and the Healthy Nurse Healthy New Jersey Team

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