Relationship Between Moral Distress and Job Satisfaction Among Emergency Department Nurses in Government Hospitals of Mirpurkhas, Sindh, Pakistan

Abstract

Background: Moral distress is a common phenomenon among nurses working in high-pressure clinical environments, such as emergency departments. It occurs when nurses recognize the ethically appropriate action but are unable to act accordingly because of institutional, organizational, or environmental constraints. Persistent moral distress may negatively affect nurses' well-being, job satisfaction, and quality of patient care. Methods: This study employed a quantitative, cross-sectional, correlational design. The sample size of this study was 88 using RaoSoft Calculator comprised registered nurses working in emergency departments and they were recruited using a convenience sampling approach. Data were collected through a structured questionnaire consisting of Moral Distress Scale Revised and Minnesota Satisfaction Questionnaire a validated instrument, all statistical analyses were performed using IBM SPSS Version 25 Descriptive statistics including frequencies, percentages, means, and standard deviations. For inferential independent-samples t-tests, and Pearson's product-moment correlation coefficient was used. Statistical significance was set at p < 0.05. Results: Emergency department nurses reported a moderate level of moral distress (MDS-R mean score: 158.6 ± 42.3) and a moderate level of job satisfaction (MSQ mean score: 65.4 ± 10.7). Independent-samples t-test analyses revealed significant differences in moral distress scores based on sex and educational qualification. Female nurses exhibited significantly higher moral distress than their male counterparts (t = significant, p = 0.038). Similarly, diploma-qualified nurses demonstrated significantly higher moral distress scores compared to nurses holding a Bachelor of Science in Nursing (p = 0.032). No statistically significant differences in moral distress were identified with respect to marital status, employment status, or specialty certification (all p > 0.05). Pearson's product-moment correlation analysis revealed a statistically significant, moderate negative association between moral distress and job satisfaction (r = −0.52, p < 0.001), indicating that nurses who experienced higher levels of moral distress tended to report lower levels of job satisfaction. Conclusion: Emergency department nurses experienced moderate levels of moral distress and job satisfaction, with higher moral distress significantly associated with reduced job satisfaction. Healthcare administrators should implement targeted interventions such as ethics consultations, peer support, and structured debriefing to mitigate moral distress and enhance nurse well-being, job satisfaction, and quality of patient care. Future longitudinal studies with larger, more diverse samples are warranted to confirm and extend these findings