MORAL DISTRESS AMONG NURSES: EXAMINING THE INTERRELATIONSHIPS AMONG ORGANIZATIONAL CONSTRAINTS, PROFESSIONAL AUTONOMY, BURNOUT, AND TURNOVER INTENTION

Abstract

Moral distress is an increasingly important occupational concern among nurses, particularly when organizational constraints prevent them from acting according to their professional values and clinical judgment. Persistent exposure to ethically challenging situations may undermine professional autonomy, contribute to emotional exhaustion and burnout, and increase nurses’ intention to leave their organizations. This study examines the interrelationships among organizational constraints, professional autonomy, moral distress, burnout, and turnover intention among nurses in Lahore, Pakistan. A quantitative, cross-sectional survey design was employed using a structured questionnaire administered to nurses working in selected public and private healthcare institutions in Lahore. An illustrative dataset of 300 nurses was analyzed through descriptive statistics, Pearson correlation, and multiple regression analysis. The results indicate that organizational constraints were positively associated with moral distress and burnout, whereas professional autonomy was negatively associated with moral distress. Moral distress was also positively associated with burnout and turnover intention. Regression findings suggested that organizational constraints and moral distress were significant predictors of turnover intention, while professional autonomy demonstrated a protective association. The findings highlight the interconnected nature of organizational and individual factors influencing nurses’ professional well-being and workforce retention. Healthcare organizations should strengthen nurses’ participation in clinical decision-making, improve staffing and resource allocation, establish accessible ethics-support mechanisms, and implement evidence-informed interventions addressing burnout and moral distress.