Understanding Moral Distress: How to Decrease Turnover Rates of New Graduate Pediatric Nurses
Heather E. Bong
For the past 10 years, the United States has been experiencing a critical shortage of registered nurses (RNs), and data suggest this trend will continue through 2025. Compensation for RN burnout cannot be achieved by simply hiring new nurses because the rate of graduation is less than the rate of need. During this period of critical shortage, federal healthcare reforms, most notably the Patient Protection and Affordable Care Act (PPACA) of 2010, have placed additional demands on physicians and nurses. These trends have led to increased RN dissatisfaction, moral distress, and subsequent turnover. Literature reviews, case studies, and methodological pieces regarding moral distress in new graduate pediatric nurses were studied, and 34 articles were analyzed; articles before 2010 were excluded unless considered a sentinel piece. Results show new graduate pediatric RNs experience moral distress as they transition from academia to the professional setting, which leads to rates of new graduate RN turnover that outpace nurses of all other tenure. With the goal of decreasing RN turnover, this article briefly examines factors that contribute to moral distress in new graduate pediatric nurses and explores unit-based interventions to reduce levels of moral distress. Interventions found to decrease moral distress include early detection of moral distress, fostering feelings of nurse engagement, participation in ethics education, promotion of mindfulness, and the creation of pediatric palliative care teams within hospital units.