Moral distress and quality of nursing work life: Mediating roles of compassion fatigue and resilience

Abstract

Background

Moral distress involves psychological suffering when actions conflict with personal ethical values due to institutional constraints. This distress erodes professional integrity and significantly undermines the quality of nursing work life. Addressing this conflict is essential for clinical workforce sustainability.

Aim

This study aimed to investigate the impact of moral distress on the quality of nursing work life (QNWL) among clinical nurses and to verify the serial mediating effects of compassion fatigue and resilience in this relationship.

Research design

This was a descriptive correlational study.

Participants and research context

We conducted a descriptive survey with 289 clinical nurses with at least 3 years of experience. Data were collected using the Korean version of the Moral Distress Scale-Revised (KMDS-R), the Professional Quality of Life Scale (ProQOL) for compassion fatigue, the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the Korean version of the Quality of Nursing Work Life (K-QNWL). Data were analyzed using descriptive statistics, Pearson’s correlation coefficients, and the PROCESS macro (Model 6).

Ethical considerations

This study was approved by the institutional review board. Informed consent was obtained from participants prior to data collection.

Results

Moral distress was positively correlated with compassion fatigue and negatively correlated with resilience and QNWL. Serial multiple mediation analysis revealed that moral distress had a significant direct effect on QNWL. Furthermore, the serial mediation path of moral distress → compassion fatigue → resilience → QNWL was statistically significant (indirect effect = −0.051, 95% CI [−0.081, −0.032]). However, the simple mediation effect through resilience alone was not significant.

Conclusions

The findings demonstrate that moral distress significantly reduces the quality of nursing work life through the sequential mediation of compassion fatigue and resilience. This suggests that moral distress induces compassion fatigue, which subsequently erodes resilience and professional well-being. Organizational strategies should prioritize early intervention and integrated support systems.