Moral Distress Among School Nurses in School-Based Suicide Prevention: Associations with Caseload and Interdisciplinary Collaboration

Abstract

Contemporary school nursing practice increasingly emphasizes the role of school nurses in supporting student mental health through interdisciplinary collaboration. Using data from a national online survey of school nurses (n = 1,283), this study examined associations among caseload, collaborative practice, and moral distress related to school-based suicide prevention. Serving a greater number of schools was associated with lower levels of collaboration with school-based mental health professionals. Lower levels of collaboration were associated with a higher likelihood of experiencing moral distress, suggesting that collaborative challenges may reflect broader workload constraints. Although caseload size was not directly associated with severity of moral distress, findings suggest that workload demands may contribute indirectly to moral distress through collaborative engagement. Attention to workforce structures alongside strengthening opportunities for collaborative practice may be important for addressing moral distress and supporting school nurses’ participation in student mental healthcare.