The American Nurses Association (ANA) has released “A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice,” which offers specific, practical guidance for nurses, leaders, and organizations.1

“There is increasing recognition that nurses are truly suffering — and some are even leaving their profession — due to negative psychological consequences,” says Liz Stokes, JD, MA, RN, director for the ANA’s Center for Ethics and Human Rights. Those include burnout, post-traumatic stress disorder, and compassion fatigue.

For nurses, the call to action speaks to the ethical obligation for self-care. For organizations, it emphasizes the need for a culture of ethical practice. “There is a need for assessment to make sure you have a healthy work environment, and to incorporate ethics into educational programs,” says Stokes.

More evidence is needed on the effectiveness of various known interventions. “We want organizations to research this to add to the body of knowledge,” says Stokes.

Moral Distress Not High Priority

Many promising practices are anecdotally believed to reduce the psychological consequences of moral distress in nursing. “But we want to have the hard evidence because that’s what changes policy and gets funding,” says Stokes.

Addressing moral distress remains a distant priority at many hospitals. That’s in part because it’s difficult to put a dollar amount on what it costs the organization. “The psychological consequences can’t be visually seen,” adds Stokes. “But we do know that nurses who are experiencing negative consequences are more prone to patient errors.”

Even if there is an intervention in place, nurses can’t always use it. “Nurses are so incredibly busy. They may not have time to step away for 15 minutes in order to reflect on a difficult situation,” says Stokes.

Bioethicists can help at the institutional level by helping to develop policies, and on the individual level by assisting nurses experiencing moral distress, says Stokes. “Their role and significance is tremendous.”


1. American Nurses Association. A call to action: Cultivating moral resilience and a culture of ethical practice. Available at: Accessed June 10, 2018.


• Liz Stokes, JD, MA, RN, Director, Center for Ethics and Human Rights, American Nurses Association, Washington, DC. Phone: (301) 628-5384. Email: