CASES OF NOTERelationships Among Moral Distress, Level of Practice Independence, and Intent to Leave of Nurse Practitioners in Emergency Departments Results From a National SurveyTrautmann, Jennifer PhD, RN, FNP-BC; Epstein, Elizabeth PhD, RN; Rovnyak, Virginia PhD; Snyder, Audrey PhD, RN, ACNP-BC, CEN, CCRN, FAANP, FAENAuthor Information Johns Hopkins University School of Nursing, Baltimore, Maryland. Corresponding Author: Jennifer Trautmann, PhD, RN, FNP-BC, Johns Hopkins University School of Nursing, 525 N. Wolfe Street/SON House, Room 301, Baltimore, MD 21205 ([email protected]). Financial support received for this research: Barbara Brodie Scholars Endowment and the Phyllis J. Verhonick Clinical Research Award. The authors thank Ann Hamric, PhD, RN, FAAN, Associate Dean of Academic Programs, Virginia Commonwealth University School of Nursing, and Linda F. Bullock, PhD, RN, FAAN, Associate Dean for Research, University of Virginia School of Nursing, for their outstanding contributions to this research study and the manuscript. Disclosure: The authors report no conflicts of interest. Advanced Emergency Nursing Journal: April/June 2015 - Volume 37 - Issue 2 - p 134-145 doi: 10.1097/TME.0000000000000060 Buy Metrics Abstract The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale–Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting. Copyright © Wolters Kluwer Health, Inc. All rights reserved.