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Nurses' Moral Distress, Burnout, and Intentions to Leave

An Integrative Review

Karakachian, Angela MSN, RN; Colbert, Alison PhD, PHCNS-BC, FAAN

doi: 10.1097/JFN.0000000000000249
Review Article

ABSTRACT Moral distress has been widely addressed across the nursing profession and within other disciplines. Forensic nurses are a vital part of the nursing profession as they care for complex patients who may suffer physically and psychologically. However, forensic nurses' moral distress in the context of caring for victims of violence has not been addressed. This integrative review of the literature reveals the consequences of moral distress on the nursing workforce particularly regarding nurses' burnout and intentions to leave their jobs. Turnover contributes to the country's critical shortage of nurses, which affects the quality of care patients receive and increases the costs for healthcare institutions.

Author Affiliations: School of Nursing, Duquesne University.

The authors declare no conflict of interest.

Correspondence:Angela Karakachian, MSN, RN, is a PhD Candidate, School of Nursing, Duquesne University, 553A Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA 15282. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received January 24, 2019; Accepted May 28, 2019

© 2019 by the International Association of Forensic Nurses. All rights reserved.
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