The Moral of the Story-Perception of Leadership With Moral Distress in Registered Nurses: A Qualitative Systematic Review.

Sherrie Bolton; Adele Baldwin; Anne Mette N Adams; Eileen Willis; Ellie Cutmore; Sandra Johnston; Nicole Snaith; Hila Ariela Dafny

doi:10.1111/jocn.70354

PubMed · 42116655

The Moral of the Story-Perception of Leadership With Moral Distress in Registered Nurses: A Qualitative Systematic Review.

Sherrie Bolton·Adele Baldwin·Anne Mette N Adams·Eileen Willis·Ellie Cutmore·Sandra Johnston·Nicole Snaith·Hila Ariela Dafny

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Abstract

AIM: To understand how Registered Nurses perceive the impact of nursing leadership on managing moral distress and mitigating burnout. BACKGROUND: Moral distress and burnout are pervasive issues in nursing, compromising well-being, patient safety and workforce sustainability. Leadership is a critical factor in shaping workplace culture and mitigating these challenges, yet evidence remains limited. DESIGN: Qualitative systematic review. METHODS: A qualitative systematic review was conducted following JBI methodology and PRISMA guidelines. Comprehensive searches across MEDLINE, PsycINFO, Embase, CINAHL and Scopus identified 5927 articles, with two studies meeting the inclusion criteria. Data were appraised using the JBI Critical Appraisal Checklist and synthesised via meta-aggregation. Confidence in findings was assessed using the ConQual approach. RESULTS: Four major themes emerged: (1) Behind the barriers, (2) Breaking point, (3) Weathering the storm and (4) Leadership for lasting change. Leadership influenced nurses' psychological safety, ethical decision-making and resilience. Inadequate support amplified moral distress, and effective strategies included authentic communication, team solidarity and systemic interventions. CONCLUSIONS: Leadership plays a pivotal role in mitigating moral distress and burnout. Evidence highlights the need for structural changes and support to sustain registered nurses' well-being and retention. RELATIVE TO CLINICAL PRACTICE: Findings offer direction for leadership strategies that promote ethical workplaces, shared decision-making and mental health supports to enhance resilience and patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strengthening leadership capability is vital for workforce sustainability, care quality and nurse retention. REPORTING METHOD: Authors have adhered to relevant EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not involve patients or the public in its design, conduct or reporting.

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Leadership Humans Ethical Dilemmas Burnout, Professional Qualitative Research Morals Nurses burnout leadership moral distress nurses perception Journal Article Systematic Review Review

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Sherrie Bolton, Adele Baldwin, Anne Mette N Adams, Eileen Willis, Ellie Cutmore, Sandra Johnston, Nicole Snaith, Hila Ariela Dafny. 2026-05-11. The Moral of the Story-Perception of Leadership With Moral Distress in Registered Nurses: A Qualitative Systematic Review.. https://doi.org/10.1111/jocn.70354

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Burnout, Professional subject Humans subject Journal Article subject Journal Article; Systematic Review; Review resource Leadership subject Nurses subject Perception subject Systematic reviews study

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