• Maria N K Karanikola, John W Albarran, Elio Drigo, Margarita Giannakopoulou, Maria Kalafati, Meropi Mpouzika, George Z Tsiaousis, and Elizabeth D E Papathanassoglou.
• Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
• J Nurs Manag. 2014 May 1; 22 (4): 472-84.

AimTo explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses.BackgroundPoor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions.MethodsA cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses.ResultsThe intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001).ConclusionMoral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress.Implications For Nursing ManagementEnhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.© 2013 John Wiley & Sons Ltd.

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