Abstract
BACKGROUND: Newly graduated nurses are particularly vulnerable to moral distress due to limited experience, low self-confidence, and inadequate ethical knowledge, which impact their ability to make and act on ethical decisions. This study aims to describe their moral distress experiences during the transition to professional practice and identify predictive factors affecting moral distress levels. METHODS: A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and a semi-structured questionnaire. The analysis was conducted separately and then integrated. In the quantitative part of the study, 205 new nurses with 1-18 months of working experience were recruited, and 25 new nurses were recruited in the qualitative part. RESULTS: Gender, type of hospital, experience time, caregiver and manager role level, and subjective perception of levels were significant predictors of moral distress. Qualitative data revealed four main themes: (1) causes of moral distress, (2) effect of moral distress, (3) coping with moral distress, and (4) suggestions for reducing moral distress. DISCUSSION: The moral distress experienced by newly graduated nurses may become more pronounced during the transition to professional life. During this period, lack of experience, low self-confidence, and insufficient ethical knowledge can increase moral distress and affect future experiences by making it difficult to make and implement ethical decisions. CONCLUSIONS: This study showed that individual, organizational, and systemic factors influence moral distress in new graduate nurses. It highlights that ethical challenges in developing professional identity are closely tied to organizational structure and systemic regulations, emphasizing the need for individual support and improvements in education and organizational systems to reduce moral distress. CLINICAL TRIAL NUMBER: Not applicable.