At our institution, the orientation program for new nurse interns in the intensive care unit (ICU) traditionally focuses on the technical skill and knowledge required for competence in this setting. However, in focus groups convened at the end of orientation, new nurses reported feeling unprepared, confused, and upset in response to ethical issues in the ICU. They were shocked by the regularity with which life and death decisions occurred, the frequency of conflicting opinions among clinicians and/or family members, and the ambiguity of the “right” thing to do. As managers of the program, we determined that the new nurses were experiencing moral distress and decided to design an intervention to address this problem.

Moral distress is defined as a situation that occurs in which one knows the right course of action to take but cannot act upon it.11 Although new nurses...

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