Preferred Name

Lauren Childers

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Erica Lewis

Jill Delawder


The COVID-19 pandemic has brought rapid changes, increased stress, and ethical challenges to nurses across the globe. These factors may place nurses at increased risk for developing moral distress and substance use disorder. This stress can also increase nurse vulnerability to substance use. Previously there was little evidence about the rates of moral distress and substance use disorder among nurses during the COVID-19 pandemic. The primary objective of this evidence-based project was to describe levels of moral distress and substance use among nurses in a community hospital during the COVID-19 pandemic and to make recommendations for interventions to improve nurse wellbeing and patient safety based on findings. An online survey, consisting of demographic questions, the Measure of Moral Distress in Healthcare Professional Tool, the Alcohol Use Disorder Identification Tool, the Drug Use Screening Tool-10 items 1 and 2, and a single item asking about amount of time caring for COVID-19 patients was sent to inpatient and emergency department nurses working at a rural, community hospital. Frequency statistics and measures of central tendency are used to describe the rates of moral distress, substance use disorder risk for alcohol and drugs, and time spent caring for patients with COVID-19. A total of 57 nurses completed the survey. Nurses were found to be experiencing various levels of moral distress, with the collective group experiencing scores in the middle of the moral distress range. One-third of the nurses reported an intention to leave their position due to moral distress. In addition, a third of nurses who participated in the survey reported risky alcohol use, while 5.3% reported harmful alcohol use. Fully 21.1% of nurses reported using illicit substances, while 5.3% reported using illicit substances daily or nearly daily. Given the literature on the crescendo effect of moral distress and the nature of substance use disorder, the lasting effects to nurses during the COVID-19 pandemic will be important to the profession for years to come. Nursing leadership must commit to implementing resources to help prevent and care for nurses who experience moral distress and substance use disorder.

Keywords: Moral distress, substance use disorder, substance misuse, COVID-19

Available for download on Saturday, November 18, 2023

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