Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

Abstract

The purpose of this study was to examine how nurses' critical reflective practice, education level, and moral distress related to their work engagement. This is an area of study relevant to nursing, given documented United States Registered Nurse (RN) experiences of job related distress and work dissatisfaction, and the nursing shortage crisis. Nurses are central players in the provision of quality health care. There is need for better understanding of RNs' work engagement and factors that may enhance their work experience. A theoretical framework of critical reflective practice was developed and examined in this study.A non-experimental, descriptive, correlational design was used to examine the relationships among four study variables: critical reflective practice, education level, moral distress, and work engagement. The purposive sample consisted of 28 intensive care unit RNs (ICU-RNs) from three separate ICUs (medical, neonatal, and pediatric) in a 355-bed Southwest magnet-designated hospital. Measures of the key variables were as follows: (1) Critical Reflective Practice Questionnaire (CRPQ) developed for this study; (2) a subscale of Mary C. Corley's Moral Distress Scale; (3) Education level measured as the highest nursing degree earned to practice as a RN; and (4) the Utrecht Work Engagement Scale. All instruments demonstrated adequate reliability and validity.Pearson correlation and multiple regression analyses indicated support for the theoretical framework: There was a negative direct relationship between moral distress and work engagement, a positive direct relationship between critical reflective practice and work engagement, and moral distress and critical reflective practice, together, explained 47% of the variance in work engagement. Additionally, in the NICU, results indicated a positive direct relationship between increased educational level and critical reflective practice. Results also indicated that moral distress was a clinically significant issue for ICU-RNs in this sample.Strategies to promote critical reflective practice and reduce moral distress are recommended. Additionally, the findings support continued study of critical reflective practice and moral distress, and the role of education level, in nurses' work engagement. Research goals include continued study of the theoretical framework in larger study samples and in reference to additional explanatory factors.