The COVID-19 pandemic resulted in unprecedented exposure to Potentially Morally Injurious Events (PMIEs) for nurses, in which they were both moral transgressors and moral victims, with deleterious consequences on their psycho-social health and functioning. Our experimental design compared memories of PMIEs with memories of severe moral transgressions (SMTs), in which participants were only moral transgressors. Drawing from Self-Determination Theory and research on moral auto-biographical episodic memories, we assessed a conceptual model describing the impact of recalling a single PMIE or SMT event on nurses’ burnout, work satisfaction and adaptive performance. Our convenience sample comprised 614 Romanian nurses, and data was analyzed with path analysis, general linear modelling, and t-tests. Findings showed that memories of PMIEs, compared to SMTs, were more autonomy thwarting, being associated with more controlled work motivation, less moral learning, higher burnout, less work satisfaction, and adaptive performance. Burnout, moral learning, and work satisfaction were significant mediators of the relationships between PMIE and SMT recall and, respectively, adaptive performance. Our results highlight the urgency for organizational practices of moral repair for nurses after the pandemic, along with interventions meant to increase their autonomy and self-determined work motivation.

Nurses have been frequently exposed to Potentially Morally Injurious Events (PMIEs) during the COVID-19 pandemic. Due to resource scarcity, they both perpetrated (self-PMIEs) and passively witnessed (other-PMIEs) moral transgressions toward the patients, severely violating their moral values. Our study investigated the impact of self- and other-PMIEs on work outcomes by exploring nurses’ episodic memories of these events and the basic psychological need thwarting associated with them. Using a quasi-experimental design, on a convenience sample of 463 Romanian nurses, we found that PMIEs memories were uniquely associated with burnout and turnover intentions, after controlling for socio-demographic characteristics, general basic psychological need satisfaction at work and other phenomenological characteristics. Both self- and other-PMIEs memories were need thwarting, with autonomy and competence mediating their differential impact on burnout, and with relatedness—on turnover intentions. Our findings emphasize the need for organizational moral repair practices, which should include enhancing nurses’ feelings of autonomy, relatedness and competence. Psychological counseling and psychotherapy should be provided to nurses to prevent their episodic memories of PMIEs to be (fully) integrated in autobiographical knowledge, because this integration could have severe consequences on their psycho-social function and occupational health, as well as on the organizational climate in healthcare institutions.

Ageism in nursing is difficult to identify, prevent and combat. Using a mixed-method approach in two exploratory cross-sectional studies (N = 512), we brought support for a proposed conceptual difference between ageism toward older adults and ageism toward older patients which may facilitate the identification of ageism in healthcare settings. We also investigated whether nurses’ moral sensitivity could buffer the negative effect of socio-cognitive factors on ageism against older patients. Our findings supported our assumption, suggesting that fostering nurses’ moral sensitivity could be a promising new avenue to prevent and combat ageism in nurses, together with comprehensive gerontological education meant to decrease stereotyping and help nurses fulfill their roles of moral advocates against older patient discrimination.

This study explored the influence of healthcare ageism on nurses’ moral distress. Episodic interviews were conducted on 25 Romanian nurses in 2020. Thematic analysis revealed that all moral distress sources reported reflected macro-, meso- and micro-level ageism, benevolent and hostile, self- or other-directed, including stereotyping, prejudice, and discrimination of older patients. The COVID-19 pandemic-related ageist measures increased healthcare ageism and transformed nurses’ representations of older patients accordingly. Nurses felt moral conflict both when passively witnessing ageist acts and when perpetrating them to adhere to group norms, highlighting the need to combat ageism for both patients’ and nurses’ well-being.