Moral Distress, Professional Burnout, and Potential Staff Turnover in Intensive Care Nursing Practice in Latvia - Phase 1

Burnout and moral distress are increasingly recognized as critical challenges within healthcare systems, particularly in high-stress environments such as intensive care units (ICUs). This cross-sectional study investigates the prevalence and interrelationships of moral distress, burnout, and turnover intentions among ICU nurses in Latvia, a country facing significant nursing shortages and structural workforce challenges. A total of 155 ICU nurses completed validated instruments assessing moral distress, the three subscales of burnout (personal, work-related, and client-related), and intentions to leave the profession. The results indicate that 68.2% of respondents experienced moderate to high levels of moral distress, especially related to providing aggressive treatment contrary to clinical judgment. Burnout scores were highest in the personal and work-related dimensions, with emotional exhaustion strongly correlated with moral distress. Approximately 30% of participants reported active intentions to leave their positions. Regression and mediation analyses confirmed that moral distress significantly predicted both burnout and turnover intentions, with burnout partially mediating this relationship. These findings highlight urgent risks not only to nurse well-being but also to healthcare quality and sustainability. This study underscores the importance of systemic interventions, including structured workload assessment tools, psychological support, and ethical consultation services. The results contribute to the international literature and offer context-specific insights for workforce resilience in Eastern European health systems.