Not yet nurses, already in distress: moral stress among German student nurses in clinical practice

Abstract Aim Moral distress has been widely documented among registered nurses and is associated with considerable psychological strain. However, little isknown about the extent to which nursing students experience moral distress during their education. This study aimed to investigate theprevalence, symptoms, and sources of moral distress among student nurses in Germany. Subject and methods A quantitative cross-sectional online survey was conducted among nursing students enrolled in qualifying nursing programs in Germany (n =136). Existing validated instruments measuring moral distress were translated, adapted to the educational context, and combined with aframework categorizing potential sources of moral distress. Descriptive statistical analyses were performed. Results Of the respondents, 84.6% reported symptoms associated with moral distress. Frequently reported physical symptoms included headaches, backpain, gastrointestinal complaints, and insomnia, while psychological symptoms comprised anxiety, depressive mood, helplessness, and despair.Participants identifi ed three main sources of moral distress: a negative ethical climate, nursing shortages, and inadequate leadership. Thefi ndings suggest that student nurses experience symptoms and triggering situations comparable to those reported by registered nurses. Conclusion Although the sample size limits generalizability, the fi ndings indicate that moral distress is already a relevant issue during nursing education.Early exposure to ethically challenging situations and structural constraints may negatively infl uence students’ psychological well-being and theirintention to remain in the profession. These results highlight the need for further research and for educational and organizational strategies torecognize, prevent, and address moral distress during nursing education.