The thwarted delivery of best practice due to external constraints on professional practice results in disorientation of professional identity, due to conflict with internalised professional values, leading to professional moral distress. Nurses have a professional and ethical responsibility to challenge less than ideal practices and to influence and improve the practice environment, but traditionally have not been explicitly taught the skills with which to address these. Contemporary nurses must be confident that they can appropriately address issues of concern on behalf of their patients or clients, as well as for themselves and their colleagues, including taking political action when necessary. Confidence to appropriately act to create change in the practice environment empowers moral resiliency.

Recognising moral distress as a potential experience of nursing practice requires that innovative undergraduate, post graduate and professional development nurse educational activities overtly discuss professional moral distress in nursing practice. Effective integration of skills for leadership, political advocacy, ethical conduct, critical reflection, conflict resolution and collaborative practice are necessary for the development of a strong and effective professional nursing culture that mitigates the potential for moral distress. Students of nursing and nurses in practice need to be aware of the factors that contribute to moral distress, as well as of the skills they have been equipped with to monitor, mediate and manage this.