Emergency nurses (EDs) play a critical role in healthcare, confronting medical emergencies while also navigating unique ethical challenges [1], [2]. The demanding environment they work in, characterized by limited resources, high pressure, and constant ethical dilemmas, intensifies the weight of their professional responsibilities [3]. To address the impact of these challenges, it is crucial to understand the concept of moral distress and its prevalence among ED nurses. Moral distress, defined as a disturbing psychological imbalance that arises from perceiving ethical wrongdoing [4], can result from various factors such as working with unqualified doctors, encountering conflicting ethical expectations, and witnessing unethical practices [5], [6], [7]. Research has consistently shown that ED nurses experience moral distress at significantly higher rates compared to nurses in other healthcare settings, with reports indicating that 71 % of ED nurses frequently or always experience moral distress [8]. The persistence of this ethical stress can lead to detrimental consequences for nurses, including burnout, job dissatisfaction, compromised patient care, and adverse effects on their mental and physical health [9], [10], [6]. However, amidst the high prevalence of moral distress, ED nurses demonstrate remarkable resilience. Their resilience is characterized by personal integrity, moral efficacy, and the ability to navigate moral adversity with resourcefulness and determination [11]. Despite facing alarming rates of moral distress, emergency nurses possess exceptional resilience, enabling them to bounce back from adversity and thrive in challenging environments. Nevertheless, the demands of their profession can deplete even the strongest internal resources over time, necessitating the assessment of resilience levels and the provision of tools to manage the unique ethical challenges faced by ED nurses.

Maintaining an adequate nursing workforce is an ongoing challenge in many developed countries, including Saudi Arabia, despite offering relatively high nurse salaries. This challenge is further compounded by the increasing demand for nursing staff and the significant impact of moral distress and resilience on nurse retention. Research conducted by Fernandez-Parsons et al. [8] revealed that 6.6 % of nurses reported leaving a previous nursing job due to moral distress, highlighting the detrimental effect it can have on nurse retention. Furthermore, the hospital programs in Saudi Arabia do not currently provide specific teaching of resilience skills as a separate course or in the form of a preparation workshop for emergency nursing. Given the prevailing circumstances, addressing these factors becomes crucial to ensure a sustainable nursing workforce and improve the well-being of emergency department nurses.

Consequently, this study aims to identify the levels of moral distress and resilience among emergency department nurses. The findings of this study will provide valuable insights to curriculum developers, enabling them to effectively integrate interventions that enhance resilience and decrease moral distress among emergency department nurses. Additionally, by identifying moral distress and resilience levels, this study can contribute to improving the well-being of ED nurses, enhancing their job satisfaction, and ultimately leading to enhanced patient care.

This study aimed to achieve several objectives. Firstly, it aimed to identify the levels of moral distress and resilience among emergency nursing in ARAR city hospitals. Secondly, it sought to determine the correlation between moral distress and resilience among emergency nurses. Lastly, it aimed to identify any differences in the levels of moral distress and resilience among different demographic and occupational characteristics.