Moral distress (MD), originally defined by Jameton (1984) as the psychological and emotional suffering that arises when external constraints prevent an individual from acting in accordance with their moral judgement, has been widely examined in clinical nursing contexts. However, comparatively little attention has been paid to MD within the academic environments where nursing students are prepared for professional practice. Emerging evidence suggests that the moral tensions experienced by nurse academics may not only constitute moral distress but, under chronic or unresolvable conditions, also meet criteria associated with moral injury—a deeper, more enduring form of moral harm characterised by violations of moral expectations, institutional betrayal, and threats to moral identity.
Drawing on the expanded DSM-5-TR Z Code category “Moral, Religious, or Spiritual Problem” (Mattson et al., 2025), this presentation explores how recurring ethical tensions in nurse education—including academic dishonesty, grade manipulation, pressure to pass underperforming students, incivility, misalignment between policy and practice, and cultural or organisational silencing—may exceed the threshold of distress and contribute to cumulative moral injury among academic staff (Ganske, 2010).
Issues such as reluctance to fail unsafe or unprepared students (Adkins & Aucoin, 2022), systemic tolerance of plagiarism, or subtle institutional expectations to “maintain pass rates” can create scenarios in which nurse academics feel complicit in actions that conflict with professional values and public protection mandates. Over time, such exposures may erode moral integrity, undermine professional identity, and contribute to burnout, withdrawal, or attrition—representing a significant concern for the sustainability of the nursing academic workforce.
This presentation aims to stimulate debate regarding whether moral distress within the nursing academy is sufficiently recognised, how it may progress to moral injury if left unaddressed, and what organisational responsibilities exist to prevent moral harm and protect the integrity of nursing education.

References
Adkins, D. A., & Aucoin, J. W. (2022). Failure to fail – Factors affecting faculty decisions to pass underperforming nursing students in the clinical setting: A quantitative study. Nurse Education in Practice, 58. https://doi.org/10.1016/j.nepr.2021.103259
Ganske, K. M. (2010). Moral Distress in Academia. Online Journal of Issues in Nursing, 15(3), Manuscript 6.
Jameton, A. (1984). Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall.
Mattson, S., VanderWeele, T. J., Lu, F., Carey, L. B., Cowden, R. G., Fung, E. N., Koenig, H., Peteet, J. & Wortham, J. (2025). Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the: DSM-5-TR. The Journal of Nervous and Mental Disease, 213(11), 297-304. https://doi.org/10.1097/NMD.0000000000001856