Moral injury, long associated with military veterans, is now recognised as a profound and growing challenge throughout the nursing profession. Nurses across all areas are routinely exposed to ethical dilemmas, competing obligations, and traumatic situations that can undermine their core values and sense of purpose. Within healthcare, nursing remains at the very heart of patient advocacy and human care, making staff especially vulnerable to the emotional and psychological wounds of moral injury. Among these professionals, nurse managers stand out as a cohort uniquely exposed to moral adversity, positioned at the intersection of patient advocacy, staff support, and organisational obligation. Yet, the recognition and conceptual clarity of moral injury in nursing leadership remains limited.

The absence of clear definitions and shared understanding risks leaving nurse managers’ experiences unaddressed, with implications for their wellbeing, their teams, and the broader culture of care. Recognising moral injury in this setting is more than an academic concern: it is an urgent professional priority that directly affects staff retention, organisational integrity, and patient outcomes.

This work responds to the call for greater attention to moral injury in non-military, high-risk roles. Through qualitative inquiry utilising in-depth interviews with nurse managers, this study seeks to explore how moral injury is understood and experienced in nursing management, and how building conceptual clarity can inform identification, prevention, and support initiatives across the sector.

Expanding this focus is critical, as nurse managers often serve as moral gatekeepers within their organisations, mediating the needs of patients, staff, and systems in circumstances that can conflict with their professional values. Addressing the nuances of moral injury at this managerial and leadership level may reveal overlooked pathways for organisational change and staff support. Furthermore, more explicit recognition will give nurse managers the personal power to articulate their experiences, advocate for necessary resources, and engage in reflective leadership that promotes and fosters psychological safety for their teams.