AimTo examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions.DesignJoanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted).MethodsFive databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.ResultsSearches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being.Patient or Public ContributionNo patient or public contribution to this systematic review.

BackgroundNurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well‐being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.AimTo explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.DesignA mixed‐methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.MethodsA mixed‐methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self‐Regulatory Common‐Sense Model.ResultsIn total, 71 peer‐review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS‐CoV‐2 / COVID‐19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well‐being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.ConclusionsIt is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.Relevance to Clinical PracticeNurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.No Patient or Public ContributionThis was a literature review study.