{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:51:38Z","timestamp":1791978698979,"version":"4.4.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>When transplant clinicians encounter ethical challenges and are constrained by their institution from acting in a manner within their professional ethical obligations, they may experience moral distress. Moral distress has been associated with negative effects such as burnout and turnover. Conversely, high grit has been positively correlated with job satisfaction, job performance, and organizational commitment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research questions<\/jats:title>\n                    <jats:p>What is the level of grit and moral distress among transplant clinicians? What correlations between demographics, grit, moral distress, and intent to leave exist among transplant clinicians?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted from October 2024 through March 2025. Three instruments, an investigator-developed demographic survey, the 12-Item Grit Scale, and the Measure of Moral Distress for Healthcare Professionals, were used to capture transplant clinician\u2019s grit and level of moral distress. Data were analyzed using descriptive statistics, Pearson correlation, and generalized structural equation modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and research context<\/jats:title>\n                    <jats:p>The target population for this study consisted of organ transplant clinicians (e.g., surgeons, physicians, coordinators, advanced practice providers, nurses, and allied health team members) in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>Ethics review and approval was obtained prior to subject recruitment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 101 transplant clinicians, higher moral distress was observed in those with advanced education, frequent ethical challenges, and specific transplant roles (e.g., advanced practice providers, physicians, multi-organ), while grit remained consistent across demographic and clinical factors. Generalized structural equation modeling suggests a potential mediating role between clinician characteristics (education), workforce factors (frequent ethical issues and specific transplant roles), and turnover intentions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Transplant clinicians who experience moral distress frequently and at high intensity may express an intent to leave their role regardless of their level of grit. Healthcare organizations must create targeted interventions and resources to mitigate moral distress and support transplant clinicians who experience moral distressing events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261489549","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T11:58:10Z","timestamp":1791719890000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A cross-sectional study of transplant clinicians\u2019 moral distress and grit"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2620-8972","authenticated-orcid":false,"given":"Preston H.","family":"Miller","sequence":"first","affiliation":[{"name":"College of Nursing, The University of Alabama College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha","family":"Modi","sequence":"additional","affiliation":[{"name":"College of Nursing, The University of Alabama College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Hoy","sequence":"additional","affiliation":[{"name":"College of Nursing, The University of Alabama College of Nursing"},{"name":"Vanderbilt Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2022798"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2023.2297922"},{"key":"e_1_3_4_5_2","volume-title":"Nursing practice: the ethical issues","author":"Jameton A","year":"1984","unstructured":"Jameton A. 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