Moral Injury in Nursing as a Moral Ecology: A Mid-Range Theory of Professional Moral Identity Alignment

Moral injury in nursing may develop when persistent structural and relational constraints disrupt nurses’ ability to enact professional moral commitments. This article develops the Nursing Moral Ecology Framework, a nursing-specific mid-range theory derived from Copeland’s Moral Ecology Framework and informed by a nursing-focused scoping review and a national study of registered nurses (N = 189). Professional moral identity alignment is proposed as the mechanism linking moral ecology to moral injury. Seven propositions explain how ecological conditions sustain alignment, generate cumulative misalignment, and contribute to injury or repair. The framework differentiates moral injury from burnout and moral distress and shifts intervention toward structural and relational accountability.