Nurses' Moral Distress During Digital Workload Monitoring in Hospital Care

Abstract

Background: Digital workload monitoring is increasingly used in hospital nursing through electronic health records, acuity scoring, task dashboards, staffing platforms, and electronic observation systems. Although these tools may support visibility and planning, they may also narrow nursing work to measurable tasks and overlook relational care, vigilance, professional judgement, and emotional labour. Qualitative inquiry is needed to understand how nurses experience the ethical effects of being digitally monitored. Objective: To explore nurses’ perceptions of moral distress during digital workload monitoring and to identify how monitoring systems influence autonomy, trust, accountability, missed or delayed care, and documentation burden. Methods: This qualitative interview study included hospital nurses with direct experience of digital workload monitoring. Semi-structured interviews explored workload visibility, documentation, surveillance, autonomy, missed care, escalation, and ethical concerns. Data were analysed using reflexive thematic analysis. Results: Five themes were identified: quantified care and invisible nursing labour; surveillance, autonomy, and trust; moral distress through missed or delayed care; documentation burden and competing accountability; and resistance, voice, and ethical repair. Participants perceived monitoring as useful when it supported escalation and staffing visibility, but distressing when data were interpreted without context or failed to generate organisational support. Conclusion: Digital workload monitoring should be governed as ethical decision-support infrastructure. Participatory design, transparent governance, contextual interpretation, reduced documentation burden, and meaningful staffing responses are needed to protect professional judgement and person-centred nursing care.