ARTICLE CRITIQUENameInstitution AffiliationCourseDate of Submission IntroductionThere is increased complexity in provision of healthcare services, and this has resulted to unforeseen issues that have serious consequences to both health care providers and patients alike. The advancement of technology has posed challenges to both healthcare providers and patients due to difficulties of choices and decision making. Inadequate resources impede provision of health care appropriately due to complication of managed directives, regulations and expectation of the organization. Moral distress and persuasive are hardly recognized and this hinders the ability of health care practitioners to deliver optimal care. This is because of the nature of moral endeavors and the intimacy relationship between healthcare provider and patient as well as their roles. Purpose of the studyMoral distress is a core issue for nurses due to its negative impact on the quality and the cost of patient care. These nurses are emotionally and ethically challenges regarding the situation in clinical setting making them to experience moral distress. The purpose of this article is to have an understanding and facilitation of identifying moral distress in nurses and to develop strategies that improve the effects of moral distress. It describes the moral distress of registered nurses of large health care systems, while identifying conditions that contribute to moral distress.Literature ReviewRegistered nurses Neonatal Intensive Care Unit (NICU) have experienced stress in the course of their duties in an attempt to control professionalism and personal values with realities of the health care. The moral distress is contributed by the surrounding end-of-life care, and the futile aggressive care without the perception of the patients` benefits. Patients experience harm which comes from pain and suffering, depersonalization of patients in the event of meeting requirements of the institution, health policy constraints and directives of managed care. Additionally there are inadequate staffs working with incompetent colleagues and effects of containment of costs contribute largely to moral distress of NICU nurses. This interferes with the ability of nurses to provide optimal care thereby creating moral distress. Moral distress affects negatively the outcome of a patient and on nursing practice by influencing the quality, quantity and the cost accrued for the care leading to frustrations. The outcome of moral distress is loss of integrity and dissat...