This study explored the influence of healthcare ageism on nurses’ moral distress. Episodic interviews were conducted on 25 Romanian nurses in 2020. Thematic analysis revealed that all moral distress sources reported reflected macro-, meso- and micro-level ageism, benevolent and hostile, self- or other-directed, including stereotyping, prejudice, and discrimination of older patients. The COVID-19 pandemic-related ageist measures increased healthcare ageism and transformed nurses’ representations of older patients accordingly. Nurses felt moral conflict both when passively witnessing ageist acts and when perpetrating them (...) to adhere to group norms, highlighting the need to combat ageism for both patients’ and nurses’ well-being. (shrink)