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Background: Various facets of spirituality are associated with well-being. Given the current urgency to promote nurse well-being, nurse spirituality merits exploration., Purpose: To investigate how spiritual distress and growth (i.e., spiritual/religious struggle, moral injury, and post-traumatic growth) contributed to nurse outcomes (i.e., burnout, job satisfaction, and intent to leave)., Methods: Registered nurse (RNs) providing direct patient care in three Southern California hospitals completed an online survey that included psychometrically robust measures. Hierarchical multiple regression analyses were used to test spiritual variables as predictors of nurse outcomes after accounting for demographic and work-related factors., Findings: In this sample of 531 demographically diverse RNs, spiritual struggle contributed to burnout and turnover intention; post-traumatic growth and employer respect for nurse well-being contributed to all three nurse outcomes., Discussion: Spiritual distress and growth are understudied but potentially important influences on job outcomes for nurses. The results here suggest that continued development of interventions to address spiritual health is worth investment., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)