Understanding Nurses Experiencing Moral Injury

What was frequently confused as burnout in previous years, has recently been accurately identified as moral injury for nurses.

Burnout, an occupational phenomenon (not a medical condition), results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy.

Moral injury, however, has been described as a deep soul wound that occurs when a person feels they must take actions, or witness actions, that violate their deeply held moral beliefs. The term describes the challenges of simultaneously knowing what care patients need but being unable to provide it due to constraints beyond a caregiver’s control.

As nurses navigate the dynamic policies and procedures of the healthcare environment in an already high-stress environment, correctly recognizing their challenges and struggles is often difficult, yet extremely important. While we’ve long understood the physical toll a 12-hour shift can have on nurses, understanding emotional impacts and their effects on the nursing workforce has been less appreciated.

How nurses experience moral injury

Nurses enter the healthcare industry with an internal yearning to care for others. Having an in-depth knowledge about patient care and being unable to ensure that patients receive quality care creates a moral conflict. You may feel a distressing disconnection between the values that led you into your profession in the first place and the compromises you must make from day to day. This is only exacerbated as financial and regulatory imperatives and inadequate care models shift focus away from the vital patient-clinician relationship.

Feelings associated with moral injury might include:

  • Shame
  • Inadequacy
  • Distress
  • Self-blame
  • Withdrawal
  • Guilt
  • Anxiety
  • Anger
  • Remorse

Moral injury during COVID-19

Understanding the difference between burnout and moral injury is important, as using different terminology reframes the problem and the solutions. Burnout is a series of events often characterized by physical symptoms of emotional exhaustion and chronic stress, depersonalization, and reduced personal accomplishment. Burnout has been discussed in the healthcare industry for many years.

However, moral injury differs significantly and is more aligned with the post-traumatic stress disorder symptoms (PTSD) observed in soldiers following battle. Moral injury became more prevalent in nurses during the COVID-19 pandemic where nurses experienced extreme conditions that compromised the quality of patient care.

While moral injury is not a new issue in healthcare, the COVID-19 pandemic increased challenges for nurses. During the peaks of the pandemic, nurses were faced with many situations that could prompt feelings of moral injury, such as:

  • Increased personal protective equipment (PPE) created an alarming sense of fear in patients, when helping them to remain calm is of the utmost importance.
  • Heightened restrictions prevented nurses from comforting patients through physical touch such as hand holding or even wiping away tears or sweat.
  • Additional equipment such as fans and ventilators made it difficult for nurses to be heard as they tried to offer kind words of comfort to patients.
  • New protocols limited patients’ visitors, leaving nurses to communicate at an increased amount with patients’ families — often delivering unfortunate updates on their status.
  • Shortage in equipment forced nurses in many situations to reuse PPE …read more

    Read full article here: nurse.com