Hidden Wounds: Moral Injury & Healthcare

Healthcare providers are often faced with ethical dilemmas in their daily work. These problems can cause moral distress and may lead to moral injury. Moral injury is the psychological harm resulting from actions or inactions that violate one’s moral or ethical beliefs. It is a term commonly used in the military context, but it is also prevalent in healthcare.

Moral injury occurs when healthcare providers are being forced to make decisions that go against their ethical or moral beliefs. For example, a physician being asked to withhold life-saving treatment from a patient due to financial constraints or insurance limitations. Being a physician, they are trained to prioritize the patient’s health and well-being above all else, so, this causes tremendous moral distress for them. Another example of moral injury in healthcare is when providers witness or participate in unethical behavior, such as discrimination or abuse of power.

The Impact on Nurses:

When nurses go through a moral injury, they can experience deep feelings of guilt, shame, and moral distress. It may make them doubt their skills as professionals, lose faith in their capacity to deliver excellent care and struggle with compassion fatigue. Over time, these experiences can accumulate and result in burnout, depression, more frequent absences from work, post-traumatic stress disorder (PTSD), and ultimately, a choice to leave nursing. Providers may also experience a loss of trust in their colleagues and the healthcare system as a whole.

The Vicious Cycle of Nurse Turnover: High nurse turnover rates have consequences for healthcare institutions and patient care. When experienced nurses leave, the staffing shortage exacerbates, placing additional strain on the remaining nursing staff. The resulting workload intensification further increases the likelihood of moral injury among those who remain. This vicious cycle perpetuates high turnover rates and compromises patient safety and quality of care.

The Impact on Health Facilities:

Financial Implications:

Nurse turnover also carries financial implications for hospitals and medical facilities. Recruiting, hiring, and training new nurses can be a costly and time-consuming process. The expenses associated with advertising job openings, conducting interviews, and providing orientation and onboarding programs can strain already tight budgets. These financial burdens can hinder the ability of healthcare institutions to invest in resources that enhance patient care.

Addressing Moral Injury:

Healthcare institutions must address moral injury now to reduce nurse turnover and create a healthier work environment. Here are some key strategies that can help ease moral injury:

1. Enhance Ethical Leadership: Promote ethical leadership at all levels of healthcare organizations. Encourage open dialogue, transparency, and accountability to address moral issues and create a culture that supports ethical decision-making.
2. Invest in Staffing and Resources: Adequate staffing levels and resources are essential to providing quality care. Address staffing shortages, ensure manageable workloads, and provide necessary equipment and supplies. This will help ease the moral distress caused by feeling unable to meet patient needs due to resource limitations.
3. Foster a Culture of Support: Implement programs that promote self-care, resilience, and emotional support for nurses. Encourage debriefing sessions, peer support networks, and access to counseling services to help nurses process their experiences and ease the emotional toll of moral injury.
4. Education and Training: Offer ongoing education and training programs that focus on ethical decision-making, communication skills, and conflict resolution. Equip nurses with the tools to navigate challenging situations, address moral problems, and advocate for their patients.

Conclusion:

Moral injury represents a significant challenge in nursing, contributing to the high turnover rates witnessed in the profession. The high nurse turnover in hospitals and facilities cannot be underestimated. It affects patient care quality, staff morale, and the financial stability of healthcare institutions. By recognizing the significance of this issue and implementing strategies to reduce turnover, hospitals, and facilities can create a more stable and supportive environment for their nursing staff, resulting in overall healthcare system effectiveness. Addressing nurse turnover is not only an investment in the nursing workforce but also a commitment to the well-being and safety of patients.

Watch how Ruth Lanius, MD, PhD, discusses how to work with the shame of moral injury.