Is It Really Burnout? The Weight of Moral Injury

I've been reviewing the research on moral injury in healthcare for several weeks and it's feeling heavy. What is becoming clearer is that a lot of what we have been told is burnout, poor boundaries, inadequate self care, or even counter transference might be attributed to moral injury and moral distress.

I talk more about it here: https://rss.com/podcasts/relitpractice

Burnout and trauma recovery remains my main focus especially with other clinicians, but we cannot have the conversation without moral injury.

One multidisciplinary, longitudinal study looked at moral injury exposure and occupational outcomes in healthcare workers. It followed 473 healthcare workers over one year, from May 2020 to May 2021. Here's what they found:

• Over seventy six percent of healthcare workers reported feeling betrayed by a healthcare or public health organization. Read that again, 76%.

• Forty-one percent had witnessed a potentially morally injurious event.

• And about eighteen percent reported directly participating in one.

• Witnessing a morally injurious event predicted a sixty six percent increased risk of wanting to leave your job one year later.

• Participating in a morally injurious event predicted a thirty eight percent increased risk of burnout one year later. Even after controlling for depression, anxiety, demographics, and physical health status.

A recent meta-analysis of 33 studies from 13 countries, representing over 31,000 healthcare workers continued the story with finding:

• Moderate positive associations with every mental health outcome examined including PTSD, depression, anxiety, burnout, and suicidal ideation.

• The suicidal ideation effect was stronger in health care workers than in prior veteran-focused meta-analyses (that one hit hard!).

• And before you blame Covid, direct COVID-19 care was associated with a smaller moral injury effect on depression and anxiety; this may suggest that purpose and role clarity may have offered some buffering against the impact of morally distressing situations.

These numbers may tell a story, but not the whole story.

I specialize in trauma and burnout recovery with high performers and folks who work in healthcare and human services. Today, I am reflecting on the stories that have been shared in my office from clients and colleagues and the brave way that mental health clinicians, social workers, nurses, doctors, psychologists and other allied health professionals show up for their patients in systems that are not designed to address realities of care.

If you are reading this and it resonates, please know that you are not weak. In fact, the part of you that recognizes the familiarity in those numbers is an indicator that your values are intact. Your sensitivities and attunement are gifts to this profession and this world.

You deserve to have healing, peace, and fulfillment in your work and in your personal life.

If you’re a mental health clinician seeking connection that meets you where you are, I invite you to join me on the first Tuesday of the month (7pm EST) for the ReLit Practice- Reset Circle.

It is a free to you, one hour reset on Zoom where we share in a somatic gounding exercise, followed by going deeper into topics that matter, personal reflection, and an opportunity to connect.

Learn more & register here: https://www.relitpractice.com/circle

Friends, you are more than numbers in a study. Keep showing up for yourself, each other, and this work.

~Stacey