Moral Injury Research

For far too long, the failings of our nation’s healthcare system have fallen on nurses’ shoulders—and hearts. More than two years into the COVID-19 pandemic, the strain has only worsened, and the consequences for nurses are devastating.

The AFT is sponsoring a research project to better understand, address, and prevent moral injury. Nurses across the country are sharing their experiences with researchers—and you can read a few of the early submissions below.

If you are a nurse who has experienced moral injury, please share your story by visiting gwhwi.org/moralinjury.html so we can identify and advocate for systemic solutions. Together, we can ensure that patients get the care they need and nurses have the fulfilling careers they deserve.

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“We are board-certified health professionals, and nothing cuts us down like the constant feeling of providing inadequate care. Before, I would attempt to build a strong rapport with these patients during their scariest times, since their families cannot visit. Mentally exhausted, I now limit my time in the room no matter if the patient is recovering or preparing for hospice.

“Being the ones primarily going into rooms, the nurses were the first ones to see the effect of insufficient PPE. As of this week, my N95 mask is three months old and has been Surfacided five times. New masks can be obtained if you walk down to the basement, where the supply chain [staff] can unlock the crate and track how many masks you’re using. However, new masks are provided to consulting doctors each time they come to the unit. Welder’s shields are taped together, cleaning wipes are sometimes unavailable, and periodically, new brands of gowns don’t have arms. In addition to skin breakdown and infection, there have been very real times where nurses, including myself, have been ordered to leave the unit to drink water or take a breather…. This was my first wake-up call that there was an ethical imbalance of care.… The needs of the patients have been placed after the safety of the staff, something that goes against the intrinsic nature of a nurse.”

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“There were many, many situations where, as the bedside nurse, I was everything for a patient. I was the nutritionist. I was the respiratory therapist. And [it got] to the point where physicians would send me into the room to ask a patient a question, because I had to be there anyway, and they didn’t want to increase their risk.… So that’s really demeaning. But I also think it is dangerous. Like, I don’t remember what the respiratory therapist told me to set the ventilator to. It feels like we were forced to take on roles that were not ever supposed to be part of our role in the position.

“The attending comes in and is like, ‘Why are you just hanging one [IV bag] at a time? You need to hang both of them because this patient needs to go to the OR.’ I said, ‘Well, the protocol is that we just hang one at a time, especially nonemergency situations, in case there’s a transfusion reaction.’… I felt powerless in that situation, because the literature is there.… When you’re not even allowed to use that in those situations, then it feels like you have nothing, you know, to offer back.… You are the one that does the actual touching of the patient and moving the patient and providing the physical care of the patient. Even though a doctor has similar sort of feelings, they are often more removed.… That like, tangible, like hands-on sort of experience hits a little deeper than just putting in orders or something.”

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“Right now, staffing is the worst it has ever been. I kept stats on myself. As the charge nurse, I was supposed to be out of staffing in order to manage the complex 36-bed unit, [but] I would be in charge with six patients routinely, anywhere from 50 to 83 percent of the time. It was so difficult to do two jobs so frequently and have to deal with all of the daily issues; it was demoralizing and made it extremely difficult to ever feel like I was doing a good job. I also carried a tremendous amount of guilt because I was unable to help any other staff and we were all working like dogs…. COVID struck, and the designated COVID units took our staff every day, so they could be 4:1 with numerous CNAs, while we took on their heavy medical patients and worked 6:1 with one or zero CNAs. ‘Merit raises’ were incredibly insulting, as I was working like a dog and only got 68 cents, the worst raise of my 17-year career.…. No support on many levels, yet being expected to be the support for the whole unit.

“Starting in maybe February 2021, I started crying at work nearly every day. Most days I would also cry on the commute to work, and sometimes I would cry in bed at night when I had to work the next day. I am a level-headed person and do not have a depressive personality. Actually, I am a very optimistic and resilient individual. I was a rock, and now I was crying all the time. I was incredibly stressed out and felt so devalued from giving and giving and giving and having the constant feeling that I could never give enough, feeling I was not appreciated and had no value. I was a number, a pawn on a staffing sheet. Patient care was suffering, and I was in staffing so much that I could not do my real job (charge nurse) and fix things. I am known for fixing things…. My manager told me that the unit never ran as well unless I was there. Well, if I’m so important, then why am I being so devalued and so unappreciated and given such an insulting ‘merit raise’?

“Work friends of mine told me that they were worried about me, probably because of the sudden tears that plagued me most days. The recruitment and retention nurse was tipped off about my tears, unbeknownst to me, and approached me in the hall. She said, ‘Hi Liz, how are you?’ I teared up and said ‘Fine.’ She said, ‘No, you are not fine.’ I told her, ‘This is just what I do now.’ I had gotten in the habit of tearing up, getting a grip, and going on with my day in just a few minutes. I was incredibly stressed and burned out.

“Finally, I made the healthiest decision of my career. I decided to give my notice without another job and take the summer off.… I was one of 35 RNs in the hospital who quit. After I gave my notice, I stopped crying all the time, like a switch was flipped. They offered me a 5 percent raise to stay full time. I decided to stay PRN [working as needed] and have only worked three shifts per six weeks from May till now (July). I am currently looking for a part-time job, but not on my unit and quite possibly at another facility.

“The sad part is that I love my unit and the staff. That is why I decided to stay PRN. Now I feel very emotionally healthy and am back to my usual self. Actually, I rebounded pretty quickly after I gave my notice. I had a one-week vacation one week after giving my notice and it rejuvenated me in such a way that upon return to work, I made a point to spread joy to others at work every chance I got until my month’s notice was done and I went PRN. When I go into work now, I can see that nothing has changed. Staffing is sparse, morale [is] low, there is a revolving door of new grads that get burned out within six months and quit. Nobody listens to suggestions, and I fear they will continue to run the staff into the ground.”