Organizational Impact on Healthcare Workers' Moral Injury During COVID-19

Abstract

The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/ 328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.

Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic

“…When organizations and leaders facilitate nurses' involvement in programs such as MEPRA, it helps rebuild trust and begins to heal the betrayals experienced throughout the pandemic. 9 …”

“…25 Encouraging collaboration between clinical nurses, organization leaders, and other key personnel can enable trust in colleagues' capabilities and often lead to innovative solutions to address complex challenges. 9 , 11 , 26…”

“…Major themes were elicited from HCWs' written feedback, which highlighted the importance of several organizational factors that were absent or lacking. 9 Of particular interest, psychological and emotional support for staff was rated effective by only 18% of nurses working with patients with COVID-19 versus 29% by those who weren't working with those patients. Similarly, information regarding professional wellness resources was rated effective by 25% of nurses working with patients with COVID-19, but by 41% of those not providing COVID-19 care.…”

“…Clear and transparent communication regarding system changes, policies that impact crisis management, and the availability of wellness resources offer a starting point for rebuilding trust when it has been eroded. 9 , 26 Given the chronicity of the pandemic, organizational leaders must engage with frontline nurses to better understand where they perceive gaps in process, content, and methods for delivering information at an institutional level. 32 Examining organizational patterns that contribute to poor perceptions of mechanisms for confidential reporting of concerns, access to ethics consultation, individual and/or team wellness strategies, and stress management tools can help illuminate areas for intervention.…”

“…Prioritizing relationships and investing in personal well-being is necessary to build back trust and enhance moral community and, as such, should be carefully prioritized in tailoring any interventions or programs aimed at improving MR among nurses. 9 , 32 , 33 Amplifying and supporting the MR of nurses, combined with increased OE during crisis, offers a pathway to reduce the detrimental effects of unavoidable ethical challenges that contribute to MI while enhancing trust in healthcare leaders and organizations.…”