Moral Injury Awareness and Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic


Natalie Purcell, Daniel Bertenthal, Hajra Usman, Shira Maguen, Brandon Griffin, Haley Mehlman, Sarah McGrath, Joanne Spetz, Sylvia Hysong, and Karen Seal

April 19, 2024

Moral injury is lasting psychological and spiritual distress that stems from violating one’s values or feeling betrayed by a trusted institution or authority. Moral injury is associated with post-traumatic stress (PTSD), depression, anxiety, substance use, functional impairments, and suicide risk. Healthcare workers whose jobs put them in high-stakes life-or-death situations, and who may experience intense and prolonged work stress, may be especially vulnerable to moral injury.

This blueprint is based on research conducted for the study, “Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis,” funded by the National Institutes for Occupational Safety and Health. Morally distressing experiences that could lead to moral injury were reported by 39% of 2,004 surveyed VA healthcare workers in inpatient units, emergency rooms, and community living centers at 21 VA medical centers across the United States during the COVID-19 pandemic. In-depth interviews were conducted with 46 VA workers who completed the survey and volunteered for a follow-up interview.

Based on the study findings, this report explores the effects of moral injury, the circumstances leading to it, occupational risk factors, and how to address them. It also describes protective factors that may prevent moral injury and offers resources for healing and support.

The blueprint contains specific, tailored guidance for frontline staff, management, and executive leaders on how to reduce risk for moral injury in healthcare organizations.