Moral Injury in Healthcare Workers and First Responders

Oct 5

3 min read

A difficult shift is over, but one decision keeps returning. You wonder whether more could have been done, whether the available resources were enough, or whether an outcome conflicted with the care you believed someone should receive.

The VA discusses moral injury in healthcare workers and identifies first responders as another group in which it has been studied. Potentially morally injurious experiences can involve difficult care decisions, being unable to prevent harm, witnessing a violation of values, or feeling betrayed by trusted people or organizations.

The response deserves careful attention when it persists and affects daily life.

Identify the question that follows you home

Try being specific about what remains unresolved. “The job is stressful” may be true, but it can leave out the part that feels hardest to explain.

You might say, “I keep questioning that decision,” or, “The outcome has changed how I feel about my work.” A counselor can help you explore the event and its impact without requiring you to have a settled explanation.

Protect patient and client privacy. For an initial inquiry, describe your own symptoms and support needs. Ask the clinician how to discuss work experiences appropriately.

Examine responsibility in its actual context

An outcome alone does not establish what a person could reasonably have done. In a clinical conversation, look at the information available at the time, your role, your authority, and the options you actually had.

There may be grief about an outcome, a concern about a decision, or a systems problem that needs attention. Those deserve distinct consideration.

You can bring uncertainty into the session. The purpose is to understand what happened and what you are carrying, rather than rush to a reassuring conclusion or a harsh judgment.

Keep the workplace response concrete

If there is an unresolved concern about care or safety, identify the appropriate channel for addressing it. Depending on the setting, that may include a supervisor, a clinical review, or a formal reporting process.

When asking for support, name the practical need. You might need clarification about a decision, guidance for a similar situation, or a private conversation about what the event has changed for you.

Therapy can help with the emotional impact. Workplace concerns still need an appropriate organizational response.

Notice how you are getting through the week

The VA's healthcare guidance describes possible withdrawal, sleep changes, self-blame, and changes in habits after morally distressing experiences. Notice what has changed for you.

Are you staying at work longer to avoid going home? Pulling away from people who usually support you? Depending more on alcohol? Those observations are useful to bring to a provider.

My articles on work stress and burnout and using alcohol to cope with stress explore related concerns. An assessment can clarify how they fit together.

Ask for care that fits the problem

Consider counseling when the experience keeps affecting concentration, relationships, rest, or your confidence in daily decisions. Ask a provider about their experience with your work context and whether additional services would be appropriate.

As a former combat medic and Licensed Professional Counselor, I understand the importance of examining the circumstances around a difficult decision. Individual counseling gives us a place to focus on how the experience is affecting you now.

Adults seeking counseling in El Paso can view my Headway profile to check availability and request an appointment. You can also review stress and adjustment counseling.

Sources and further reading

VA: Moral Injury in Health Care Workers and VA: Moral Injury, Professional Guidance.