Every nurse knows the pain of being prevented from giving a patient what they need. Maybe fear of retaliation prevented you from voicing a safety concern in the OR that harmed a patient. Maybe you were diverted to the frontlines to care for patients with COVID-19 and had to use substandard PPE because it was better than nothing 

These brief but acutely significant moments can leave long-lasting scars caused by moral injury or distress—when you are prevented from giving the care you know you must.

Moral injury is well established as a reality among military professionals during war, and it’s increasingly being identified as the cause of high trends in stress, burnout and compassion fatigue across nursing. Many think moral injury is a key contributing factor to The Great Retirement that’s creating historic staffing shortages.

While the past cannot be undone, future moral injury can most certainly be prevented from creating lasting damage. That’s the message Michael Rempel, DNP, RN, CNOR, is sharing today during his session on Moral Injury: Understanding Signs and Triggers in Healthcare.

As a perioperative education specialist at University Hospital in Newark, NJ, Rempel has researched the moral injuries perioperative nurses have experienced through the COVID-19 pandemic.

“Nurses have an ethical obligation to do no harm and do what is right. We have our ethical principles like beneficence, justice, nonmaleficence, and fidelity that guide us in our decision-making process,” Rempel says.

He’s challenging every nurse in any role to apply these ethical principles to take an active role in protecting the profession from moral injuries, starting now. Here’s what you can do:

If you are a leader …

“Protect your team from moral injury by seeking ways to prevent work-related traumatic experiences so you can support staff to function at their full potential,” Rempel suggests.

He says leaders should also provide accessible outlets and avenues for their team members to express their feelings and seek mental and emotional assistance. “This can be especially helpful when organizations have programs that offer primary and secondary levels of support to promote staff mental, physical, and emotional well-being.”

Leaders also have a responsibility to protect themselves by taking time for self-reflection when traumatic events cause them to harbor guilty feelings, Rempel cautions. “If we do not address the inner self and make amends with our own feelings, these feelings can eat away at us and can lead to self-harm.”

If you are working on the frontline …

Practice resiliency for yourself and your peers and loved ones by allowing yourself and your colleagues time and space to speak up, voice concerns, and listen to create a strong support system, Rempel suggests. “Traumatic situations will continue to happen in our practice, it is simply the nature of what we do. However, by offering support and counseling for our peers and our loved ones, we can mitigate these deepened moral scars from happening.”

He also encourages nurses to practice with a sense of purpose by promoting a positive state of confidence and optimism.

For every nurse in any role …

While nurses prove time and time again that they are resilient and can tackle any challenge, Rempel says nurses also must recognize that the mental injuries endured through the pandemic and in other aspects of perioperative care are real. “We have to be there for our brothers and sisters in their time of need as they are for their patients every given day.”

Make time to hear more from Rempel today at 9:30 AM today so you can protect yourself and your staff from the triggers of moral injury.

Looking for ways to keep moral injury from harming your team? Read about Rempel’s work on Understanding and Addressing Moral Injury in Health Care in the February 2022 issue of AORN Journal.