How to Identify and Address Moral Injury at Work

Pink rose in a vase. Rose's shade on the wall appears wilted.

Source: Unknown, Canva, author's editing.

Employees across the range of occupations are resigning in unprecedented numbers, often in distress. Attempts to address employee dissatisfaction and burnout with bonuses, mindfulness, and extra time off do not seem to be working well enough; employees continue to quit, sometimes angrily and dramatically, airing a range of grievances on social media.

Don't Just Blame the Burnout

But what if the problem we typically called "burnout" is not just burnout? What if it is something that may appear similar, but has a different cause and, if incorrectly addressed, can make individuals feel increasingly worse? And what if Great Resignation is actually a Great Disillusionment?

Responding to the epidemic of employee anguish and quitting requires correctly identifying its causes and using precise terminology to describe it. And while burnout is the most popular explanation of employee distress, in many cases, the problem might be a less known but more insidious: moral injury. Preliminary data from my ongoing research indicate that, conservatively, the experience of at least 25% of those reporting feeling burned out might be better explained by moral injury.

Consider the story of "Henry." Henry joined a well-known not-for-profit organization to use his accounting talents to serve a social cause he strongly endorsed. But he discovered egregious donation mishandling—and was told to cover it up. Discovering the embezzlement was bad enough, but now Henry faced a dilemma: blow the whistle on individuals involved and risk a massive backlash against the entire cause he believed in, or keep quiet, save the face of the cause, but become a party to the problem. Henry found himself struggling to sleep at night and controlling his emotions during the day, including anger at the organization's management for tarnishing the cause and shame over his own lose-lose situation. In addition, his health issues that were under control returned with a vengeance.

In another example, "Kim" became a human resources professional because she cared about people. At first, working at an up-and-coming marketing agency was a dream come true. Over time though, she noticed that there was much turnover, and in exit surveys, many complained about being "pushed out" or "bullied out" as soon as they passed the age of 35 or so. A recruiter who brought in replacement talent confirmed her suspicion—there was an unwritten rule to only consider the résumés of those in their mid-20s. Kim's supervisor made it clear that if she wanted to keep her job, she would support the company's "energy." Raised to respect her elders, Kim was mortified. What was she going to tell her family when they ask, "How's work?" at the next gathering? Can she even face her family while working for an ageist company?

What Is Moral Injury?

The original understanding of moral injury, similarly to PTSD, comes from research on military troops. Understanding this origin also helps understand the distinction between these syndromes. While PTSD might be caused by the threat to one's mortality, moral injury is caused by a threat to one's morality, such as harming a child, destroying a school, or a place of worship. Jonathan Shay, who coined the term while working with military veterans, also stressed the role of betrayal by the leadership in high-stakes situations in the development of moral injury.

Building on prior research and expanding the concept of moral injury to a range of occupations, I suggest that it is part of the broader classification of workplace stress reactions. Briefly, PTSD predominantly impacts the sense of safety, moral injury predominantly impacts the sense of trust and/or self-respect, and burnout impacts one's sense of engagement and efficacy. While these may co-occur and overlap, causes and effects are sufficiently different and require different interventions.

The key focus of non-military research on moral injury has been on health care workers. Nurses and physicians are significantly distressed by the inability to deliver the care they took an oath to provide due to the pandemic, severe understaffing, bureaucratic red tape, and the underlying profit-before-the-patient organizational cultures. Approximately 1 in 5 health care workers have left their jobs since the pandemic started. However, the high prevalence of moral injury in health care was well-documented prior to March 2020, and attributed to systemic issues that emphasized efficiency and financial metrics at the expense of physician/patient communication, trust, and overall patient care.

Similarly, educators currently experience deadly impacts of the pandemic and struggle with lacking resources to meet student needs. Yet, even before the pandemic the K–12 professionals reported levels of moral injury similar to those of military veterans, with teachers being distressed when forced to implement poorly-researched and potentially harmful curricular and disciplinary practices.

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Moral injury was also found in journalists covering the refugee crisis in Europe and in the general civilian population.

In the most generic form applicable across occupations, workplace moral injury is a trauma response to witnessing or participating in workplace behaviors that contradict one's moral beliefs in high-stakes situations with the potential of physical, psychological, social, or economic harm to others. The focus of high-stakes situations and significant harm allows preserving the gravity of the concept.

Injurious events may fall into three categories:

• 1. Transgressions by others (e.g., managers, coworkers, or clients).
• 2. Transgressions individuals committed themselves.
• 3. Betrayal—feeling that managers, colleagues, or policymakers had betrayed occupational values, employees, or clients/customers/students/patients.

Violation of deeply held values can shake the core of an individual's identity and self-concept. Moral injury may result in a range of feelings, such as guilt, shame, anger, grief, anxiety, and disgust. It also often leads to disillusionment in people, particularly in authority figures, and organizations (hence leaving employment in favor of self-employment). Self-loathing, existential, and spiritual crises are also common. Some individuals may develop physical illness or maladaptive behavior (substance abuse, self-isolation).

The moral injury framework can be applied across a wide range of occupations. In Henry's case, his managers are committing a financial transgression while also betraying the cause and those the organization is meant to serve. To make matters worse, he is expected to commit the same transgressions. In Kim's case, the company systemically practices ageism, and she is pressed to betray her values by supporting the system.

Moral injury is a hard problem to overcome—but overcoming is possible. I will address what individuals and organizations can do in the next post.

Author's note: Individuals or organizations interested in participating in the next phase of my research project on workplace moral injury and disillusionment can sign up here. You may also use this form to submit confidential comments on this post.

This post also appears on Fast Company.