Organizational Impact on Healthcare Workers' Moral Injury During COVID-19: A Mixed-Methods Analysis

J Nurs Adm. 2022 Jan 1;52(1):57-66. doi: 10.1097/NNA.0000000000001103.


Objective: 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.

MeSH terms

  • Adult
  • Burnout, Professional*
  • COVID-19*
  • Health Personnel / organization & administration*
  • Health Personnel / psychology*
  • Humans
  • Mental Health*
  • Morals*
  • Workplace* / organization & administration
  • Workplace* / psychology