Soul wounds

Is it burnout, or is it moral injury?

When we feel helpless around our beliefs at work, we may think we're burnt—but it may be this instead.
Is it burnout, or is it moral injury?
Illustration: Risovanna (Shutterstock)
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Nearly three years later, May 25, 2020 still haunts me. I was working as a psychologist in a Houston hospital, dealing with the initial chaos of the pandemic, when I heard the name George Floyd. I was attempting to treat patient’s mental health and, in many, additional physical trauma—whether from a rubber bullet injury from a protest or the impact of the pandemic.

I quickly learned that he was a 46-year-old Black man, murdered under the knee of a white Minneapolis police officer. The anger and disbelief in the following weeks manifested in violent protests that were impossible to ignore. To many, including myself, I seemed burned out. But it was so much more than that.

I was morally injured. My soul was wounded. Stemming from research on military troops and similar to PTSD, moral injury occurs when “we perpetrate, bear witness to or fail to prevent an act that transgresses our deeply held moral beliefs.” While the threat to one’s mortality often causes PTSD, moral injury is caused by a threat to one’s morality.

How moral injury shows up at work

Moral injury often represents the helplessness people feel when forced to abandon their moral beliefs in high-stakes situations—typically due to a lack of resources or a policy that requires them to ignore aspects of their humanity. For example, an emergency physician treating a gunshot wound in a war zone without the proper tools or access to a hospital bed will likely be concerned about the patients’ outcomes. Or a soldier who is ordered to destroy a school or a place of worship or take the lives of children. When our sense of right and wrong gets violated, we can experience moral injury.

While military service members have rare and intense experiences, moral injury happens in other professions. For example, consider healthcare workers. A nurse or physician during the pandemic may have been unable to deliver the care they took an oath to provide due to severe understaffing, bureaucratic red tape, or systemic issues outside their control.

Alternatively, consider the moral quandary of layoffs and rescinded job offers. Most leaders don’t want to fire employees but have to balance caring for the economic health of the business. Their moral compasses scream at them: “This is wrong. These people deserve to keep their jobs.” Yet it may be the only way to save the company.

Some leaders faced a new moral issue in requesting, or often demanding, employees to return to the office. Many leaders worry about potentially exposing others to a deadly virus or disagree with the argument that connection and collaboration must happen in person, but their company says it’s required.

Many of us experienced moral injury by witnessing tragic global events. How are we supposed to go about everyday life? Our research with Forrester Consulting discovered this issue is common among managers, with 71% saying they’ve been asked to do more than ever to support their employees but nearly half feeling ill-equipped to do so.

It’s not as simple as burnout

We’ve been oversimplifying and misrepresenting the problem by calling it burnout. Burnout is defined by the World Health Organization as a syndrome resulting from chronic workplace stress that hasn’t been successfully managed, characterized by feelings of exhaustion, cynicism, and increased mental distance from one’s job. And according to a recent American Psychological Association survey, burnout is more prevalent than ever, with nearly 3 in 5 employees reporting negative impacts of work-related stress. However, the lack of attention to moral injury and misinterpretation of burnout results in ineffective ways of addressing the problem.

Burnout has become a catch-all, socially-accepted word to describe all work-related stress, and we need updated vocabulary. For example, workers may characterize their feelings as burnout when experiencing grief or depression. Or maybe they’re unhappy at work and find it easier to chalk it up to burnout.

When characterized as burnout, it puts the onus on the person suffering, and the solutions are often individually-focused. Common burnout interventions like wellness apps, yoga, or time off won’t help a leader grappling with layoffs or an employee with an immuno-compromised partner who is being forced to return to the office. You can’t self-care your way out of moral injury, and sometimes individually-focused solutions to systemic problems only add an insult to injury.

Addressing moral injury for employees and teams

Addressing moral injury on an individual level requires significant time to understand our emotional capacity. As an individual, challenge yourself to assess what is coming up when you experience those feelings and leverage the tools at your fingertips—whether that’s getting help from a therapist, taking time off, accessing resources online, or all of the above.

However, it’s essential to acknowledge that moral injury is much more of a leadership issue than an individual issue. It’s the responsibility of leadership to make sure the individuals who work for them have access to the resources and support they need.

For instance, layoffs are a decision that HR teams didn’t make but are responsible for implementing—undoubtedly the most challenging part. HR leaders are forced to lay off friends, people they know are experiencing hardship at home, or people overcome with emotion and shock. It’s critical that company leaders not just acknowledge the difficulty of that position but set those individuals up with the support they need, or they’ll be at risk of suffering moral injury.

And it’s not just the HR leaders who need this support, but the administrative staff answering phone calls, emails, and various questions about severance, unemployment, and more. There are the recruiters who hired the laid-off workers; there are the hiring managers fielding the next rounds of candidates. So for the leaders who make these difficult decisions, it’s critical to consider the people who aren’t in the room when the decision is made but are tasked with delivering the bad news.

How leaders can help

Leaders must also be aware of their verbal and non-verbal messaging. For instance, if you offer PTO, but leaders say (or show) everyone is so busy that there is no time for rest, employees won’t feel comfortable taking time off. Or if the implicit message is that you only discuss work-related issues at work, employees won’t feel comfortable expressing concerns.

Leaders can incorporate space and time for employees to evaluate their capacity. For instance, one leader talked about how every Monday, during an all-hands meeting, they provide fifteen minutes for people to share feelings unrelated to work. Exercises like this allow employees to evaluate their mental health and the potential for moral injury.

Leaders also need to ensure they’re fostering an environment of psychological safety by providing multiple ways for employees to voice their concerns with transparent and action-driven follow-up baked into the process. When concerns are shared, validate feelings of moral injury and listen to understand how someone feels. For example, rather than suggesting a self-proclaimed burned-out employee take a vacation or a day off, ask them what system-level changes they’d like to see and how you can help. And allow employees who suffered a moral injury to actively participate in the restorative process to help rebuild their sense of trust.

It’s okay not to be okay

It’s also worth noting, especially amid layoffs, that it’s okay not to be okay. There will be a whirlwind of emotions for every person involved, and none of these feelings are wrong. Even the employees who avoided layoffs may feel a sense of survivor’s guilt. Everyone needs to build up their distress tolerance, which is the idea that things may not be great, but we’ll be okay. Negative emotions are part of the human experience.

Sometimes the solution can’t be realistically implemented in your organization. Working in a hospital environment amid the pandemic and societal unrest forced me to make difficult decisions that violated my moral beliefs. I worked through my moral injury with therapy and a career shift and decided to join a technology company where the day-to-day work wasn’t as intense on an individual level.

From a company leadership perspective, we must stop thinking about burnout as an individual problem and create a safe space where employees can share their feelings and explore the possibility of moral injury. Companies should build programming that validates feelings, recognizes the potential of moral injury, and understands that the issue is frequently systemic and reflects a structural failure to support employees’ capacity.

Dr. Jessica Jackson is a licensed psychologist and clinical strategy manager for Mental Health Equity at Modern Health.