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Moral distress--widespread among healthcare professionals--impacts well-being, retention, and patient care.

Morally injurious events can lead to guilt, shame, and helplessness in even the most resilient clinicians.

Moral injury is linked to burnout, depression, PTSD, and suicidal ideation in healthcare workers.

Organizational level change, Acceptance and Commitment Therapy and Trauma informed Guilt Reduction offer hope.

Sixteen years ago, I started as a psychologist at a large VA hospital. Since then, I’ve listened to hundreds of healthcare workers—nurses, physicians, social workers—describe the moments that keep them up at night. During COVID-19, I served as a consultant for the a research team in Canada to develop and test an intervention for moral distress among healthcare workers.

During the study, one nurse told our research team that, when facing moral distress, she was taught to “shove it down, suck it up, be more resilient, keep going. We are not robots. We are human beings and we have feelings and experiences.” (Smith-MacDonald et al., 2022). That line has stuck with me. It captures the reality that healthcare professionals are asked to do the impossible, sometimes at the expense of their own sense of right and wrong.

Potentially Morally Injurious Events (PMIEs)

A Potentially Morally Injurious Event (PMIE) is any situation that violates a deeply held personal value and carries high stakes (Litz et al., 2009). In healthcare, PMIEs can occur at multiple levels:

Individual Level: These events might involve being forced to provide care that feels futile, making decisions where all options lead to negative outcomes, or feeling powerless to act on one’s clinical judgment (Beadle et al., 2024).

Societal/Relational Level: PMIEs can be triggered by communication breakdowns with patients and........

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