Moral injury. A new type of burnout?

Post-pandemic there have been huge changes in the workplace. This has resulted in a large number of resignations with burnout being thought of as one of the contributory factors. The classic signs of burnout - mental exhaustion, disengagement, negativity, cynicism and reduced productivity - are well established but now a new study from the University of Sheffield, Affinity Health and Softer highlights that moral injury and stress in the workplace can contribute to a new type of burnout.

The new study, which looked at the experiences of workers in a number of different industries including law, healthcare and HR, considers that moral injury can lead to a type of burnout that is more intense, more challenging to overcome and even lead to increasing the number of resignations.

Moral injury originates from research with the military and refers to the violation of deeply held beliefs. This might be as a witness of an event or as being a participant who has to obey orders in circumstances that were felt to be morally wrong, for example having to shell a school or hospital where civilians would be injured. There has also been work with health care workers and education providers. This cited external pressures and circumstances such as the pandemic or financial interventions as being morally injurious, leaving them unable to provide the service they were employed to give and powerless to intervene.

In other businesses moral injury can be linked to working in toxic environments where an employees values and beliefs are challenged.  This could be around bullying, sexism, racism, homophobia or another moral issue and may be directly experienced, witnessed or learned about such as a colleague’s transgression or betrayal, an unfair redundancy or disciplinary procedure, a failure to act on a whistleblowing complaint, or unfair use of managerial power. 

The study found that although people’s experience of moral stress was different in source, severity and length, many of the respondents felt that the impact on them was so great they had no option but to resign from their positions. This would appear to show that as well as the original problem, there was a lack of support from managers and colleagues that exacerbated the situation and led to feelings of disengagement and, in some cases, of being in a type of abusive relationship.

Many of the warning signs of moral injury are similar to the ones experienced with classic burnout but additionally there may be a sense of shame, embarrassment and hopelessness. The loss of deeply held values and beliefs may also result in feelings such as guilt, anger, grief, anxiety and disgust as well as disillusionment with figures of authority and organisations, social withdrawal and a loss of trust.

Moral injury is caused and experienced differently to burnout but the feelings experienced by someone in a morally injurious situation can contribute to the development of burnout. As moral injury impacts on an individuals trust and self-respect, the strategies and tools needed to mitigate it are different to those needed for burnout and organisations need to be careful not to conflate the two.