A recent study published in the American Journal of Critical Care (AJCC) has found that moral injury is still common among critical care nurses, with those newer to the profession being most at risk. The research, titled "Moral Injury Among Intensive Care Unit Nurses: Roles of Moral Resilience and a Healthy Work Environment," explored how often moral injury occurs and examined factors that might protect against it.
The study surveyed 304 critical care nurses online during the later stages of the COVID-19 pandemic. More than half of respondents (55.6%) met clinical criteria for moderate to severe symptoms of moral injury. The results showed that both moral resilience and a healthy work environment were linked to lower levels of moral injury.
Sarah Sumner, PhD, RN, CCRN, OCN, CHPN, who works as a clinical nurse in the ICU at Providence Saint Joseph Medical Center in Burbank, California, led the study. She said: "Healthy work environments - characterized by transparency, recognition, collaboration and psychological safety - provide the scaffolding for nurses to reflect, speak up and sustain their moral compass."
The survey included nurses from 22 hospitals within Providence Health System across urban and rural areas in the western United States. All participants had at least one year of experience working in an adult intensive care unit.
The findings indicated that only nurses with more than 21 years of experience or those who interacted with chaplains almost daily had average scores below the threshold for clinically significant symptoms of moral injury. Younger and less experienced nurses—both in general nursing and specifically in ICU settings—had higher rates of these symptoms compared to their more seasoned colleagues.
Additionally, over one-third (34.4%) reported never having received ethics education, while nearly two-thirds (69.3%) had never taken part in an ethics consultation. While prior ethics education or consultation did not lead to lower moral injury scores directly, those with such experiences showed greater moral resilience. This suggests that opportunities for ethical discussion may help nurses handle difficult situations better.
A new aspect highlighted by this study is that frequent contact with hospital chaplains was tied to lower scores on measures of moral injury. According to the researchers, chaplains may provide support beyond spiritual needs by helping staff cope during morally distressing times.
