COVID-19 health care workers experienced high rates of potential “moral injury” that are comparable to rates experienced by military veterans, according to a new study.

“Moral injuries can happen when health care workers’ values and beliefs conflict with their actions or the ways they witness others acting,” says lead author Jason Nieuwsma, a researcher with the Department of Veterans Affairs and psychiatry and behavioral sciences department at Duke University School of Medicine.

“While ‘burnout’ is often used to describe the effects of ongoing stress in the workplace, moral injury is used to describe the damage done to the conscience or identity of people who might witness, cause, or fail to prevent acts that go against their own moral standards,” Nieuwsma says.

“For example, with health care workers, this might entail them making choices or being part of situations that stray from their genuine commitment to healing.”

The study in the Journal of General Internal Medicine builds on a decade of research into moral injury among veterans by comparing data from VA with findings from the Healthcare Worker Exposure Response and Outcomes (HERO) registry.

Researchers relied on data from a study of 618 post-9/11 combat veterans and a separate survey of 2,099 people working in health care during the COVID-19 pandemic. The health care workers were among those enrolled in the HERO registry—a research registry supported by the Patient-Centered Outcomes Research Institute that includes over 55,000 health care workers and their families. Among those on the registry are nurses, therapists, physicians, emergency responders, and environmental service workers.

Veterans were asked about moral experiences in the context of their military service. The health care workers were asked about their experiences during COVID-19.

The findings show that 46% of veterans and 51% of health care workers indicated being troubled by others’ immoral behavior, whereas 24% of veterans and 18% of health care workers indicated being troubled by violating their own morals and values.

Read the full article about health workers' moral injury by Sarah Avery at Futurity.