"Running towards the bullets”: Moral injury in Critical Care Nursing in the Covid-19 Pandemic

Particular strain has been placed on intensive care units (ICUs) where the very sickest patients were sedated, intubated and often ventilated as doctors and nurses fought to wrestle each individual from the grip of a deadly virus with a high mortality rate, no known cure and no known reliable course of treatment (Harris et al, 2021). This paper explores 110 interviews with 54 critical care nurses across a 12-month period during the pandemic. We do so through the concept of moral injury, described by Williamson et al (2021: 453) as “the strong cognitive and emotional response that can occur following events that violate a person's moral or ethical code.” We consider four common examples of moral injury experienced by the ICU nurses during these times: i) unsafe staffing levels; ii) lack of support from senior staff; iii) inadequate equipment to provide good care; iv) inability to provide patients with a dignified death. We go on to consider the implications of repeated moral injury of ICU nurses ranging from experiences of debilitating anxiety to PTSD as well as widespread feelings of anger and guilt leading to an intention to leave the profession. We end by exploring the ways that organizations have attempted to heal the emotional wounds left by these repeated instances of moral injury but argue that current efforts fall drastically short leaving nurses vulnerable to its lingering effects and the possibility of further damage occurring in the future.

Speaker Biographies

Dr Martyn Griffin is a Senior Lecturer in Organization Studies at Sheffield University Management School. He was previously at the University of Durham and the University of Leeds. His research focuses on democratic organizations, power and freedom in organizations and cultural perspectives and influences on how we understand organizations. He has published in journals such as Academy of Management Learning and Education, Organization Studies, Management Learning and Journal of Management Inquiry.

Dr Peter Hamilton is Associate Professor in Human Resource Management at Durham University, UK. His main research interests are on discourse and rhetoric within the processes and practices of employment relations and human resource management. Has also conducted research on equality and diversity, and dignity at work. He is currently involved in two research projects related to the Covid-19 pandemic: one examining workers’ experience of being furloughed; second, how critical care nurses navigated their way through the pandemic. Both studies are based on longitudinal qualitative data sets.