Dr. Andrea Hollingsworth
Hollingsworth Consulting

Angie (not her real name) is an ER nurse. In a recent therapy session, she told me this:

“I went into this profession [nursing] because I have a big heart. I wanted to help hurting people. But I feel like I’m not allowed to truly help. Everything feels “too little, too late.” My job doesn’t let me be the person I want to be. I’m forced to provide half-ass care to people in pain, and I can’t stand myself for it.”

Here is a huge-hearted (and highly skilled) nurse who wants to care well for patients. But larger, systemic factors prevent her from doing so. The result?

“I’m just so weary. I vacillate between frustration and numbness. Most of what I do feels futile and pointless.”

There is a term for Angie’s suffering, and it’s not “burnout.” Rather, it’s “moral injury.”

What is moral injury?

Angie is a healer, but she is powerless to provide high quality health care due to structural factors outside her control. Work has become for Angie a place of deep existential anxiety. She feels like her best efforts to help only result in her betraying her deepest values, her moral calling.

The effect of this inward conflict, day after day, might look like burnout. But moral injury goes beyond feelings of general stress, strain, and overload at work. It’s more akin to a deep spiritual depletion – a sense of being exhausted and harmed in the depths of one’s soul.

What does effective management look like when team members are suffering moral injury?

There are, obviously, no simple answers to this question. However, it must first be said that moral injury can produce serious emotional and psychological effects. Managers should be equipped to point affected team members to professional mental health support/resources.

But when it comes to everyday managerial communication strategies with workers suffering moral injury, what can be said?

Let me offer some starting points.

Compassionate Leadership in Situations of Moral Injury

  • Tip #1: Call it what it is. If you’re a leader in an at-risk field for moral injury (e.g., healthcare, K-12 education, child protection, the military), start asking and talking about moral injury with your team members. Help them understand why their hurt might be different, perhaps deeper, than other types of professional “burnout.” Emotional validation is a crucial part of leadership. It builds understanding and trust. You could try saying something like, “Hey, I get that this goes beyond surface stress for you. The struggles here are impacting you at a pretty deep level. That pain is valid, and I’m here if you want to process it some.” For anyone suffering moral injury, merely being witnessed and validated (especially by a leader) can boost resilience.
  • Tip #2: Model and encourage self-compassion. Self-criticism and shame are painful elements of moral injury. The human mind wants to put blame on someone, and it often turns first to the self. How can you help your team members challenge their inner critic? Begin to practice self-compassion in your own life, and encourage your direct reports to do the same. A helpful three-part mantra to pass along might be:
    “I’m suffering because I want to help more than I can.”“Many helpers are suffering in this way; many want to help more than they’re able.”“May I be kind to myself, for this is not my fault. I’m doing all I can.”
  • Tip #3: Champion mindfulness. Recent research suggests that regular mindfulness practice helps ease the pain of moral injury amongst veteransnurses, and other professionals. Encourage those you lead to just notice their moment-to-moment experience without judging it. If they are stuck in negative thought patterns, tell them to practice simply observing their body sensations, thoughts, and emotions. (A mindfulness app, like Headspace, can be incredibly helpful here!) Nonjudgmental attention to the present helps shift negative mental habits, like fixation on the past (“I never signed up for this!”) or the future (“what if my job makes me a permanent cynic?”)
  • Tip #4: Share stories. One of the most healing antidotes to moral injury is connection with others who truly “get it.” Are your team members are struggling with a conflict between their sense of moral duty, and the constraints and/or demands of their job? If yes, it’s important that they have time and space to commiserate, vent, and share stories with one another. Doing so humanizes the painful experience. It increases felt support, boosts resilience, and helps assure workers that they are not alone in the pain of their inner conflict. So, set aside time during meetings to connect around these issues. Better yet, create meetings/luncheons devoted to discussions of moral injury (and solutions for resilience in the face of it).
  • Tip #5: Help shift the locus of control. The first century Greek philosopher, Epictetus, said: “What, then, is to be done? To make the best of what is in our power, and take the rest as it naturally happens.” If your team is struggling with moral injury, it can be beneficial to lead a discussion around what they can and cannot control. For example, if you lead a team of nurses, they might not be able to control their patient load. But they can control the quality of personal presence they bring to their patients, even if they cannot spend as much time with them as they might like. Accepting the uncontrollable things while making the best of what’s in one’s power can bring a sense of relief, freedom, and personal efficacy.

I hope these tips offer some ways to compassionately address the pain of moral injury in the workplace. Perhaps you have more strategies you’d like to share with me. If so, I would love to hear them. Send me a note and let me know what you’re doing to help heal and empower yourself and those in your charge.

About Andrea

Dr. Andrea Hollingsworth is Founder and CEO of Hollingsworth Consulting, author of the bestselling book The Compassion Advantage (2024), and one of today’s leading global experts on compassionate leadership. Since 2008, she has been studying, speaking, and writing about the science and spirituality of human emotions and relationships. Her articles have been published more than a dozen times in peer-reviewed journals, and she has taught at prestigious institutions like Princeton, Boston University, and Loyola University Chicago. In addition, Dr. Andrea has delivered talks to audiences at some of the top-ranked universities in the world—including Cambridge University in England and Heidelberg University in Germany.

Dr. Andrea spends most of her time inspiring leaders and teams to use The Compassion Advantage to build supercharged organizations through cultures of care— especially in times of challenge and change. Andrea lives with her family in Minnesota where she cheers hard at her son’s soccer games and relishes every opportunity to visit the north shore of Lake Superior.