Organizational Impact on Healthcare Workers' Moral Injury during COVID-19 A Mixed-Methods Analysis

Katie E. Nelson, Ginger C. Hanson, Danielle Boyce, Cathaleen D. Ley, Deborah Swavely, Michelle Reina, Cynda Hylton Rushton

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: The aimof this studywas to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey ofmid-Atlantic healthcareworkers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/ 328) of commenters had moral injury scores of 36 or higher. Three themes emerged: Organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.

Original languageEnglish (US)
Pages (from-to)57-66
Number of pages10
JournalJournal of Nursing Administration
Issue number1
StatePublished - Jan 1 2022

ASJC Scopus subject areas

  • Leadership and Management


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