Healthcare Workers’ Perspectives on Working during the Covid-19 Pandemic: Moral Injury, Mental Health Difficulties, and Organisational Influence

Background: Healthcare workers’ (HCWs) exposure to potentially morally injurious events (PMIEs) cannot be overlooked in the Covid-19 pandemic. Research suggests witnessing or enacting PMIEs can lead to psychological growth or development of moral injury (MI); the swing of the pendulum being dependant on the quality of support an individual receives before, during, and after the PMIE (Greenberg et al., 2020). MI has been linked to several detrimental mental health outcomes (Gupta & Sahoo, 2020). Aims: This study aimed to explore how HCWs who experienced PMIEs made sense of their experiences, and whether this led to the experience of MI or psychological growth over the long term. A secondary aim was to explore whether experience of MI impacted on HCWs family and social life, as well as their emotional and psychological wellbeing over the long term. A final aim was to explore what organisational factors impacted on experiences of MI during the Covid-19 pandemic. Method: A total of 15 HCWs from a range of clinical occupational backgrounds were recruited using purposive and snowballing sampling techniques. Participants worked in UK hospital settings during the Covid-19 pandemic. Individual semi-structured interviews were conducted via video-call. Data were transcribed and analysed using a qualitative reflexive thematic analysis (TA) method (Braun & Clarke, 2019). Findings: The analysis produced six themes and 13 sub-themes. The overall themes were “perspectives on morally injurious events”, “surviving pandemic pressures and morally injurious events”, “the betrayal of the NHS”, “betrayal by government”, “managing moral injury”, and “navigating post-pandemic life”. Conclusions: Several factors contributed to the experience of MI and psychological growth. A key factor was whether moral repair had been attempted by the employee’s institution. This influenced employees’ meaning making and decision to leave their role.