Moral Resilience and Moral Injury of Nurse Leaders during Crisis Situations: A Qualitative Descriptive Analysis

Abstract: Nurse leaders, though heterogeneous, are bound together by a common Code of Ethics. Nurse leaders apply their Code of Ethics to patient scenarios and to their interactions with nursing colleagues who rely on their leaders as advocates and exemplars of ethical nursing practice. The COVID-19 pandemic subjected nurse leaders to extraordinary stressors with the potential for emotional, physical, and moral injury. Our team conducted a qualitative study exploring the experiences and scenarios that exposed nurse leaders to moral injury and strategies that nurse leaders employ to bolster their integrity as care providers and moral human beings. We used a template organization style to organize qualitative data with a deductive analytic process to code data and build themes.

Of 1,063 leaders who completed an online survey about moral injury and moral resilience during the pandemic, 183 leaders provided open-ended responses pertinent to the study aims. Five themes emerged: 1) Absent nursing voice; 2) An inability to say no to unfair labor practices; 3) Abandonment and missing leadership 4) Leadership capacity; and 5) Finances over patients. Overall nurse leaders felt abandoned, exploited, and betrayed by their superiors and their organizations. Moreover, nurse leaders were further injured by their inability to protect vulnerable patients and staff from harm. These themes highlight an absence of trust within healthcare organizations exacerbated by the pandemic. We offer suggestions for repairing organizational trust which may bolster the moral resilience of nurse leaders and translate into patient and staff safety, autonomy, and equity.

Cynda Rushton – School of Nursing – Johns Hopkins University; Ginger Hanson – School of Nursing – Johns Hopkins University; Katie Nelson – School of Public Health – Johns Hopkins University; Sandy Swoboda – School of Nursing – Johns Hopkins University