(363) Moral Injury, Burnout, and Intent to Leave: Ideas From the Front Line to Mitigate Moral Injury

Introduction: This study aims to investigate components, prevalence, and relationships of moral injury (MI) to burnout and intent to leave (ITL) among healthcare workers (HCWs) as well as suggestions from varied HCWs about how to prevent MI.

Methods: We constructed a survey of HCWs assessing components of MI, burnout, compromised integrity (CI), ITL, and suggestions for MI mitigation.

Results: Of 1402 healthcare workers, 561 (40%) responded (48% nurses, 20% physicians, 7% APPs, in addition to Social Workers, Medical Assistants, Nursing Assistant and Radiology Technicians). Seventy-one percent were female, and 68% white. Burnout was present in 63% of all respondents and particularly high in the Emergency Department (ED, 73%), the Medical ICU (MICU, 67%) and in nurses (67%). Groups with high proportions of workers of color, such as social work, spiritual care and medical assistants had very high burnout rates (80%). ITL in 2 years was moderate or high in 56% overall, and 74% of Medical ICU workers intended to leave (p = 0.01 from chi-square test, vs other HCWs). Sixty-nine percent of respondents worried about CI at least “somewhat often.” Main drivers of MI were unaddressed inequities (71%), abuse by patients or families (71%), compromised care from lack of support (69%), decreased quality of care (QOC) from lack of resources (67%), fear or experience of violence (65%), decreased QOC from insufficient time (65%), and aggressive, unwarranted care (43%). In ED and MICU, main drivers were risk of violence (88 and 95% respectively) and abuse by patients/families (94 and 95% respectively). Concerns of non-beneficial treatment were frequent in the MICU (88% often, frequent, very frequent). Top options listed to prevent MI were 1) increased resources and staffing, 2) safer work conditions, 3) more time with patients, 4) non-beneficial care policies, and 5) more empathic leaders.

Conclusions: In HCWs, MI and CI were common and nearly universal in certain settings (MICU and ED), and frequent among roles with high proportions of persons of color. MI could be addressed via attention to structural inequities, insufficient time and resources, and abuse/violence in hospital settings.