COMMENTARY

How Doctors and Nurses Can Team Up to Fight Moral Injury in Healthcare

Wendy K. Dean, MD; Simon G. Talbot, MD

Disclosures

November 20, 2019

Four Key Steps to Combating Moral Injury

If we want to find solutions to the drivers of moral injury, we need to cross departments and tear down clinical silos to share our experiences, ideas, and lessons learned. We have to bury latent hostilities, whether they arise from insecurities, poor communication, or rigid organizational structures.

How can we do that?

First, we need to create a regular opportunity for communication. Believing that change will occur by itself, without dedicated effort, assures it will not happen. Instead, set up a regular forum to identify common challenges among healthcare professional groups you work with. Create working groups to address the most pressing or widespread challenges, and jointly present the findings and recommendations to hospital leadership or administrators. Ask administration to provide sufficient resources for a task force to address the issues.

Second, jointly sponsor events that address common challenges. Although doctors and nurses often focus on different concerns during encounters with a patient, there are some aspects of medicine today that frustrate us all. Prior authorizations, unaffordable medications, crushing documentation and compliance requirements, intrusive regulations, and licensing challenges are all issues that matter to all of us. Working together to solve them will be much more successful than working in isolation.

Third, intervene when you encounter toxicity, whether in print or in person. Write letters to editors of publications that print divisive work, and give feedback to the authors. Asking doctors who are badmouthing nurses, or nurses who are declaiming doctors, to reconsider their attitude for the good of their patients is uncomfortable yet critical for improving dysfunctional workplace cultures. Sniping and condescension signal a lack of mutual respect. Teams rely on trust and respect to function optimally, and if that is not the culture of your institution, it is yours to change.

Finally, demand that leadership set a collaborative tone and intervene with bullies. Ask for bystander intervention training. The only people who can't choose to walk away from an environment poisoned by superiority complexes and entrenched tribalism, who are powerless to change it, and who are at its mercy are the patients. For their sakes, let's call out the thinly veiled hostility and self-righteousness when it appears. That way, we can stop the distraction and focus on our shared mission of patient care.

Patient care is a difficult job in the current healthcare environment. Each clinician group has a niche role, without which care is compromised. If we respect those differences as necessary to ensure the best care of our patients, then break down silos and recognize each other as teammates rather than opponents. We can create a healthcare environment where clinicians can do good for their patients and be well themselves.

Wendy K. Dean, MD, is a psychiatrist and vice president of business development and senior medical officer for the Henry M. Jackson Foundation for the Advancement of Military Medicine in Bethesda, Maryland. She is also cofounder of Moralinjury.healthcare, an organization devoted to building advocacy to end moral injury in the healthcare professions.

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