Scan Your Shift for Moral Injury
Moral injury is one of those sneaky little irritants that can wear on your mental health, particularly if you work as a first responder or in healthcare. In short, moral injury is when we need to do something in the course of our work that goes against our inherent morals and values.
The most classic example is combat. Something that is appropriate and important in a combat situation may not be how you would conduct yourself on a normal Thursday. This disconnect leaves us feeling a bit . . . wonky. To use a precise mental health term.
Which is what makes moral injury dangerous. It’s the tiny rock in your shoe that you don’t really notice, but eventually you end up with a painful blister. And the hard part is that moral injury is a part of the job if you are working as a firefighter, law enforcement officer, medic, healthcare professional, or a wide variety of other helping roles.
The Key To Protecting Yourself
When it comes to protecting your mental health against moral injury, the most important thing is to recognize it. Simply noticing that the reason you feel a little funky after a shift is due to a morally complex situation can quickly diffuse some of the negative impact.
Once we recognize it, we can assess what we need. Sometimes the recognition is enough. We see it, we take a moment to process it, and we go on our way. Other times, we need a bit more support. Maybe we need to talk to a colleague that was in the same scenario to connect about how frustrating it was. Or maybe we just need to get out for a run, or spend some time playing with the dog. Something simple to rebalance us.
So How Do We Recognize It?
Here are a few areas where MI is common within first responder or healthcare shifts. This list isn’t exhaustive, but it will get your mind moving.
Providing services (or not providing services): Sometimes we experience moral injury because of who we are serving. For example, if your job is to save the life of a drunk driver who just plowed into a family and killed a child. You do your job and you save their life, but it doesn’t feel great. Or perhaps it is those moments when you can’t provide services. Maybe you are law enforcement and a DV victim doesn’t want to press charges. I could list examples for hours, but take a moment and think of your role, what comes to mind?
Use of violence: The most intense example of this would be an officer involved shooting. Which is absolutely the necessary step in some circumstances, but it still doesn’t feel great. This could also be something like wrestling down a patient and then strapping them to the gurney, knowing full well that they are fighting you out of fear. Again, it is what has to happen, but it leaves us feeling a bit off.
Difficult decisions: These jobs are far from straightforward. Your day may include a multitude of decisions that don’t have a clear answer. Patient care, arrests, management decisions. Ugh. It’s important to assess the impact these decisions can have on you.
Organizational BS: Every organization has it. And sometimes the rules handed down from the top don’t align with the decisions on the front line. This can include everything from working short-staffed to discharging an unwell patient because their insurance won’t pay.
Again, these are some of the common sources of moral injury within first response and healthcare, but the list could go on and on. The most important thing is to take a moment at the end of each shift and scan through your interactions. Did anything leave you feeling a bit icky? If so, moral injury might be the culprit.
So What Do We Do About It?
Here is how I want you to think about it. Your mental health is like a soup - the key is balanced ingredients. Moral injury is going to be a part of the job, but we want to notice when it is piling up. Just like too much spice or vinegar in your soup, it can throw everything off. We want to balance the MI we face during the shift with activities that re-energize and calm us. If you aren’t sure how to do that, we have plenty of resources to help.
S.
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If you are a first responder, healthcare professional, or deathcare professional (or you love someone who is) we have a plethora of mental health resources and trainings for you. Here are some more to explore.