When Healers Are Harmed: How Systems of Power Create Moral Injury for Clinicians
“It’s not burnout. It’s moral injury - the wound left behind when you are asked to act against your values.” - Mary Coughlin
When Healers Are Harmed: How Systems of Power Create Moral Injury for Clinicians
How Systems of Power Cause Moral Injury
A Social Worker During COVID-19
How Trauma-Informed Developmental Care (TIDC) Addresses Moral Injury
Healthcare is built on systems of power, and while those systems are meant to maintain order and safety, they often have unintended consequences. One of the most profound consequences is moral injury — the emotional and psychological harm that occurs when clinicians are forced to act in ways that go against their core values.
Moral injury isn't burnout. It’s not about being tired — it’s about being torn. Torn between what you know is right and what you’re told to do. Torn between your duty to protect and your duty to enforce.
This post shines a light on how power-driven policies, hierarchies, and rules harm clinicians, not just patients. It highlights how nurses, doctors, and healthcare providers experience moral injury when they are asked to enforce visitation bans, restrict parental access, or follow protocols they know are harmful. And it explores how Trauma-Informed Developmental Care (TIDC) can disrupt this cycle by creating systems of care that prioritize humanity over hierarchy.
What is Moral Injury?
Moral injury happens when someone is forced to act against their deeply held moral beliefs. In healthcare, moral injury happens when nurses, clinicians, and healthcare providers are told to prioritize rules over relationships, and it’s more common than you might think.
How is it Different from Burnout?
Burnout is about exhaustion. Moral injury is about betrayal.
Burnout comes from doing too much. Moral injury comes from doing what feels wrong.
Burnout can be solved with rest. Moral injury requires repair.
Moral injury is often described as a “wound to the soul.” It happens when the actions you’re forced to take are at odds with your deepest values as a caregiver, a human, and a healer.
How Systems of Power Cause Moral Injury
Healthcare systems run on protocols, policies, and hierarchies. These systems create control, but that control often comes at a cost. When clinicians are told, “You have to enforce this policy,” even when they know it will harm a patient or family, moral injury occurs.
Examples of Power-Driven Harm:
Visitation Bans: Nurses were forced to enforce COVID-era visitation bans, telling parents they couldn’t see their babies in the NICU. They watched fathers cry through the glass and mothers sob on the phone — and had to say, “It’s the policy, I’m sorry.”
One-Parent-Only Policies: In NICUs with one-parent-only visitation policies, nurses had to tell fathers they couldn’t hold their baby, even as mothers sat inside. “There’s nothing I can do,” they said. But there was something they could feel.
Hospital Discharge Deadlines: Discharge policies dictated by insurance or administrative timelines forced clinicians to send parents home before they felt ready, knowing that the parent didn’t have the confidence or knowledge to care for their baby alone.
Medical Hierarchies: Nurses who flagged early signs of distress in a baby were dismissed by senior physicians. They had to stand by as their instincts were ignored, knowing it might cost the baby precious time.
These moments may seem small in isolation. But for clinicians, they are anything but small. Moral injury accumulates. Each moment of betrayal is a wound that never quite heals.
Stories of Impact
These aren’t abstract concepts — they’re lived experiences. Let’s make this real.
A Nurse in the NICU
A nurse stands outside a NICU window, face pressed to the glass. She’s watching a father press his hand to the other side, his eyes filling with tears. She wants to let him in. Every fiber of her being tells her, “This is wrong.” But she can’t. The policy says “only one parent allowed.” She’s the one tasked with enforcing it. She feels it in her heart. She feels it in her soul. This is moral injury.
A Social Worker During COVID-19
A social worker facilitates a “goodbye call” for a dying patient and their family. The only connection is through a phone screen. The family weeps as they say goodbye to their loved one from outside the hospital. The social worker stays on the call, watching, absorbing the pain. “This isn’t what goodbye is supposed to look like,” she thinks. But she is the one who had to enforce it. This moment will stay with her. This is moral injury.
A Nurse Silenced in a Huddle
A nurse tells the team, “Something’s not right with this baby. I’ve seen it before.” The attending physician says, “The numbers look fine.” No one follows up. Hours later, the baby has an acute decompensation. The nurse knew. She saw it before it happened. But she wasn’t listened to. Her voice was dismissed, and now she questions whether she could have done more. This is moral injury.
How Trauma-Informed Developmental Care (TIDC) Addresses Moral Injury
Clinicians need care too. They need spaces where their values, voices, and humanity are honored. Trauma-Informed Developmental Care (TIDC) addresses moral injury by shifting from systems of control to systems of care.
How TIDC Helps:
Relational Authority Over Positional Power: TIDC prioritizes the lived experience and wisdom of nurses, parents, and clinicians, not just those with “positional power.”
Voice & Choice for Clinicians: Just as parents deserve voice and choice, so do nurses, clinicians, and social workers. They deserve to be heard when they know something is wrong.
Healing Environments for Clinicians: TIDC promotes spaces where clinicians can speak up, ask for help, and be supported in their moral and ethical obligations.
Healers deserve healing too.
Public Health Implications
When moral injury goes unaddressed, it drives clinicians away from healthcare. It fuels burnout, disillusionment, and a mass exodus from the field. But when clinicians are given space to heal — through relationships, reflection, and shared humanity — they stay.
Questions to consider:
How many nurses left the field because they were tired of “following policy” over following care?
How many clinicians are still carrying the weight of moral injury from COVID-19?
How can we create systems that heal, instead of harm?
Call to Action (CTA)
In our next and final post of the series, we’ll shift from harm to hope. What does it look like to reclaim care from control? We’ll share a roadmap for disrupting systems of power and building systems of care. Stay tuned for Part 6.
Reflection Prompt
Have you ever experienced moral injury as a clinician? Have you ever been asked to do something that went against your values as a nurse, doctor, or healthcare provider? Drop your story in the comments — your voice matters.
Take care and care well,
Mary
