Rehabilitation Professionals are suffering from moral injury leading to burnout

Moral Injury and Rehabilitation Professionals

Have you heard the term moral injury? It is becoming an increasingly important and widely discussed topic in healthcare medical circles. It is not a new concept, however, it is one that is gaining more attention and recognition in the rehabilitation field.  This includes occupational therapists, physical therapists, and speech therapists.

In a nutshell, moral injury is when someone experiences a sense of moral distress or betrayal due to a situation, decision, or event that conflicts with their morals or ethical values. This can have a lasting impact on their well-being.  It can significantly affect rehabilitation professionals, most of whom got into their fields to help people.

Healthcare professionals who experience moral injury can suffer from psychological distress, burnout, and decreased job satisfaction. It is important to recognize and address this issue in order to ensure that healthcare workers are supported and that their mental health and well-being are prioritized.

The first time I learned my feelings had a name I felt a HUGE sense of relief. But figuring out what to do about it, when ethical issues in health care systems are so prevalent is very difficult.

What is moral injury?

Moral injury is the psychological, emotional, and spiritual distress caused by acts or omissions that conflict with moral and ethical beliefs. 

Causes of Moral Injury in Rehabilitation

Moral injury is often experienced by rehabilitation professionals who are put into situations that violate their moral or ethical code. The psychological distress associated with moral injury can manifest itself in various ways, including depression, anxiety, guilt, and anger.

Additionally, moral injury can be caused by systemic issues within the healthcare system such as a lack of resources or inadequate support.

One moral injury example within the rehab profession is the increase in productivity requirements can lead to questionable practices leading to moral injury. The continued decrease in insurance reimbursement makes healthcare less and less profitable leading to decisions such as running groups, concurrent patients, and point-of-care documentation.

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Symptoms of moral injury

Symptoms of moral injury can vary from person to person but may include feelings of guilt, shame, anger, anxiety, and depression. Other symptoms may include difficulty sleeping and difficulty concentrating.

I personally felt disillusioned with healthcare. I also questioned if I had made the right decision to be in healthcare in the first place. I also started researching all the ways to leave the field of occupational therapy. Overall I felt very depressed because I had gotten into therapy to help families and children and felt torn.

Preventing and addressing moral injury

It is important to recognize and address moral injury in order to ensure that healthcare workers are supported and create a culture of unacceptance of unethical situations.

Healthcare organizations can address moral injury by putting patient care above profit.  

  • By not requiring unachievable productivity requirements that require subpar patient care.
  • By reimbursing therapists for their knowledge and experiences with raises. 
  • By billing ethically and using assistants as outlined in your state practice act.  

They should also provide adequate resources and support to their staff, as well as implement policies that promote ethical practice. 

Additionally, healthcare organizations should provide training on moral issues and create a safe space for healthcare workers to discuss their moral and ethical dilemmas.  They should also provide a way to anonymously report ethical issues.

Working toward a society where healthcare is reimbursed at fair rates is paramount. The differential in pay between healthcare and education workers and those in the tech or pharmaceutical fields is eye-opening. Insurance reimbursement directly affects rehabilitation workers' rates. Why is this? Because the reimbursement is directly tied to TIME. You can't work faster and make more money when they work with timed codes.

While people are complaining about inflation and cost of living raises not keeping up with inflation, rehabilitation professionals are dealing with PAY CUTS.

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Impact on healthcare workers

The impact of moral injury on healthcare workers can be profound and long-lasting. It can lead to feelings of guilt, shame, anger, anxiety, and depression. It can also cause difficulty sleeping, nightmares, flashbacks of traumatic events, avoidance of certain situations or activities that remind them of the trauma, and difficulty concentrating.

In addition to these emotional impacts, moral injury can also lead to physical health problems such as chronic fatigue, headaches, and digestive issues.

It can also lead to burnout and decreased job satisfaction. Healthcare workers may also experience difficulty forming relationships with colleagues and patients as a result of their moral injury.

Recognizing and addressing moral injury is important in order to ensure the emotional and physical well-being of healthcare workers. It is important to provide support and resources to those who are experiencing moral injuries, such as counseling, peer support groups, and education about the issue. It is also important to create a safe and supportive environment within the workplace so that healthcare workers can feel comfortable discussing their experiences with moral injury.

Coping strategies for moral injury are also important. These can include mindfulness, stress management, and self-care. It is also important to have access to resources such as spiritual advisors or chaplains who can provide support and guidance.

Is moral injury the same as burnout?

No, moral injury is the feeling you have after an incident that conflicts with your morals or ethics.  This moral injury can lead to burnout. 

Consequences of moral injury

The psychological distress can have a lasting impact on healthcare professionals. It can lead to burnout, decreased job satisfaction, and feelings of guilt and shame. 

The rate of healthcare worker depression is staggering. And the rate of rehabilitation professionals attempting to leave the profession is also staggering! We all know about the issues with teachers (low pay, long hours, burnout) and nurses. The same goes for rehabilitation professionals as well. The group Alternative Careers for Healthcare Rehabilitation Professionals on Facebook has a staggering 45,000+ members!

Who is going to care for you if you have a car accident or stroke?  Who is going to help the next generation of children live up to their full potential?

Final Thoughts

Finally, it is important for healthcare workers to be aware of the signs and symptoms of moral injury so that they can seek help when needed. We need to evaluate jobs and decide when it is time to look for new employment.  

New graduates need to be educated on practices that at not ethical and should not be tolerated. 

Even experienced therapists can be roped into situations they do not realize are unethical and should not be tolerated until they are in the situation.  We need to be educated on where to report unethical situations in our state.

Most of all, I believe rehabilitation professionals need to band together and not accept these unethical situations. 

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