"Running towards the bullets”: Moral injury in Critical Care Nursing in the Covid-19 Pandemic

The Covid-19 pandemic placed unprecedented strain on healthcare professionals around the globe, particularly those working on intensive care units (ICUs). It was widely reported that instances of moral injury – a betrayal of what is ethically right by those in positions of power – was widespread leading to severe emotional and psychological consequences. Despite this, however, a lack of deeper qualitative research exists on this topic. In this paper we ask: What are the experiences and implications of moral injury in critical care nursing during the pandemic? Drawing on 103 interviews with 54 critical care nurses, we offer insights into the experience of moral injury focussing on: i) unsafe staffing levels; ii) inadequate equipment to provide good care; iii) inability to provide patients with a dignified death. We provide accounts of the implications of moral injury ranging from debilitating anxiety to PTSD and sectioning, as well as widespread feelings of anger and guilt leading to an intention to leave the profession. Through the voices and experiences of critical care nurses our study proposes a deepened understanding of moral injury as cumulative, intersubjective and systemic, in such a way that invites a more collectivist approach to moral repair