The idea of moral injury in healthcare attracted much public attention during the recent COVID-19 pandemic. Duty to care, particularly in circumstances such as the pandemic, raised the awareness of the phenomenon of moral injury in nursing among practising nurse and nurse leaders and managers. The concept of moral injury was introduced originally from a military context, mostly identified, and observed among veterans. Some evidence from the early literature on the concept suggests that moral injury, as an experience, was conceptually confused with other existing experiences conceptualised as burnout and/or moral distress. This may have led to an under recognition and lack of awareness of moral injury as a discreet experience.

Although the experiences conceptualised as moral injury, moral distress, and burnout have some commonalities in symptoms and outcomes, it is argued that as individual experiences these three differ in humanly and ethically important ways. It is further argued that these different experiences need to be recognised and addressed appropriately. Failing to do so may add to the rising number of nursing professionals leaving their profession.

This reality raises significant challenges for both nurse leaders and managers and for healthcare organisations. It is incumbent on leaders and managers in healthcare organisations to be sensitive to the development of moral distress, moral injury, and burnout in staff members and colleagues, and to work to find ways to support the well-being of nurses and other healthcare practitioners, thus enabling them to flourish as persons and as healthcare professionals.

In this chapter we will consider the evolving use of the concept of moral injury in the healthcare literature, including attempts to differentiate it from concepts of moral distress and burnout. We will also consider some of the factors identified as contributing to the experience of moral injury in individual practitioners. The chapter will conclude by suggesting some measures that can be taken to help ameliorate and or mitigate the experience of moral injury.