Dean to health workers: ‘Our voices are more powerful than we think’

Wendy Dean, an expert on burnout, stress and moral injury in healthcare, was the guest speaker at the AFT Nurses and Health Professionals Breakfast July 23. Dean, the author of If I Betray These Words: Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First, shared actionable strategies to tackle moral injury, followed by a lively question-and-answer session.

Dean made a distinction between burnout and moral injury. Burnout manifests as exhaustion, cynicism and reduced productivity due to a flawed healthcare system. Moral injury, on the other hand, "is the sense of betrayal by those in legitimate authority in high-stakes situations that causes you to transgress your deeply held moral beliefs and expectations and healthcare. Those are the promises that we made to our patients to put them first," said Dean. The feeling is "not a mental health problem. It is an appropriate response to a toxic environment."

Dean offered several solutions to address moral injury. She called for the establishment of morally centered healthcare organizations that are just, trustworthy and courageous. She also pointed out that unions can advocate for change by bargaining morality; she suggested that they call for their facilities to conduct retention and exit interviews to measure moral injury, invest in physical and psychological safety, and empower discussions of moral and ethical dilemmas in healthcare. Finally, Dean also pointed out the essential role healthcare workers can play in educating the public and legislators about frontline challenges.

"Our voices are more powerful than we think, especially when it comes to educating legislators," said Dean. "The more we can talk about our day to day and help them understand, the better off we will be."

She stressed the importance of having a unified voice from those in healthcare; otherwise, meaningful solutions to moral injury will remain out of reach. "Stand up," Dean said, "because whatever we are not changing, we are choosing."

[Adrienne Coles, photos by Russ Curtis]