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Managers need training on signs of moral injury in nurses, report warns

Working in the pandemic has meant making ‘unthinkable decisions’ and staff need more support

Working during the pandemic has meant making ‘unthinkable decisions’, RCN says, and staff need more support

Nurse managers should be trained to recognise signs of ‘moral injury’ in staff, a report on the experiences of nurses in Northern Ireland during the pandemic recommends.

The report, published by RCN Northern Ireland, analyses personal accounts from more than 670 nurses, submitted between April 2020 and March 2021.

RCN report provides a picture of nurses’ experiences

It details the physical and emotional toll of dealing with redeployment and multiple patient deaths, but also how nurses pulled together and supported each other.

Recommendations based on nurses’ feedback include the need to train nurse managers

Working during the pandemic has meant making ‘unthinkable decisions’, RCN says, and staff need more support

Illustration of a nurse comforting a colleague
Picture: Annette Taylor-Anderson

Nurse managers should be trained to recognise signs of ‘moral injury’ in staff, a report on the experiences of nurses in Northern Ireland during the pandemic recommends.

The report, published by RCN Northern Ireland, analyses personal accounts from more than 670 nurses, submitted between April 2020 and March 2021.

RCN report provides a picture of nurses’ experiences

It details the physical and emotional toll of dealing with redeployment and multiple patient deaths, but also how nurses pulled together and supported each other.

Recommendations based on nurses’ feedback include the need to train nurse managers to recognise early signs of ‘emotional or moral injury’ and take appropriate action to support staff.

Moral injury is a concept that originated in war zones, used to describe the impact on individuals of making decisions or witnessing situations that go against their beliefs or moral code.

It is an increasingly recognised phenomenon in healthcare and has become more prominent during the pandemic, when pressures on services and COVID-19 restrictions have made it harder for nurses to deliver the care they wish to provide.

Tired and stressed but proud of the team: what nurses said about their experiences of the pandemic

  • ‘I really do not know how much longer I can keep this up. My heart breaks when I see how tired and stressed the nurses are’
  • ‘I am immensely proud of my team who have relearnt old skills, developed new skills and given 100%’
  • ‘On the outside it looks like I am living my best life, happy and bubbly – off ward and inside I’m starting to crumble’
  • ‘The ward I have been placed on has been very supportive… All staff work together to help each other.’

Source: SenseMaker: the lived experience of nursing in Northern Ireland during a pandemic 2020/2021

Nurses need greater support after being forced to make ‘unthinkable’ decisions

Rita Devlin

Acting director of RCN Northern Ireland Rita Devlin said nurses had been forced to make decisions ‘that only a few months ago would have been unthinkable’ and it was important to learn from their experiences.

‘Throughout this report we have made recommendations of what needs to happen next to support nursing staff through this difficult time and those who are still suffering from the effects of what they witnessed,’ she said.

Other recommendations include providing ‘trauma debriefing’ to nursing students and all staff who were redeployed, as well as quiet spaces – sometimes known as ‘wobble rooms’ – where nurses can spend some private time after a difficult event.

The report also highlights the importance of safe staffing levels and the need to improve communication to ensure front-line nurses are fully involved in changes to working practices and roles.

Northern Ireland's Department of Health said it recognised ‘the enormous strain COVID-19 has placed on nurses’ and had introduced a range of measures to stabilise and strengthen the nursing workforce and support staff well-being.


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