At times, we can feel drained, if not emptied of energy. It could be the long hours, professional isolation or workforce shortages that contribute to this feeling. However, sometimes the deepest distress comes from something harder to describe: knowing what the right thing to do is, but being unable to do it because of barriers that are beyond your control. This is known as a moral injury.
Within healthcare, Dean et al. described moral injury as “the frustration, anger, and helplessness associated with existential threats to a clinician’s professional identity, as business interests erode their ability to put patients’ needs ahead of corporate and health system obligations”.¹ It is the psychological, emotional and spiritual harm that arises from the violation of one’s core beliefs and values. Moral injury centres on guilt, shame, anger, betrayal and moral disorientation. It has been described as a betrayal of what is right and a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.² Moral injury is increasingly being recognised as a source of distress among health professionals as they come up against structural constraints that obstruct their ability to provide the best care and advocate for their patients and their professions.
Within the rural and remote healthcare context, moral injury can look like:
- A GP having to prescribe sub-optimal treatment as the gold-standard option is unavailable.
- The inability of community health workers to provide continuity of care due to short-term funding cycles.
- An Aboriginal Health Professional carrying community grief during sorry business whilst being expected to function at full capacity at work.
Unfortunately, health care workers often internalise moral injury, ruminating about ”What I should have done,” becoming angry or resentful towards leadership, policy or the health system, or withdrawing or avoiding colleagues, tasks or certain patients. However, repeatedly overriding your moral instincts has psychological consequences, such as increased depression, anxiety, disengagement, reduced job satisfaction and workforce attrition.
So, what can we do? As we know, there is no ‘quick fix’ for systemic issues. But there are individual and collective practices we can do to reduce the burden of moral injury and protect our integrity:
Name the value that was violated. Reflect on what mattered to you in the moment. Was it Cultural Safety? Equity? Fairness? Community responsibility? Notice what emotions are present and where you feel them in your body. Name the value of yours that has been injured. This shift alone can reduce the intensity of the emotional response.
Separate responsibility from constraint. In rural and remote health, we often carry a disproportionate level of responsibility, believing we are responsible for more than we actually are. Reflect on what was in your control, what was outside of your control, and what you did do that aligned with your values, even if it was in a small way. This is not about minimising it but accurately locating responsibility and accountability. If a system fails, this does not equal personal moral failure. You could try a mindful reframe, such as, “Given the constraints, I acted with as much integrity as I could.”
Create structured debriefing spaces. Moral injury thrives in silence, as we often believe we are the only ones experiencing these emotions. If the workplace is safe enough, or you have a safe colleague to debrief with, set up a regular meeting and ask each other if anything felt ethically uncomfortable this week. Ask questions such as “Were any of my values compromised this week?” and “What supports do I need?” These conversations normalise the moral complexity we face and reduce our sense of isolation.
Close the day with micro-practices. Moral injury often follows us home, so spend a couple of minutes at the end of the day naming that moment that felt morally heavy. Name one action you took that reflected your values, and release the day by taking three slow, deep breaths, imagining on each exhale that you are releasing what is not yours to carry home with you.
Take action where possible. Write a letter advocating for change, support a colleague who spoke up, seek cultural consultation, or mentor a junior staff member to navigate ethical complexities. Even small acts of alignment with your values help restore a sense of integrity and counteract helplessness.
Practice self-compassion. As health workers, we have an enormous amount of compassion for others, but often forget to turn this inward. A brief self-compassion practice could be something like placing your hand on your chest and silently saying, “This is hard. I care deeply about doing the right thing, I am also human and working within limits.” Practising self-compassion reduces shame and emotional exhaustion, whilst maintaining accountability.
Moral injury cannot be solved at an individual level. Whilst reflective and mindful practices are protective against further harm, moral injury needs to be addressed at the leadership level, acknowledging (and addressing) things such as chronic resource gaps and unsafe workplace cultures.
If this Mindful Monday strikes a chord with you, the good news is that it means your moral sensitivity is still there. Our Bush Support Line (1800 805 391) psychologists are there 24/7 if you would like to talk through what you are experiencing, or are trying to process your emotional responses.
Remember, it is the circumstances you work in, not a failing of yours, that causes you to feel this way. Don’t view your distress as a weakness; it is evidence of your commitment to caring.
Be kind,
Dr Nicole Jeffery-Dawes (she/her)
Senior Psychologist, Mental Health & Wellbeing Service
References
- Dean, W., Morris, D., Manzur, M.K. & Talbot, S. (2024). Moral Injury in Health Care: A Unified Definition and its Relationship to Burnout. Fed Pract. 2024 Apr;41(4):104-107. doi: 10.12788/fp.0467. Epub 2024 Apr 15. PMID: 39399281; PMCID: PMC11468615. Accessed 19 February 2026 at https://pubmed.ncbi.nlm.nih.gov/39399281/
- What is Moral Injury. moralinjuryproject.syr.edu. Accessed 19 February 2026. https://moralinjuryproject.syr.edu/about-moral-injury/
