There is no shortage of high risk situations in healthcare right now.

On the heels of the acute COVID era, there is great uncertainty. From burnout, staffing shortages and turnover, to the need for enhanced supports for new nurses to bigger concerns around competence and safety as healthcare providers find their roles expanding quickly to meet patient needs.

The face of healthcare has changed.

During a recent workshop on Communication Skills for Difficult Conversations, I heard heart-heavy scenarios from healthcare professionals in all areas of patient care that were creating significant stress. Some of the issues shared include:


💔 Turning patients away from family clinics due to physician shortage or full caseloads.

💔 Feeling underprepared and undereducated for the increase in mental health work being done on the front line

💔 Unable to spend the desired time with patients due to increased workloads and staffing shortages

💔 Listening to patient’s make the difficult decisions between affording their medication or paying their rent

💔 Trying to help family members or patients who are waiting months to years for tests before they can start a treatment plan, knowing that some (i.e. in the case of cancer) may die waiting


The moral stress and strain they were carrying was palpable, and while every healthcare professional will respond differently to the challenges in their work environment, they were asking a common question:

How can we go home at night knowing we provide great care in these conditions?

Moral Injury

Moral injury occurs when a person who holds strong values (such as “do no harm” in healthcare) has to interact and engage with patients in a way that is inconsistent with their personal and professional values resulting in undesirable psychological, social and spiritual impacts.

The impact of moral injuries may be overlooked as healthcare workers are focused on trying to do their job and other colleagues share similar feelings.

Here are three questions to pause and reflect on as it may build self awareness around the symptoms of moral injury and access to interventions sooner.

1. Do you experience feelings of guilt and shame related to the challenges you experience in providing care? Do these feelings follow you home?

2. Do you experience increasing levels of frustration, anger, and blame towards the healthcare system?

3. Are you criticizing your own work more? Feeling lower confidence in your ability to do good work?

This may lead to changes in your relationships at work and at home, an increase in errors at work, changes to sleep and nutrition, and a loss of empathy or compassion for others.

If left undetected or unresolved, moral injuries may develop into mental health conditions such as depression, alcohol misuse and PTSD.

Communication Strategies to Reduce Moral Injuries

Because healthcare workers care deeply and often prioritize the needs of others ahead of their own, they may recognize a moral injury or take the time to talk with others about the challenges they are facing in the workplace.
Ironically, it is often through conversations with others that we can explore new ways of thinking, problem solving, and understanding around difficult situations.

Communication offers an important layer of protection against some of the effects of moral injury such as isolation and negative self talk.

Here are three ways communication skills can support you

Promoting Open and Honest Dialogue. Normalize talking about the hard stuff.

Create a space where healthcare professionals can discuss the challenges, seek guidance and find potential solutions that empower all parties involved in patient care. Through active listening and a collaborative exchange of ideas and thoughts, better decision making can occur resulting in a more collaborative and ethical approach to patient-centered care, reducing the likelihood of moral injury.

Promoting Self Awareness, Care and Compassion. Recognize it is normal, healthy and okay to prioritize your own well being. Understand that you are not responsible for the systemic problems of the healthcare system, nor the consequences of one's life.

You can choose to work actively to make changes within the system as your approach to making healthcare better. Develop strategies to leave work at work. This could be creating a "drive home" playlist of music to help you wind down from the day, relieve work stress, and feel more calm and relaxed.

Enhance Conflict Resolution. Learn how to provide the safety, information, validation and trust your patient's need to make empowering decisions, and then let them make the decisions they have to make for their lives.

Here are three potential scripts you can use to address the concerns of your patients in a professional and caring way, while empowering them to take choices for their lives

🔗 "I agree that not having a family doctor is upsetting, here are the options we have right now - what supports you the most today?"

🔗"I wish I could make the changes needed in healthcare to give you what you need, I want that for you too, what I can share is ..."

🔗 "I am sorry you are having this experience and I can see how you came to this conclusion. What else do you want me to know about this?"

Overall, communication skills contribute to the well being, confidence and skill set of healthcare providers to navigate the complex challenges patients present with without taking on the additional moral injuries often associated with care.

How Coaching Can Help

Working with a communication coach offers an opportunity to build the self awareness needed to identify your personal risks to moral injuries, design strategies to create a more balanced approach to your own self care, while creating a more fulfilling career.

Remember, it is important for healthcare providers to find a healthy balance between caring for others and caring for themselves. By implementing some or all of these strategies, you can reduce the risk of moral injuries while providing much needed self care and compassion on your off hours.