Abstract
The COVID-19 pandemic brought unparalleled pressure, stress, and a dramatic change in practice to healthcare systems across the world. National Health Service (NHS) staff have reported higher levels of burnout, stress, and other mental health issues that they relate directly to the impact of the pandemic. Burnout is often used as a ‘catch-all’ term for psychological distress in the workplace and it has been suggested that, during the pandemic, experience of ‘burnout’ may be influenced by ‘moral injury’; the distress that can arise from actions, or lack of action, that is seen to violate one’s ethical code. Moral injury has commonly been discussed at an individual level, where a single person may be the ‘perpetrator’ of an unethical act, and experience guilt and shame as a result. This study instead investigates NHS staff experiences of burnout and betrayal-based moral injury, in which a trusted authority betrays ‘what is right’. Sixteen NHS staff members were interviewed in relation to their experiences during the COVID-19 pandemic. Data were thematically analysed, and three themes constructed: abandonment as betrayal; dishonesty and lack of accountability; and fragmented relationship to management or the NHS. This analysis concludes that self-identified ‘burnout’ in NHS staff may include a significant moral component, and that failure to engage in moral repair following betrayal-based moral injury may relate to a long-term loss of trust or fragmented relationship with the organisation. In addition to traditional trauma-informed psychological support, leadership at all levels could benefit from training in betrayal-based moral injury and engagement in moral repair with staff to reduce staff intent to leave and encourage mutual trust. Limitations and potential avenues for future research were identified.