The impacts of burnout, moral injury, and related harms among workers and learners in health and public safety are inequitably experienced based onoccupation, gender, race, ethnicity, employment setting, and other factors. Workforce shortages disproportionately harm lower socioeconomic, rural, andmarginalized communities and the organizations that serve them, contributing tofurther disparities in access, quality of care, and health and well-beingoutcomes for vulnerable populations.
Burnout is associated with physical and mental harms for workers and learners, including increased risk of occupational harms (e.g., needle sticks, sleepdisruption), mental health symptoms (e.g., PTSD, depression, suicidalideation), and substance use. Moral injury has also been associated with psychological harms, and moral distress, a precursor to moral injury, has been implicated in physical and mental harms for nurses, including experiences of intense stress and possible worsening of underlying health conditions.
Relational and interpersonal challenges can occur because of burnout and moral injury. Tensions, betrayal, exhaustion, and other symptoms of burnout and moral injury can disrupt relationships and communication with colleagues, supervisors, and patients/communities.
Burnout and moral injury also result in career harms, including greater intent to leave a job, turnover, and decreased performance. In health professions students, burnout increases the likelihood of intent to drop out of training.
As burnout and moral injury cause workers to leave their jobs, staffing shortages necessarily lead to poor access to care and quality of services for patients and communities. Additionally, worker and learner burnout has been shown to reduce empathy, magnify racial bias, and increase the risk of errors and other threats to patient safety, leading to further reductions in quality of services.
Workers experiencing burnout and moral injury leave their jobs at higher rates,and learners experiencing distress may also drop out, diminishing the pipeline ofnew workers. All of these add to recruitment and retention challenges experienced by organizations and the resultant decrease in quality and lower patient satisfaction ratings, which can affect their reimbursement from private and government payers. Health worker turnover also increases expenses for organizations, hurting their bottom line and diverting resources away from patient care.
Reduced access and quality cause an erosion of public trust in health and public safety institutions, which then leads to worsening health outcomes for patients and communities, increased health disparities, and an ongoing cycle of harm for workers, patients, communities, and society.
The outcomes of burnout and moral injury further perpetuate their drivers, effectively creating a negative cycle. For instance, as recruitment and retention challenges worsen in organizations, workers may be required to work additional hours or complete tasks for which they were not properly trained. Under such conditions, workers may experience increasing moral injury and burnout due to the excessive work demands, values conflict, and growing distrust, ultimately leading to turnover and worsening recruitment and retention challenges.
