COVID-19 clinician moral injury survey

<b>Abstract</b><br/><p><b>Background</b></p> <p>Moral injury is an emerging explanation of burnout and suicidality, but remains poorly quantified in at-risk practitioners. We hypothesized that COVID-19 pandemic-related moral injury differs between frontline clinicians, genders, age, and country of practice.<br>  </p> <p><b>Methods</b></p> <p>We conducted an online cross-sectional survey of international physicians, nurses, nurse practitioners, paramedics and respiratory therapists between April and June 2020.  We included the adapted version of the Expressions of Moral Injury Scale (EMIS). The primary outcome was differences in moral injury scores between clinician roles.</p> <p><b>Results</b></p> <p>Three hundred and two clinicians participated, including physicians (61% [n=184]), nurses (28% [n=85]), and nurse practitioners (5% [n=14]). The median age was 39 (IQR 32-76), females comprised 54% of the respondents, and the majority resided in Canada (n =183 [61%]) or the United States (US; n = 106 [35%]). Emergency medicine (88% [n=265]), and intensive care (6% [n=17]) were the main specialties responding. Median moral injury scores across multiple domains were higher for nurses compared to physicians, as well as for younger, and female respondents. Moral injury scores were also significantly higher for respondents from the United States, the United Kingdom and Australia, compared to Canada.</p> <p><b>Conclusions</b></p> <p>Our research suggests that during COVID-19, measures of moral injury differ across roles, gender and place of work. Future research is warranted to better understand the impact of moral injury on clinicians’ psychological well-being during the COVID-19 pandemic.</p>