Supporting nurses—personally and professionally—is essential for providing high-quality patient care. Nursing Conversations is a relaxed, engaging podcast created and produced by the WE CARE team at the University of Alabama at Birmingham, bringing together nurses from all backgrounds and generations to discuss the real challenges, triumphs, and evolving landscape of healthcare.
Each episode dives into the topics that matter most to today’s nurses, including career growth, leadership, advocacy, work-life balance, mental health, and professional development. Through insightful discussions, practical strategies, and expert perspectives, this podcast fosters a supportive community where nurses feel empowered, valued, and equipped to thrive—both at the bedside and beyond.
Hi, everybody. Welcome to Well Nurse, your go to podcast for all things wellness and nursing. As a nurse, you dedicate your time and energy to caring for others, but it's equally important to prioritize your own well-being. Join us as we explore practical tips, inspiring stories, and expert insights to help you enhance your physical, mental, and emotional health. Hey, everybody.
Joey:Welcome to Well Nurse. I'm Joey Travis, and I'm joined by Dana Morrison. Hey, Dana. Why don't you tell us about today's guest?
Dana:Sure. Hey, Joey. So today on the podcast, we have doctor Wendy Dean. She has practiced as an emergency department physician, surgeon, and psychiatrist. She left clinical medicine when she found the priority of revenue generation was crowning out patient centered care.
Dana:She has since focused on creative ways to make experiences in the health care system better for both patients and clinicians. She works on innovations in technology, ethics, and health systems, and she has served in various leadership positions, including overseeing research, funding for the US army, and in the non profit sector. In 2019, she turned her attention to addressing moral injury in health care and she founded moral injury of health care with doctor Simon Talbott. She's also a podcast host of moral matters, 43 cc, and the workplace change collaborative. She's also a published author with her book, If I Betray These Words, Moral Injury in Health Care and Why It's So Hard for Clinicians to Put Patients First, which is now available on Amazon.
Dana:Yeah.
Joey:We do a deep dive into the topic of moral injury and how it differs from burnout, and she provides some helpful strategies as well. So let's go ahead and dive in.
Joey:You began your career as a surgeon, and then you transitioned into psychiatry. So what inspired that kind of unique path?
Wendy:I wish I could say it was inspired by something. I think what happened was as much as I loved surgery, I realized at some point, a career in surgery, especially general surgery, which is where I was, was not gonna give me the opportunity to do so many of the other things that I enjoy. At least I couldn't see the path to that. And also the particular field I was interested in was plastics. And at the time that I trained, you had to do 5 years of general surgery and 3 years of plastics.
Wendy:That seemed like a really long road for a career that wasn't going to let me do much outside of work. So I sort of dropped back and spent 2 years in an emergency room trying to working in an emergency room and trying to sort out what else in medicine was really interesting to
Dana:me. Okay. Great. So let's jump right in to, your specialty. Tell us about moral injury.
Dana:What is it and how is this different than burnout?
Wendy:So moral injury, I, I came across this concept about gosh, 7 years ago when I had been talking to physicians across the country and physicians, because those were the folks I was, I was talking to at the time. Not because I didn't think anybody else was suffering, but I've been talking to them and they kept saying that they were struggling, but they weren't burnt out. It was it was qualitatively for them quite different than burnout, which they interpreted as sort of this being overworked, overtired, needing a break. They said, you know, I, I know how to work really hard. I signed up for this.
Wendy:I knew I was going to work long hours. I was going to see impossibly hard things. What I didn't know was that it was going to be so hard to get my patients the care that they needed. And that's what breaks my heart. And so we started looking for different language.
Wendy:And Simon Talbot is my co founder and co author. And I came up with, it came across this concept of moral injury, which is betrayal by a legitimate authority in a high stake situation that leads you to transgress deeply held moral beliefs and expectations. And we feel like those deeply held moral beliefs and expectations are embodied in the oaths that we take when we become part of a part of our profession, our healing professions. And that that oath is not necessarily a concrete thing. It's not something that we all take, but it's an integral part of what we do in our education and training that that makes it so clear to us that our patients always come first.
Wendy:And that is not, that is not just physicians. That is anyone in a healing profession. So as soon as we published our first article in July of 2018, on this, on this concept, we heard from physicians, nurses, nurse practitioners, physician assistants, physical therapists, respiratory therapists, social workers. And then outside of healthcare, we also heard from veterinarians, educators, public defenders. Like this is this is language that a lot of people are resonating with.
Dana:Yeah. I love that. I know both of us have worked, bedside nursing as well as as nurse practitioners. You're right that it's like you can't put words to how you feel sometimes when you know what you need to do and you just can't do it. And that is something that we hear reflected when we ask our nurses, like, what's going on?
Dana:You know, and it's so it is so different than burnout. I you mentioned you've are you seeing different specialties? You've worked in multiple environments, that are are vastly different. Do you see a lot of difference in the the moral injury you see? The or does everyone pretty much experience this the same way?
Wendy:It's remarkable how similar it is. And it's also remarkable how when I hear when I hear from people, it's almost always the same thing. Like this, this is this is the accurate, accurate explanation of my experience. I've been looking for this language for a decade, 2 decades. It just seems, it really seems to land home with people in a way that this sense of burnout doesn't entirely, you know, it's yeah.
Wendy:People are tired. Yes. We have too much to do and too few resources to do it with, But it's that qualitatively different thing. This is not, this is not I'm bone tired. This is I'm I'm soul exhausted.
Joey:We have many health care workers that are leaving the profession for good. And something that gets lost is our hospital leaders are experiencing a similar level of distress. And I think it's very easy, you know, as staff nurses or as those involved in direct patient care, to overlook the challenges that, you know, our hospital leaders are also facing. But all the research and and a lot of the stuff that you're showing in your data is that both are experiencing kind of a similar level of distress.
Wendy:Yeah. Healthcare is a really, really hard place to work right now. I honestly think clinicians and administrators are each doing their level best to do what they were trained to do. Clinicians to keep their patients well and alive and administrators to keep the organization well and alive. And that is no easy task right now.
Wendy:Are we have done as we have done some studies and others have as well that look at what the administrator experienced, the administrator and manager experiences of moral injury. And we found that 40% of those who had been in management positions experienced moral injury during the pandemic. They know they knew what their workforce needed and they couldn't get it for them. So what that tells me is that we are each having, you know, each side of what we what we sometimes artificially put up as a barrier between clinicians and administrators is experiencing similar distress. That is a point of commonality from which we can start to understand each other better and move toward this towards different.
Wendy:But I think we have to be willing to be curious about what happens on the other side of that imaginary barrier.
Joey:So what are some strategies we can do to kinda help mitigate that gap?
Wendy:Yeah. My favorite one is just being curious. Just be human. Like, be curious and be human. Be present for whatever interactions you have.
Wendy:And this is for both clinicians and administrators. I think we'd make a lot of assumptions and I really prefer not to make those assumptions and just to ask the questions and, and, you know, ask multiple layers of questions. When something pops into your head, ask it. And it can be as simple as your job looks really hard. What are the pressures that you experience?
Wendy:Either person, either side of that equation can ask that of the, of the other side. And I bet we'd get a really interesting answer. And the other question that I think is really important is what do you need from me? How can I help you with the pressures that you experience? What stories do you need from me?
Wendy:What data do you need from me?
Joey:That's really good. One of the things you write about a lot, is the rapid and widespread commercialization of health care, and where, whether it's just optics or it's actual, we see that maybe financials incentives of organizations might be prioritized over the well-being of health care workers and patients. How can we address this issue?
Wendy:This is a tougher one, and I think this is something that everyone so first of all, everyone is gonna be a patient at some point, so we all care about this. When we have a corporatized healthcare system, a financialized healthcare system that is concerned about the bottom line to the point where the needs of patients get a bit lost, care erodes. It cannot help but because it is not front and center. The first thing that we can do is start paying attention to what's happening, to understand the landscape of healthcare, and then to understand where where people are trying to make change, where the movement is to make change. If you're a healthcare worker, you can start looking at your hospital.
Wendy:Every hospital is a little bit different in how they, in the challenges that they face. So understanding what's really the pebble in your organization's shoes and then working to fix those is important. You can also look at your state legislature and see how they are moving. Are they moving to reinforce corporate practice of medicine laws? Are they looking to, address non compete clauses?
Wendy:You know, where are they moving in healthcare? And then do the same thing for the federal for federal agencies. For example, there is a request for information out right now from the federal trade commission, department of justice and health and human services asking for public comment on the impact of corporate greed and healthcare. Anybody can go and put comments in there and help the federal government understand where they might need to move to close loopholes that are causing this this corporatization and consolidation and vertical integration. So there's plenty of places.
Wendy:I mean, the simplest thing that people can do this year is to educate them about who is on their ballot in the fall, who shares their outlook on healthcare. If nobody does, then they could make appointments and go talk to your legislators because sometimes they just don't have they don't have the education that they need. You know, we we take what we do for granted because we do it all day, every day, but it's kind of opaque to people who aren't in healthcare. So go educate your legislators. They'll probably be grateful for it, and then you'll have somebody you can vote for.
Wendy:And by all means, vote.
Joey:Yeah. On that note, one of my favorite papers you wrote was reframing clinician distress, moral injury, not burnout. And one of the suggestions that you wrote about was the importance of being active in the, you know, in health policy and communicating with legislators. Why for the maybe, the bedside nurse in particular, that frontline staff, is that so important?
Wendy:Oh, because they're they're making decisions about where resources are going, And they may not understand how resources flow in healthcare or what's important about that specific decision that they're making. And so the other thing that I think health care workers don't understand is how much weight they carry when they tell their stories. What we do is quite unusual. And I think we have more power than we give ourselves credit for. So going and talking to those legislators, helping them get educated about the legislation that they're going to be voting on can be incredibly helpful for both sides.
Dana:Yeah. I love that. I feel like that is such a unknown, thing for for most bedside nurses. I know I'm speaking for myself, and possibly Joey would agree with me. But I know this year, our interest in health policy has really, we've really been inspired because we are in a role, where we were able to go.
Dana:We actually went to DC, and we're able to bring up some of the the things that we need votes on, and talk about why they're important. And, you know, when you actually go up there, you're not normally speaking with the senator or the congresswoman. You may be speaking with their health policy adviser.
Joey:Right.
Dana:And they've never worked in health care besides the, you know, health policy label, I should say. But they're not the bedside with us. So it was kinda cool that, you know, just a a bunch of nurses from Alabama could go up to Capitol Hill and talk about what's going on down here.
Wendy:Yeah. And they crave those stories because those stories help them bring the the the votes alive. So the the stories that bedside that bedside clinicians can bring support their vote one way or the other.
Dana:What are some of the other things you would recommend, or what are some maybe exciting developments you've seen or heard about that aim to combat moral injury?
Wendy:Well, I I think we all have to keep in mind that, although we've been talking about things like moral distress for a long time, moral injury came into the health care lexicon in full force, really just about 5 years ago, which seems like a long time when you're suffering, but in the lifespan of new technology or new concepts, it's brand new. So for example, with burnout, we've been talking about that for half a century. So some of the exciting things are that people are now moving from characterizing and quantifying the experience to starting to look at ways that we might mitigate it, prevent it, address it. And that work started just about a year ago for our team, with our collaborator, Deborah Morris in the UK, by just looking at what is a non morally injurious organization. So we asked 50 experts in moral injury around the world.
Wendy:What would that look like? If we, if we can't point to 1 organization, that's doing this really well, which we've struggled to do, imagine it so that we know what we're aiming toward. And so that paper will be coming out in the next few months. We're also starting to look at once we have, since we've, we've sort of gotten that idea of what a non morally injurious or morally centered organization looks like, we can start to put together some framework around. How do you bring shared values into an organization?
Wendy:How do you use those shared values in conversation and in decision making? How do you all within the organization hold each other accountable to that shared framework, which by the way, builds trust. When teams trust each other and work well together, patients trust them more. Patients have better outcomes and they have higher satisfaction scores. So all of these things, even though they, they seem like they could be disconnected, they're not.
Wendy:Like we're human. We feel these relationships, even if our patients don't see it, even if we are polite and kind and and compassionate with them, if we aren't working well together and we don't have good relationships with each other, they can feel it And it and it will impact their experience, if not their outcomes.
Joey:So we've tried several strategies here at UAB and our health care system to help address burnout and moral injury, with varying levels of success depending upon what we're talking about. But what strategies have you found, and your organization found
Wendy:a If there's not leadership buy in small teams can pull together, can try to change their hyper local environment, but really to do this on a, on the scale of a, even a hospital or a health system, you must have leadership buy in. And it depends again on what your, what your system is and what their challenges are, what the particular changes are that you need to implement in order to get to better. But part of part of deciding how you do that is listening. And if, if leadership is struggling to listen because their pressures are so great, that's gonna be that's gonna be a tough situation.
Dana:Yeah. I was about
Dana:to ask. So what do we do if it's our leaders that come to us saying, yeah, this is me.
Wendy:So then you say, okay, great. So we're feeling it from our side. You're feeling it from your side. Let's figure out where that's coming from. And what can we do as a, as a system, as a whole to either maybe push back on legislators, to ask for different legislation, to ask for a relief of some regulation.
Wendy:If you can do it as a whole system, that's ideal.
Joey:You cofounded an organization called moral injury of health Care. Can you tell us a little bit more about, your work with this organization and what what the goal is?
Wendy:Yeah. So the the original goal of the organization was to catch some of the energy that was coming off of this initial article that we published. But it's grown into a real advocacy organization. So it's, we're a nonprofit. And what we are trying to do is raise awareness and do research that aims to bring change in this space.
Wendy:So understanding that moral injury and burnout are separate entities. And it's not either, or it's both, and They don't always run together, but they sometimes do. So if you see one, you should look for the other. I mean, 5 years ago, that was unknown. And so now we're starting to work with more collaborators to look at now that we understand this experience better.
Wendy:How do we move towards different and what would that, what would those strategies look like? Just, just like you were asking if it's about leadership, what kind of leadership is that about? What kind of leadership will move these changes to better?
Joey:So we have the chance to read your book over the weekend if I betray these words.
Wendy:Over the weekend. Wow.
Joey:Fantastic. It was fantastic. And I highly recommend it to all the listeners. So can you tell us maybe the goal behind whenever you wrote that? I know initially you had said in multiple interviews that you didn't necessarily intend, you know, set out to write a book with your career.
Joey:So how did that kinda come to be?
Wendy:Yeah. So, there's a lot that I'm doing now that I never expected to do. Like, you know, being on a microphone as much as I am writing, writing a book was never on my bucket list. You know, my husband always told, like, in the dedication to the book I wrote to my husband who always said I should write a book. I used to think he loved me.
Wendy:Writing a book is no easy thing, but this work needed to get out in the public. And this idea of what I wrote about physicians, because I know them best. But I was also really clear that it's not just physicians, patients, the public, the general public really deserves to know what's happening behind behind the curtains, for our healthcare workforce, because we need them to advocate with us. So that was the whole point of writing the book was to to write it in a way that was accessible to the general public, but also would bring some new information to the healthcare workforce as well.
Joey:You also host cohost several podcast, and, a lot of your podcast guests come outside of medicine. I just wanna know I think it's probably an intentional choice, but can you elaborate more on that choice?
Wendy:So one of the reasons is I'm relentlessly curious. Like, I just wanna know how other people are doing things. And I think when we, when we only pay attention within our, the walls of healthcare, we lose out on opportunities to think differently and broad more broadly. So when I was working for the department of defense doing research funding oversight, we had clinicians from all different specialties working on regenerative in regenerative medicine fields. And I realized doing that work that the place where innovation happened was at the nodes where they were different specialties met.
Wendy:It wasn't, it wasn't in the silos. It was where they met and had brought different ideas that nobody had seen before. And so I feel like that's part of what we do, in the podcasts is to think, what, what are we missing in healthcare? What are other, what are other sectors doing? And if nothing else, you know, it's sort of an entertaining distraction, right?
Wendy:And a, and a little and a little side journey. And, you know, maybe it doesn't bring anything, but I I find oftentimes it helps me think more creatively to get outside of healthcare.
Dana:Yeah. I love that. I completely agree. I feel like there's so much that we can benefit from just learning, especially when it comes to looking at a lot of our health care organizations as a whole. I mean, we are businesses, and there's a lot of other businesses out there.
Dana:I know they're probably going through some form of their own moral injury. Maybe it doesn't have to do with patients, but, certainly, they have their own struggles. So I love that you're opening up this conversation. And, you know, the more we dig, the more we find issues. And I think one of the things we're seeing that we didn't have a word for is moral injury.
Wendy:Yeah. Yeah. I'm very
Dana:exciting to hear that, you know, someone is researching this.
Wendy:Yeah. It's interesting. I, I know that I I know that the nursing literature has paid a lot of attention to moral distress in the past few decades. But there is some, there's something resonant about this, you know, about the moral injury term because it's more about it. It's not just I'm challenged by the situation I'm in, but that this situation, this repeated situation is doing something to how I think about myself.
Wendy:Right? Can I still be the good nurse that I think of myself as if I continue to work in a place that doesn't allow me to do my job, as I believed I would do it when I entered the profession? So Ed Yong had the best, the best quote, was from Ed Young in November of 2021 in the Atlantic. But he said, health care workers aren't leaving their jobs because they can't aren't leaving because they can't handle their jobs. They're leaving because they can't handle not being able to do their jobs.
Wendy:And I thought he really put it in a nutshell. Yeah.
Dana:I feel like that resonates deeply with me. I remember being in clinic being so frustrated, and it was because I was, you know, sending my patient who didn't have money home to, you know, to hopefully pick up medicines that they can't afford, that they can't even drive to to pick up. Right. Right. And you're just looking at them and you're like, my hands are tied.
Dana:And it's it's like you mentioned at the beginning. It's definitely it could be soul crushing, especially during that time after time. But I'm so appreciative of all your recommendations you've given us so far as far as, you know, asking the questions, maybe reaching out to the legislators, figuring out what's going on with leadership, and actually communicating with leadership, which I feel like something a lot of us as bedside staff sometimes we, you know, we feel like they're very distant. Really enjoyed this conversation. One thing that we do ask all of our our guests here is we do like to know, their definition of a nurse.
Dana:I know that you've worked with nurses in the past. Hopefully, those have been great experiences. But what would you say is your definition of a nurse?
Wendy:Oh, bedside nurses are the bomb. Like, they kept me they kept me out of trouble more times than I can tell you when I was training. And working in the ER, the nurses were my rocks. I mean, it was they're amazing.
Joey:I do have to say, I think that's my favorite answer yet that we've we've had is we are the bomb. So we thank you we thank you so much for sharing your expertise with us. And there's gonna be links on the show notes to your podcast as well as your website, and your book, if I betray these words. Thank you so much and, for all the amazing work you're doing as well. We really appreciate your time.
Wendy:Thank you so much.
Dana:Wow. What a great conversation. I love talking with doctor Wendy Dean.
Joey:Yeah. I feel like she is a great voice for really moving the needle on this conversation of moral injury. And as leaders and as well as bedside staff, we have a lot to learn from her perspective. We hope you enjoyed that conversation with doctor Wendy Dean. More information about her resources are in the show notes.
Joey:Thank you for listening. And are you enjoying the podcast? Why don't you subscribe, like, give us a 5 star rating, maybe a review, and share with a colleague, And we can't wait to be with you again on Boner's.