A Seat at the Table: The Intersection of Moral Injury and Experiences of Black Social Workers in Healthcare

The etiology of moral injury (MI) is linked to experiences of combat veterans, that if left untreated, manifests into symptoms of post-traumatic stress disorder¹. MI is present when there has been a betrayal of what is morally right by someone who holds authority and is in a high stakes situation². Additionally, MI disrupts an individual’s professional efficacy in just and ethical behavior ³. Due to the COVID-19 pandemic, scholarship has expanded to adapt MI into healthcare workforce experiences; MI can lead to long-term physical, mental, and psychological consequences increasing occupational burnout, compassion fatigue, and a lower sense of psychological safety among healthcare workers³. More recent scholarship has aimed to identify how MI emerges in social work practice. Yet, there is limited exploration of how race-related stress (RSS) and systemic racism in healthcare may trigger MI of BIPOC healthcare workers and, more specifically, medical social workers.

Through the lenses of Black Feminist and Intersectionality theories, this study aimed to explore MI experiences of Black social workers (N= 21) employed in healthcare institutions in Texas during COVID-19 pandemic, amid anti-Black racism and targeted violence. Interpretive phenomenological analysis supported in-depth understanding of the intersection of being a Black social worker and experiencing MI through the investigation of the following research question: “How do Black social workers in the state of Texas perceive race as a trigger of moral injury?” Virtual semi-structured interviews were conducted with participants; questions included how race influences interdisciplinary team communication, patient care, psychological safety, and professional efficacy. All interviews were transcribed verbatim and identifying information redacted. Initial coding was conducted to search for meaning statements from raw data. The research team met frequently to discuss initial constructs that led to comparisons within and across interviews to develop final themes. Consensus was reached on disagreements and peer debriefing, memo writing, and researcher triangulation was sought to enhance rigor.

The study revealed three primary themes that describe how RRS intersects with MI experiences for Black social workers: (1) the expectation of “white” professionalism, (2) long-term effects of acts of betrayal that devalue the Black experience, and (3) systemic doubt that fuels distrust, and hinders psychological safety. The results of this study identify additional factors that can lead to understanding how Black medical social workers may identify unique triggers of MI triggers, a consequence of historical and current systemic, structural forms of oppression resulting in individual, interpersonal, and institutional barriers that constrain the ethical practices of Black medical social workers.

Research implications call for recentering knowledge on MI to integrate perspectives of BIPOC communities. Standardized measures of MI fail to capture the complexity of MI with respect to RRS in healthcare and overlook how systems of oppression may influence unique MI experiences rooted in social injustice. Quantitative and qualitative methodological designs ought to assess for MI and RRS by developing culturally informed and inclusive research practices and teams aimed at deconstructing the homogeneity of the healthcare workforce.