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Could moral distress and moral injury be one of the reasons why people develop empathy fatigue and burnout?
Last year, I wrote a blog post for Nature Watch Foundation, “Let’s talk about compassion fatigue”, which focused on burnout and empathy fatigue (EF) within the animal care community. The intention was to raise awareness among those who care for animals in all kinds of roles and to highlight the idea that our perceptions and the meaning we give to the events we experience are the reasons we feel distressed and suffer in many work situations.
This does not mean we should blame ourselves or dismiss the feelings of hopelessness and helplessness that arise in many situations when caring for, protecting, and trying to save animals. However, understanding how our minds work and how we can build a stronger mindset to deal with challenging situations can help us develop a different set of actions that makes us more resilient and prepared to deal with stressful and painful events.
Too many veterinarians are leaving the industry
The rate of veterinarians leaving the profession is up to 20%, with many leaving the workforce as early as 3-4 years post-graduation. Reasons linked to such numbers include:
High levels of stress in the work environment,
Students’ expectations do not match the reality of the job,
High debt of professionals post-graduation, and
Low salaries (Paton et al., 2024).
Studies continue to show that our industry experiences an alarming loss of professionals by suicide, and Witte et al. (2019) highlighted that veterinarians and vet nurses/technicians experience a higher risk of suicide when compared to the general population.
If we want to keep animal care professionals in the industry for many years to come, we need to investigate these alarming statistics and implement strategies to change the current reality.
We all need to understand and be aware of empathy fatigue and burnout
As animal care professionals, it is important to have a deep understanding and awareness of empathy fatigue and burnout so we can arm ourselves with the best tools to mitigate their effects on us, our colleagues, and our employees. But more importantly, having such an understanding makes us better at caring for animals under our care.
Where do moral distress and moral injury fit?
Another important issue that has more recently come to light in the animal healthcare community is moral distress and moral injury.
When reading and writing about empathy fatigue and burnout, there was always this deep question inside my mind: Could moral distress and moral injury be one of the reasons why people develop empathy fatigue and burnout?
I ask this question because all these issues are intertwined and share common symptoms. How can we know what is affecting us?
Moral distress and moral injury are not the same, and they also differ from burnout and empathy fatigue. Moral distress occurs when a person has an emotional reaction because moral conflicts in distressing situations, such as euthanasia stress, challenge their ethical and professional principles.
Moral injury is a more serious issue, which evolves from moral distress and impacts people psychologically, socially, and spiritually as it involves situations where moral beliefs and values feel threatened.
Both issues can trigger inner reactions like guilt, self-blaming and blaming others, shame, anger, suffering, disgust, and powerlessness (Ammar & Shoka, 2022). More simply, moral distress and moral injury occur when complex ethical challenges are present, and the person has to compromise their values and beliefs, as they do not match those of the pet owner, management, other colleagues, etc. This causes the person to make decisions and take actions they do not agree with.
So what can we do?
A good starting point to differentiate between moral distress and moral injury, empathy fatigue and burnout is to learn more about them and undergo some self-testing to determine a baseline measurement about ourselves. These tests should not be used to diagnose any condition but to give guidance about our current mental status regarding these topics and, if necessary, to seek help. We can only manage what we measure!
Here are some free self-tests for empathy fatigue, burnout, moral distress and moral injury that are available online:
As moral distress, moral injury, burnout, and empathy fatigue share similar symptoms, Figure 1 illustrates some specific aspects of each condition.
Figure 1: Interconnection of symptoms among EF, burnout, MD, and MI. Adopted from: Ammar & Shoka, 2022.
Understanding the interplay of such conditions and the particular signs for each one can help us preempt signs of problems before they become more serious mental health issues.
The question remains
However, the main question raised earlier in this article still needs to be answered. Could moral distress be the starting point of empathy fatigue, moral injury, and burnout within the animal care community?
The answer to this question is not easy. More awareness and research are needed on these topics, especially within the animal care community.
Most veterinarians, vet nurses, animal care shelter professionals, and animal research technicians experience daily ethical conflicts. Yet they have limited or no training on how to decrease the impact of such challenges or how these issues can seriously impact their stress, well-being, and job satisfaction.
In the next post, I will share some ideas on managing and preventing moral distress and injury within the veterinary industry.
References:
Ammar, A., & Shoka, A. (2022). Moral Injury and Education Trauma! Moral Injury Seriously Hinders the Education and Career Development. In A. Ammar (Ed.), Learning and Career Development in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-031-02078-0_17
Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics, 28(5), 590-602. https://doi.org/10.1177/0969733020966776
Nett, R. J., Witte, T., Spitzer, E. G., Edwards, N., & Fowler, K. A. (2019). Suicide Risk for Veterinarians and Veterinary Technicians. Posted by Randall J. Nett, MD, MPH; Tracy Witte, PhD; Elizabeth G. Spitzer, MA; Nicole Edwards, MS; and Katherine A. Fowler, PhD. Available at: https://blogs.cdc.gov/niosh-science-blog/2019/09/04/veterinary-suicide/. Accessed Jan 21, 2024.
Paton, M. W., Kalemtzaki, E., Stoewen, D., Hameedunisha, T., Yang, H., Donlin, J., & Endenburg, N. (2024). WSAVA professional wellness guidelines. The Journal of Small Animal Practice. Advance online publication. https://doi.org/10.1111/jsap.13689
Rushton, C. H. (2016). Moral Resilience: A Capacity for Navigating Moral Distress in Critical Care. AACN Advanced Critical Care, 27(1), 111–119. https://doi.org/10.4037/aacnacc2016275
Tomasi, S. E., Fechter-Leggett, E. D., Edwards, N. T., Reddish, A. D., Crosby, A. E., & Nett, R. J. (2019). Suicide among veterinarians in the United States from 1979 through 2015. Journal of the American Veterinary Medical Association, 254(1), 104-112. https://doi.org/10.2460/javma.254.1.104
Witte, T. K., Spitzer, E. G., Edwards, N., Fowler, K. A., & Nett, R. J. (2019). Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014. Journal of the American Veterinary Medical Association, 255(5), 595-608. https://doi.org/10.2460/javma.255.5.595
Dr Giana Gomes is a RTT therapist, a certified compassion fatigue professional and currently studying Masters of Guidance and Counselling at JCU Singapore. She is a former veterinarian and a research scientist. She is the founder of Trueselfhealing online, where she helps the veterinary care community to deal with moral distress, moral injury, burnout, and emotional fatigue and many other issues caused by the stresses of our modern world.
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