Moral Injury: The Invisible Occupational Hazard

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By Nicole B. Dhanraj, PhD, CRA, RT(R)(CT)(MR)

Today’s radiology environment is complex, competitive, and rapidly changing, which sometimes results in radiology staff facing numerous dilemmas in their daily work. Radiologists, coders, managers, nurses, and technologists are caught between expectations, obligations, and fulfilling the demands of the organization’s business goals. The organizational need to do more with less and increase productivity can cause employees to feel confined and powerless to perform fully in accordance with their beliefs and values.

The demands of our profession sometimes cause employees to compromise on what they believe is right for patients and the organization. An employee’s inability to act in a manner that preserves their ethics and values, or their inability to justify another’s actions is described as moral distress. If an employee or manager does not address such distress properly, the employee can experience deep soul wounds with significant consequences to himself, the patient, and the organization. Wounds that pierce a person’s morality are referred to as moral injury.

Moral injury is not a new concept. It originated from soldiers’ experiences after war and has now permeated through various disciplines, including radiology. However, while there is much research available on the problem itself, the scientific research is limited within the radiology discipline, despite radiology being a ripe environment for moral injury occurrences. Unfortunately, employees label it as stress whilst managers may misinterpret the injury superficially as defiance, disengagement, or toxicity.

This topic is of significant value to managers because employees who are morally distressed and become morally injured may lose their purpose, dissociate with patients, and ultimately contribute to high turnover rates by becoming burned out and disengaged. If managers are not attentive to this invisible hazard, it will have gross negative consequences not only for the organization, but also on our ability to deliver quality patient care. It is important for imaging leaders to recognize the impact of moral injury and consciously put methods in place to mitigate its debilitating effects.

To learn more, please join my 2018 AHRA Virtual Fall Conference session, “Moral Injury: The Invisible Hazard,” on Monday, October 29 at 2PM EST. In this session, you will gain a closer look into this invisible, dangerous hazard within radiology and learn more about the implications of moral injury on the patient, the organization, and the employee. I will offer some strategies on how to prevent and cope with being morally injured, as well as strategies for managers to support those in moral distress.

Nicole B. Dhanraj, PhD, CRA, RT(R)(CT)(MR) is the chief of radiology at Guam Memorial Hospital in Tamuning, Guam. She can be reached at

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