“The needs keep coming"

In July 2021, I found myself unexpectedly flying cross-country to my sister in San Francisco. Kathleen is an ICU nurse and COVID critical care had taken its toll: she was traumatized and had been approved for medical leave. My job was to bring her back east to be with the rest of our family while she waited for a spot to open up for her own treatment.

Kathleen’s breaking point underscored for me that no one is “too strong” or “too skilled” to be laid low by stress, trauma, and emotional exhaustion. She is an award-winning critical care nurse; she’s been published in peer-reviewed medical journals; she completed a Zen Buddhist chaplaincy program in order to minister to her colleagues at the hospital. A month prior, she’d been featured in The Atlantic’s coverage of COVID on the front lines.

Health care workers around the world, in my family and maybe in yours too have experienced not just trauma but moral injury. 

Moral injury was first described in the 1990s by Jonathan Shay, a psychiatrist who worked with Vietnam veterans. Since then, we’ve recognized moral injury in other settings, too, like health care. Moral injury arises when you take part in, witness, or fail to prevent an act that deeply violates your conscience or threatens your core values.

It can be individual in nature (e.g., I made an error in judgment; I did nothing as a bystander) or stem from systemic factors (e.g., I had to choose who to help because there weren’t enough supplies; I was told to adhere to policies that hurt someone).  In some cases, leadership piles on ever-increasing demands requiring workers to harm themselves (by pushing past their own human limits), their families (by being emotionally and physically unavailable), and those they serve (by turning away those in need of help). Outgrowths of moral injury can include depression, addiction, burnout and self-harm.

One moment among many for Kathleen was turning away a woman who was trying to visit her dying mother on Mother’s Day. She knew it was wrong, but it was what she was tasked with doing and she did it. Moral injury also comes about through being betrayed by those in positions of power - those in a position to do the right thing who choose otherwise. Kathleen talked about feeling “disposable” in those days before the vaccines. Nurses were at the bedsides doing the tasks of every other worker in order to minimize exposure to the virus. If something happened to her, she could be replaced. As an individual, she didn’t matter. 

Increasingly, I’m becoming concerned that there are a  significant number of educators in this country (and locally) who may be living with moral injury. 

Consider our school-based counselors, social workers and psychologists. The CDC, the American Psychological Association, the American Academy of Pediatrics and other groups have recognized a significant increase in youth mental health issues and reported cases of trauma. Here’s how that looks through the eyes of a school psychologist—what she describes is above and beyond her regular duties and caseload.

[My calendar] does not reflect the 3 students who barreled into my office on Monday screaming and crying, the students who were waiting at my door when I was providing counseling to other students on Tuesday, the cursing student who came into my office as another student exited, the student who had a panic attack on Wednesday and needed to be seen again, the parent who showed up on Monday without an appointment who I have still not had time to call back, the parent who I had to call today because I’ve seen their teen 3 times this week, the student who I had to turn away because I had too many students in my office already, the teachers asking me to provide counseling, and the student who entered my office this afternoon just before the bell rang for dismissal and reported decades of trauma. The problem is this has become typical. 

I have parents calling because there are no appointments available [outside of school] and there are six-month waitlists for services at a minimum…. I have teachers crying and get calls to go to the classroom and meet with them. I write reports after school hours and on weekends. My counseling notes have not been updated in months.

I am exhausted. We are all exhausted… The needs keep coming. And we’re not able to meet them. We are drowning as we try to save the world."

​Here’s what a social worker had to say:

This year has been even harder than last year. I’m spending more time in classrooms, intervening with students, providing counseling support to students (and really their parents too), trying to problem solve, being a listening ear for teachers, and sitting in on more Special Education meetings than I ever have.  This is on top of all of the new initiatives and programming that are getting added to our work loads, including a more active role in threat assessments and prevention.

I want my students to feel like I did everything I could so that they feel supported in their educational journey. That their school is a safe place. I love my job and I love the kids that I get to work with. These students have never once made me question if working in schools was the profession for me. But I am tired.”

And from a school counselor: ​

We desperately need intervention teachers to support kids. I’ve watched teachers in tears this week asking for support to meet students’ learning/behavioral needs. Teachers don’t need coaches or specialists to tell them what to do, they need people in the building to help them do it.” ​

And finally, from a teacher: ​

Today was another difficult day… we received an email [from central administration]. More training. My English team teacher read the email, closed her Macbook, and wept. She said she cannot do one more thing. Her family life is falling apart because of the constant demands [at work].

At our staff meeting, I sat next to one of the most amazing teachers I have ever met. Her eyes were red and welled with tears… She said she has seven and a half years left; she doesn’t know how she is going to make it. We are trying to prop each other up."

Like my sister, these are veteran professionals with advanced degrees and certifications. As with my sister, their work is a calling. 

​What they are describing is not “too busy” or “too stressed” or “going through a rough patch”—it feels to me like moral injury. Education shares with nursing an ethics of care and a history of innovation. Let’s be bold in seeking to build a public education system in which all can flourish.