"If I die, they do not care": U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19.

Objective: The COVID-19 pandemic brought unparalleled pressure, stress, and a dramatic change in practice to health care systems across the world. National Health Service (NHS) staff have reported higher levels of burnout, stress, and other mental health issues that they relate directly to the impact of the pandemic. Burnout is often used as a "catch-all" term for psychological distress in the workplace, and it has been suggested that, during the pandemic, experience of "burnout" may be influenced by "moral injury": the distress that can arise from actions, or lack of action, that are seen to violate one's ethical code. This study investigates NHS staff experiences of burnout and betrayal-based moral injury, in which a trusted authority betrays "what is right."

Method: Sixteen NHS staff members were interviewed in relation to their experiences during the COVID-19 pandemic, and data were thematically analyzed.

Results: Three themes were identified: abandonment as betrayal; dishonesty and lack of accountability; and fractured relationship to management or the NHS.

Conclusions: This analysis concludes that self-identified "burnout" in NHS staff may include a significant moral component, and that failure to engage in moral repair following betrayal-based moral injury may relate to a long-term loss of trust or fractured relationship with the organization. In addition to traditional trauma-informed psychological support, leadership at all levels should be trained to be aware of betrayal-based moral injury and to engage in moral repair to reduce staff intent to leave and encourage mutual trust. (PsycInfo Database Record (c) 2022 APA, all rights reserved).