The hidden crisis: Moral injury among French healthcare workers

Background: Amidst reports that one in five doctors and one in four nurses might leave their professions within three to five years due to high levels of burnout, this qualitative review explored the deeper crisis impacting healthcare workers in France, questioning whether factors beyond burnout contributed to their distress. Methodology: This study analyzed testimonies from French healthcare workers and reviewed relevant literature to uncover the underlying causes of their distress. Results: The qualitative analysis revealed profound distress among healthcare workers, stemming from a misalignment between their ethical standards, specifically the principle to 'put patients first,' and the practical realities of their work. Testimonies underscored unsustainable working conditions and economic pressures that compel healthcare workers to make decisions that compromise care quality and their own integrity. Nurses reported closing their practices due to non-profitability, forced to prioritize financial considerations over patient needs. Similarly, general practitioners expressed disillusionment, feeling disconnected from the type of medicine they aspired to practice. This distress goes beyond mere burnout, touching on deep-seated conflicts between personal values and professional demands, leading to significant attrition among healthcare workers. Comparative insights from the United States highlight a global trend where healthcare professionals face diminishing trust in systems that favor financial or operational efficiency over patient-centric care. 'Moral Injury,' as identified in our literature review, aptly describes the situation faced by French healthcare workers. It refers to the psychological distress that occurs when they cannot practice according to their ethical beliefs due to external constraints-whether from profit maximization in predominantly financialized systems like those in the United States or from funding and management gaps in public systems like those in France. Conclusion: Healthcare workers observe that the French healthcare system, once praised for its excellence and accessibility, no longer allows them to put patients at the heart of their concerns, in contradiction with their values. It is therefore essential to recognize the existence of "Moral Injury" to guide the structural and organizational reforms necessary to transform our healthcare system. (c) 2024 Published by Elsevier Masson SAS.