Caught Between Patients and Systems: Moral Injury in Trauma Practice.

Moral injury (MI) arises from conflicts with deeply held moral or professional values. Distinct from burnout, compassion fatigue, or PTSD, MI occurs when providers feel unable to provide care in alignment with their values due to circumstances beyond their control. This mixed-methods cohort study explored MI among trauma health care providers (THCPs) at a Level I Trauma Center. Study participants were trauma team providers who completed trauma-focused interviews and the Moral Injury Symptoms Scale for Health Professionals (MISS-HP). Clinically significant MI was common, consistent with existing literature. Qualitative analysis identified system-driven themes including prolonged care, resource scarcity, throughput pressure, compromised standards of care, and repeated exposure to violence. Mitigating MI in high-acuity settings requires greater alignment between leadership and providers. Findings emphasize the need for organizational reforms alongside employee mental health support to address MI effectively. Further studies should assess these system-level drivers across trauma roles and disciplines.