When Trust Feels Fragile: Moral Injury, Leadership, and Staying Human

Feeling overwhelmed and unsure where to start is a common experience, but it can be especially intense for leaders at all levels, formal and informal. It has become abundantly clear that we lead groups of individuals and are held accountable to stakeholders that are anything but homogeneous. They differ in backgrounds, experiences, political beliefs, culture, and religion. In historical healthcare systems and other operational ventures, as much as it may be advocated that we check those things at the door to do the job we're hired to, it never truly happens that way. Strategy is often driven by national or state policy, inherently making everything we do, shrouded in some type of political mist.

This diversity can create tension and uncertainty, making it difficult to find the right words or actions. We hear over and over, that we can't make everyone happy and it's true, but then we are left questioning who is "in" and who is "out". This is then all even further exasperated with the impact of moral injury, something more and more visible each day as we become less and less separated from the flood of information hitting us at every click in our phone or on our laptop. While I am not an expert on moral injury, exploring its impact on leadership can shed light on why even the strongest leaders sometimes feel lost and why trust can falter.

Understanding Moral Injury in Leadership

Moral injury occurs when an individual "engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs" (Watson et al., n.d.). For leaders, this can happen when decisions must be made that affect people in ways that feel unjust or harmful. Unlike physical injury, moral injury wounds the conscience and spirit. It can lead to feelings of guilt, shame, and doubt. In just the last few weeks, the general public has witnessed the murder of people streamed through social media over and over again. The circumstances of these murders tied directly to the political climate of the US and further compounded by the ability to almost instantaneously know details about the person killed before their next of kin are even notified.

No one is immune to these feelings. Some may do better at detaching the duties of their job or their responsibilities from the overwhelming feelings inside, but for most, questions are circling through their heads.

• When do I address this?

• What is appropriate to speak about?

• How will I handle backlash if it occurs?

• What if my leadership disapproves?

• Should I have done something sooner?

• What if what I do in my personal time creates conflict in the work place?

• What is the policy on speaking about any of this?

What I would be hard pressed to believe, is that a large portion of nurses, techs, doctors and caregivers in hospitals around the country today, aren't resoundingly feeling some type of heaviness even as they perform surgery, tackle daily support duties, deliver good and bad news on diagnoses with the utmost professionalism.

How Overwhelm Affects Leadership Communication

When overwhelmed, leaders may find themselves at a loss for words. This silence or hesitation can be misinterpreted by others as weakness or indecision. In reality, it often reflects the leader’s internal struggle to reconcile competing demands and moral concerns. This is a known part of the job though, that when you are given a platform of trust, power, and influence, that you are prepared to tackle what others don't. It's the epitome of a Messy Monday ideology.

And even though, when we are on the receiving end of the message, we may find ourselves saying, "It would have been better if you said nothing at all", that is truly for our own comfort, because then we can apply our own assumptions to what we hope that leader is thinking and feeling instead of knowing if we are in alignment of not. If we're not in alignment with our leadership, the moral injury starts all over again and we're left debating if this disconnect with those we rely on for pay, benefits and employment is worth the less tangible and more emotional impacts.

Simply speaking up, by the way, does not make you a "good" leader. There are many other skills and competencies that come into play, but we can't utilize those if we stay silent on everything that is divisive in nature.

• Acknowledge the difficulty: Recognizing that feeling overwhelmed is normal can reduce isolation and self-judgment.

• Seek diverse perspectives: Engaging with trusted advisors or representatives from different groups can provide clarity and new ideas.

• Communicate openly: Even when answers are not clear, sharing the process and challenges can build trust.

• Set realistic expectations: Being honest about what can and cannot be achieved helps manage stakeholder hopes. This is the chance to talk about actions with measurable outcomes.

  
  

Leaders as Both a Push and Pull

Research on moral injury, especially in military and healthcare settings, highlights its profound impact on mental health and decision-making. Studies show that unresolved moral injury can lead to burnout, depression, and reduced effectiveness. While leadership contexts differ, these findings suggest the importance of addressing moral injury proactively.

Recent reviews on moral injury also reflect on the intersect of Us versus Other and how conflict and distress in the moral construct and disrupt the dynamics of "Us-groups" and being defined as an "Other". Looking back over time, we can see the power exuded with driving fear in populations that you should never risk being an "Other". Yet it is often the "Others" that bring about necessary change, ironically, creating new "Us-groups". Brett T. Litz, Hannah E. Walker. 2025. Moral Injury: An Overview of Conceptual, Definitional, Assessment, and Treatment Issues. Annual Review Clinical Psychology. 21:251-277. https://doi.org/10.1146/annurev-clinpsy-081423-022604

Leaders inherently agree to be an "other" the moment they step into a leadership role. They are differentiating themselves in ways that bring clear benefits but also create new consequences. As mentioned previously, leaders are not immune from experience moral injury or moral distress, however they also can uniquely compound it, multiple it and even create it for others under their influence.

It is a responsibility to not be taken lightly and will pull the best of leaders in a multitude of directions when they are pressured to address even the most clear cut of situations. Trust is fragile when leaders face moral injury and overwhelming demands. Rebuilding and maintaining trust requires consistent effort:

• Transparency about challenges and decisions

• Demonstrating empathy for diverse viewpoints

• Following through on commitments

• Admitting mistakes and learning from them

  
  

Trust grows when leaders show they are human, fallible, and committed to doing their best despite difficult circumstances and when they show who they are at the heart of it, so that those around them can make the most educated decisions on if this leader/follower relationship is one that is viable moving forward.