The huge current effort to ensure adequate staffing and resources may be successful, but it looks likely that during the covid-19 outbreak many healthcare workers will encounter situations where they cannot say to a grieving relative, “We did all we could” but only, “We did our best with the staff and resources available, but it wasn’t enough.” That is the seed of a moral injury. Not all staff members will be adversely affected by the challenges ahead but no one is invulnerable, and some healthcare workers will hurt, perhaps for a long time, unless we begin now to prepare and support our staff.

This article investigates the current and future challenges for health care workers and management within health facilities due to their experiences and roles with the Covid-19 pandemic. Key issues highlighted include:

• Healthcare staff are at increased risk of moral injury and mental health problems when dealing with challenges of the covid-19 pandemic.
• Health care managers need to proactively take steps to protect the mental wellbeing of staff.
• Managers must be frank about the situations staff are likely to face.
• Staff can be supported by reinforcing teams and providing regular contact to discuss decisions ad check on wellbeing.
• Once the crisis begins to recede, staff must be actively monitored, supported, and, were necessary, provided with evidence-based treatments.

These are extraordinary times with the covid-19 outbreak and the extent of the medical response required worldwide. There is also a pressing need to ensure that the tasks ahead do not cause long lasting damage to healthcare staff.

Available at: http://www.bmj.com/

BMJ 2020;368:m1211 doi: 10.1136/bmj.m1211 (Published 26 March 2020)