The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic Psychological Needs

Abstract

The COVID-19 pandemic resulted in unprecedented exposure to Potentially Morally Injurious Events (PMIEs) for nurses, in which they were both moral transgressors and moral victims, with deleterious consequences on their psycho-social health and functioning. Our experimental design compared memories of PMIEs with memories of severe moral transgressions (SMTs), in which participants were only moral transgressors. Drawing from Self-Determination Theory and research on moral auto-biographical episodic memories, we assessed a conceptual model describing the impact of recalling a single PMIE or SMT event on nurses’ burnout, work satisfaction and adaptive performance. Our convenience sample comprised 614 Romanian nurses, and data was analyzed with path analysis, general linear modelling, and t-tests. Findings showed that memories of PMIEs, compared to SMTs, were more autonomy thwarting, being associated with more controlled work motivation, less moral learning, higher burnout, less work satisfaction, and adaptive performance. Burnout, moral learning, and work satisfaction were significant mediators of the relationships between PMIE and SMT recall and, respectively, adaptive performance. Our results highlight the urgency for organizational practices of moral repair for nurses after the pandemic, along with interventions meant to increase their autonomy and self-determined work motivation.

Injurious Memories from the COVID-19 Frontline: The Impact of Episodic Memories of Self- and Other-Potentially Morally Injurious Events on Romanian Nurses’ Burnout, Turnover Intentions and Basic Need Satisfaction

“…The results of a previous study we conducted supported a unique association between Romanian nurses’ episodic memories of PMIEs and burnout, work motivation, work satisfaction, moral learning and adaptive performance, mediated by autonomy-thwarting [ 10 ]. Thus, memories of PMIEs were more autonomy-thwarting than memories of severe moral transgressions (SMTs), leading to increased burnout and decreased work motivation, work satisfaction, moral learning and adaptive performance.…”

“…Nurses’ exposure to PMIEs has soared during the COVID-19 pandemic in Romania and all around the world, due to the ethical challenges posed by resource scarcity [ 5 , 6 , 7 , 8 , 9 ]. PMIEs are most often not acknowledged immediately after being experienced, but rather upon recall, which means that their impact on psycho-social functioning is dependent upon a person’s memory of the event [ 8 , 10 ]. Although the effects of nurses’ memories of PMIEs during the COVID-19 pandemic on some well-being indicators have been explored before [ 10 ], we aim to widen the scope of this incipient line of research and further investigate their impact on nurses’ lives and careers.…”

“…PMIEs are most often not acknowledged immediately after being experienced, but rather upon recall, which means that their impact on psycho-social functioning is dependent upon a person’s memory of the event [ 8 , 10 ]. Although the effects of nurses’ memories of PMIEs during the COVID-19 pandemic on some well-being indicators have been explored before [ 10 ], we aim to widen the scope of this incipient line of research and further investigate their impact on nurses’ lives and careers. Drawing from Self-Determination Theory (SDT), recent research on moral memories [ 11 ] and moral injury [ 5 ], our study aims to investigate how memories of work-related PMIEs influence nurses’ burnout and turnover intentions after at least six months from exposure.…”

“…Thus, the effects they found could be attributed to memories of PMIEs rather than exposure to them. However, the instruments they employed (i.e., scales measuring whether exposure had occurred) and the differences in the amount of time having passed from exposure to data collection prevent us from drawing precise conclusions concerning the role of their episodic memories in the respective outcomes [ 5 , 10 , 12 , 13 ], since episodic memories from the same time period have to be recalled in detail during data collection to explore this topic [ 11 , 25 , 26 , 27 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Protective Factors against Morally Injurious Memories from the COVID-19 Pandemic on Nurses’ Occupational Wellbeing: A Cross-Sectional Experimental Study

“…One potential explanation for this trend is the negative impact of the repeated recall of autobiographical episodic memories of these events. Thus, studies found that nurses’ episodic memories of PMIEs can have a unique negative association with their burnout, work motivation, work satisfaction, and adaptive performance several months after the event, mediated by autonomy thwarting [ 12 ]. Memories of self-PMIEs had stronger associations with burnout and turnover intentions compared to memories of other-PMIEs (i.e., enacted vs. witnessed PMIEs), mediated by the thwarting of all three basic psychological needs [ 13 ].…”