Creative connections – pathways to repair and recovery from moral injury

By: Sue Spencer

On 1st June 2015 I found myself unexpectedly unbusy, sent on “gardening leave” and unemployable. This blog is my reflection on my experience of presenting poems about my nursing career at an academic conference and how I found myself compelled to share this work (1).

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“Doing my job”

My story is about how bullying, alienation, exile, lies, betrayal and eradication can happen to anyone. I thought I was simply doing my job – I thought I should be auditing practice, aspiring to excellence and developing connections with the local community.

I believed I was equipped to cope, that I had the required leadership skills and the know-how to be a senior manager and effect transformation. I now know that I was mistaken – I now realise that within a complex web of absences, ideas were formulated that led to the assumption that I was driven by a motivation to be seen to be doing good rather than actually doing the right thing – the appearance of action not the substance.

When thinking through how I was feeling a decade ago, it was the absence of action that distressed me most. 12-hour shifts that resulted in very little continuity of care (most staff were very part-time) and no accountability (handovers were brief and there was no analysis of lengths of stay or referral patterns). When getting to know staff it became clear that they were more interested in the social life offered or preoccupied with the stress of developing fund-raising projects rather than concentrating efforts on providing evidence-based care and making timely referral phone calls. Again, there is plenty of evidence and insights into the conditions that result in suboptimal care and missed opportunities for interventions that can make a difference (2).

I thought I was adequately prepared for what I was walking into BUT I wasn’t – there were behaviours, omissions and oversights that I was meant to ignore. I was supposed to be so full of my own sense of importance and missionary zeal that I would ignore the ingredients essential for good governance and safe practice. The mistakes I made were many BUT that was probably the one that cost me my job, my wellbeing and ended my nursing career; I was let go and erased from the organisation.

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The Power of Poetry

Meeting Julia Darling in 2003 changed the focus of my writing from academic to creative. Since then, I have been committed to creative approaches to reflective practice. The Moral Injury Conference in April was the first time in a decade that I felt able to share my own learning to an academic audience.

Sue speaking at the Moral Injury Conference in April

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Here  I share some of my thinking about what I have learnt about the power of poetry, moral repair, being brave and sharing vulnerabilities.

1. Sharing poems within the context of moral injury meant there was shared understanding that something significant had happened to me. That I had chosen to be there to share how writing and reading poetry aloud had helped me recover from isolation, alienation and eradication and there was a kind and respectful audience. It wasn’t just about sympathy for what had happened or appreciation of poetry as a form of self expression– it was also about how I signalled the connections with the wider world of poetry and the poets who have addressed injustice and political wrongs (3).

2. The power of poetry is that it gives you a voice that isn’t just about self-indulgence or inner monologues (4). Sharing poems that have been crafted and edited over a decade, meant I was able to stand up in front of an audience of strangers and admit that I had mis-stepped in my career. I didn’t have to be specific about the organisation; I didn’t even have to provide details of what had gone wrong or what had happened. The poems told a story about sites and scenes within my nursing career that shed light on why what happened occurred and why similar happenings continue to occur to practitioners in 2025.

3. I deliberately chose not to present a forensic account of what the circumstances were when I found myself unexpectedly unbusy in 2015. Instead, I let the poems communicate the essence of a range of feelings (some experienced, whilst others were gathered from academic articles). I read poems that offered insight into environmental conditions within practice and the precursors to events that provided a narrative that illuminated how we should not ignore signs, symptoms and data from our emotions (5).

4. Sharing my poems opened a line of inquiry that indicated that NOT all is what it seems in organisations that are about caring for, caring about and caring with (6).

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Key take aways

The evidence is growing that there is something URGENT and IMPORTANT to address around the cultures, environmental conditions and the relationships in caring professions (7).

I am sharing this story not for some self-indulgent reverie BUT because I know I am NOT the only one that this has happened to in healthcare. I know there are others who have been misrepresented, lied about and abused. We know a lot about scapegoating and ostracising whistleblowers(8). I keep wondering how many more public inquiries there will be before someone twigs that “something needs sorting” and that too many assumptions are being made in caring professions about motivation, relationships and the spaces between. I have witnessed how stress and overwork can do untold damage to the capacity to care for other people. As a consequence I have been on the wrong end of ruptures in the moral fabric of a team and unkindness in times of change, uncertainty and insecurity.

I believe that we can do better than this and talking about distress/injury/betrayal can make all the difference to those of us who have been isolated by our experiences (9). To heal from these experiences might not be about bouncing back but returning changed – never the same again. We might not be able to work in those environments again BUT we shouldn’t be discounted and cast aside. We have value, we have other ways to contribute and most of all we need to be connected to other humans and the more than human world to help us appreciate that we still have a reason to be here and re-discover and re-vision our purpose in the world (10).

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References and links

1.      https://www.durham.ac.uk/research/institutes-and-centres/moral-injury/events/conferences/

2.      Jackson, D., 2022. When niceness becomes toxic, or, how niceness effectively silences nurses and maintains the status quo in nursing. Journal of Advanced Nursing, 78(10), pp.e113-e114.

3.      Cloud, A. and Faulkner, S.L. eds., 2019. Poetic inquiry as social justice and political response. Vernon Press.

4.      Audre Lorde 1985 Poetry is not a luxury. Claudia Rankine 2014 Citizen An American Lyric

5.      Susan David 2016 Emotional Agility Penguin Books

6.      Renzenbrink, I., 2007. The Shadow side of hospice care. Illness, Crisis & Loss, 15(3), pp.245-259.

7.      Boy, Y. and Sürmeli, M., 2023. Quiet quitting: A significant risk for global healthcare. Journal of global health, 13, p.03014.

8.      McHale, J. V. 2022. Whistleblowing in the NHS: the need for a new generation to learn the lessons. Journal of Medical Ethics, 48(10), 684-684.

9.      DeMarco, M.J., 2024. 6-Fold path to self-forgiveness: an interdisciplinary model for the treatment of moral injury with intervention strategies for clinicians. Frontiers in Psychology, 15, p.1437070.

10.  Walker, M. U. 2006. Moral repair: Reconstructing moral relations after wrongdoing. Cambridge University Press.

Supporting bereaved healthcare workers.

by Jules Lewis RGN MSc

My name is Jules Lewis and I am a Swan End of Life Care Lead Nurse at The Shrewsbury and Telford Hospital NHS Trust and PhD Student at Staffordshire University. I am also bereaved by suicide, my beautiful best friend Janet took her own life in February 2019 aged 47, a caring and compassionate friend and nurse for over 20 years.

I set up, with the support from our lead volunteer & our administrator, a staff bereavement support service at the hospital where I work. This intervention includes 1-2-1 support sessions, a safe space to be heard, with compassion, kindness, understanding, support and signposting to other support services as required.

Funding for this service was gained from Health Education England following a successful business case application. This money is used to backfill my hours to allow me to do this work for a few hours per week, and to cover the cost of room bookings to ensure we have a safe space to support staff. We are lucky enough to have a perfect venue on the hospital site but not in the main building. 

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Bereavement support cafes.

We also offer an ongoing peer support group, in the form of staff bereavement support cafes, these run every few months throughout the year.  This support is for all bereaved staff who work at the hospital, it is to support staff with personal bereavement or professional deaths (the death of a person they cared for). This can range from expected, unexpected, traumatic & bereaved by suicide. I am currently supporting several staff who have been bereaved by suicide.

“It has proved more valuable than I ever thought. Just to have the space and time to process and talk about my feelings following my bereavement I have found incredibly helpful.”

Bereavement café attendee    

At the December café each year we have a tree of hope where staff who attend the café and others can write a bereavement memory tag and place it on the tree in memory of their loved one. It remains in our conference centre for several weeks over the Christmas and New Year period.

“Having a safe, secure and confidential person to speak with has really helped me work through some of the difficulties of my recent bereavement.”

Bereavement café attendee

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The aim of my PhD pilot project is to evaluate the effect a bereavement intervention has on healthcare staff’s health and wellbeing.

In addition to our bereavement support we have also set up a walk and talk session, available to all staff, once a month at lunchtime. On a 20–30 minute walk we offer a listening ear and kindness. Signposting to further support as appropriate and required. We aim to encourage staff to get into nature and boost their health and wellbeing.

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Poetry.

I’d like to share two poems by my friend Brendon Feeley. We gift the first beautiful poem – ‘No Judgement Here’ to staff at our bereavement cafes.

Jules Lewis and Brendan Feeley

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No Judgement Here

This is a safe environment.

There is nothing for you to fear.

There is no need to worry.

There is no judgement here.

If you feel you need a friend,

reach out and you will find

this world can be incredible,

with people caring and kind.     

By Brendon Feeley

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This 2nd poem is one that I hope will give nurses and others the hope to get help and support for the future.

Not Today

When the darkness falls around you

and the light has all but gone,

it’s then that you dig deepest

for the strength to carry on.

With the biggest smile you can muster,

stare into the darkness and say,

I’ve bested darker days than this,

and you won’t win today. 

By Brendon Feeley

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Thank you for reading this blog, we hope it makes a difference at the hardest of times.

Best wishes,

Jules and Brendon.

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