[00:00:00] Hey, and welcome back to pulse check podcast.

[00:00:03] And he, he, Hey, he, he and everyone listening today, we’re headed back to the deadly shame paper that we chatted about recently. And if you haven’t gone through all the pages, I hope that you will, but you don’t have to because we’re picking more of it apart today. It’s called. Deadly shame, redressing the devaluation of registered nurse labor through pandemic equity written by national nurses United.

[00:00:31] And it is one part of our conversation today on moral injury and fragmented care and why this topic is so interesting. Key. What’s up with this topic? Why, why is this interesting? Wow. 

[00:00:44] Pressing or is it just so. Prevalent. So for me, it’s not necessarily interesting. It’s just that you were, you were explaining this to me earlier that, you know, there’s not anyone in our medical field that’s untouched by this unscathed.

[00:01:04] Right. The idea of moral injury is when someone knows the right thing to do, they’re witnessing something other than the right thing to do. And because of the. Institutional constraints. They’re unable to speak up. And that is just so sad. I think. Cause when I think about medical professionals, which of course I am not, I always think about how much these people want.

[00:01:35] Other people, right? That’s pretty much why people get into medicine is their caregivers. They want to take care of people. They want to make our world better. Yet. They enter a system that is so utterly broken. And by just going through the system, it ultimately breaks these humans. And with that, we get really fragmented care.

[00:01:57] Right? If you if you. You’re trying to heal place, heal people from a place of being broken, how much healing can you really do? And later in this episode, we will reference a study that talks about the PTSD. Physicians Carrie, just from, from doing their job. One of my favorite quotes about this is from Dr.

[00:02:18] Stephanie Mitchell, who is a midwife in Alabama, and she talks about being a dented pan and she says, you know, you can make the most beautiful bread ever, but if you’re doing it in a dented. Every single time your bread is going to be dented. And I, I think about this because if you are giving care from a place of being broken, it doesn’t matter how much you want to give really good care or how much you believe.

[00:02:48] And you’re trying to give really good care. It’s broken care because you’re coming from a place of brokenness. 

[00:02:57] Yes. He, he, I totally agree that this is something that. Truly truly affects everyone. Why it’s so important that we talk about it. Why it’s so important that we share these definitions. What stuck out to me was like you addressed the definition of moral injury.

[00:03:13] Actually, if you’ve ever, if you’ve never heard of this. I hear you. I’m right here with you. This is not something that I knew intuitively what this meant. I had heard of PTSD. I had heard of burnout, but if you’re a medical professional listening, have you heard of moral distress and moral injury? And they’re not new terms.

[00:03:35] Andrew Jameson, J J mutton professor of ethics, coined moral distress in the eighties. And that was the definition that he, he just shared one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. And then Jonathan Shay veteran affairs psychiatrist.

[00:03:53] Added moral injury, which is a betrayal of its right by someone who holds legitimate authority in a high stakes situation. So distress is like this underlying, I feel like that’s kind of the day-to-day and then the injury can occur on top of, or in addition to I’m in a high stakes situation. And this can happen if you’re the perpetrator.

[00:04:21] If you’re a witness failing to prevent an action or an injury, or if you’re just bearing witness to acts that train, scratch transgress deeply held moral beliefs. So it becomes moral injury. If the events in both grave threats to personal integrity or loss of life, 

[00:04:44] So as a healthcare professional, when you’re standing there watching one of your colleagues do something that.

[00:04:57] You know, this isn’t a matter of just disagreeing on how to carry out care or how to treat a patient. This is more so that you’re witnessing something that is unethical. Right? And so as that professional, that’s witnessing this and you’re surrounded by other medical professionals who also aren’t speaking up.

[00:05:28] How does that feel? 

[00:05:30] It’s pretty messed up. Huh? There’s this really, really strong culture and hierarchy in medicine. And that plays into people’s react, folks, reactions, to things that plays into this like internal dialogue of all of these high ranking important. I think it’s very parallel to the military.

[00:05:55] I, I’m not in the military, but the stories that I hear and a lot of this information, unfortunately comes from. Like even Jonathan Shay veteran affairs comes from understanding PTSD from, or veterans. There’s this hierarchy that is so ingrained. And we see all of these people that are, oh, this person is doctor so-and-so and head of whatever and charge nurse.

[00:06:20] And this nurse has been here for 35 years. And all of these factors that we put all of this importance on, and no one’s saying anything. No, one’s saying anything. I remember distinctly having conversations about what I didn’t know. Moral distress and moral injury and ethics and human rights at the nurses’ station in front of multiple physicians, residents, charge nurses, veteran, you know, longstanding nurses, lifelong nurses, new nurses, and just posing questions of human rights and questions of like, why do we do this?

[00:06:54] Does this have to happen? And it was so bizarre that no one said anything. And I thought, is there something dead inside with all 15 of these people that I’m working with? Because I like most of them, even I know them, I’ve worked with him for years. Our kids know each other, like, come on, what is going on?

[00:07:14] Is there something dead inside? Am I. Am I just pushing, am I just being difficult? That’s when that, as gender discrimination comes in, that we recently discussed just know your place and be quiet and stop rocking the boat. When we were trying to have discussion, which is, I think, a safe time to talk about.

[00:07:35] Issues because it’s not happening right then, so we can discuss it, let it out like what were some extenuating circumstances or other factors that maybe I didn’t witness when I’m talking about something that I saw or heard about, you know, that’s, when that can be explained and discussed and nothing, there was just nothing from anyone and it it’s, it makes you feel crazy, 

[00:07:58] an isolated and wound and.

[00:08:02] You are a whistleblower, 

[00:08:07] right? Yeah. And, and it, you question like if you, if you are a whistleblower, if you do move forward with reporting or, you know, whatever, all of those steps are that sometimes are just for show. How difficult will it be? Because all of these people don’t care or seemingly don’t care, or won’t speak up with you or won’t have these difficult conversations or can’t come to terms with it.

[00:08:37] And, and I understand that’s a psychological, you know, like that’s maybe their trauma safety net, maybe that’s their brain protecting them. Now I know that. In the moment. And regardless of when it happens, it’s still hurt. You’re still hurting other humans. You’re still being hurt by witnessing it or doing it yourself because of institutional constraints.

[00:09:01] So my goal with this episode and us discussing this is not like, Hey, look at all the shit that’s going on. And isn’t it disgusting. Is this isn’t your fault? This is not your fault. You are not, not a good enough person. Like he said, we do want to help other humans. That’s what we love. That’s why we keep freaking going back to work because we really love that part.

[00:09:26] We love our patients. We love sometimes there’s some really great comradery and there’s some support and family feelings within the group, which also makes it really amped up because then when you witness something or you see something and you feel like, oh my gosh, these are my people. The, it becomes really messy when it’s someone that you care about.

[00:09:45] You’ve worked with closely, you’ve gone through traumatic events together and also there’s this whole other level of, and this beautiful white paper. Oh my gosh. It just hits on all of these points. These geniuses genius writers hit on. Even the point that then you have to grapple with the fact that you are all working for an institution.

[00:10:09] That allows and perpetuates and possibly sets up harm occurring to patients, communities, and staff that they employ and have within their walls. 

[00:10:24] Well, I think you just hit the nail on the head is that it is much deeper than just. Oops. I saw Dr. Jones do something bad today and that’s that we’re going to leave it here.

[00:10:41] It doesn’t get left there. The patient carries it for the rest of their life. Those witnesses carry it for the rest of their life. Who does the violation? Who knows if they carry it for the rest of their life. It’s hard to believe that someone who violates patients regularly like that. Carries all of that with them, but it’s deeper than just another day on the job.

[00:11:08] It has this rippling effect. And you know, that study that we mentioned in the intro, it’s a 2016 study and it actually is a compilation of nine different smaller studies that accumulated to look at 1,616 physicians. And they evaluated the prevalence of PTSD among physicians. And they found that your average adult is going to have a three to 4% rate of PTSD or three to 4% of adults are going to experience PTSD now to put some.

[00:11:51] Reference around this prisoners of war or people who have been traumatized by war or torture typically fall in the range of 20 to 45%. So where do our physicians fall in that? Not much lower because they have a 14.8% prevalence of PTSD. 15%. Roughly of our healthcare physicians are walking around and giving care from a place of truly being traumatized to the point that they have P T S D.

[00:12:35] Can we take a moment to just think about how that might lead to worse clinical outcomes and, you know, Patient dissatisfaction and how it ripples into the morale of that unit. And, you know, I don’t know. Where you practice, whatever unit you are listening from now. I don’t want you to think that this doesn’t happen on your unit.

[00:13:07] And some units, some hospitals, some providers, some systems are going to be better than others, and some will be worse, but this is indiscriminate. It happens on every single unit at every single hospital, within every single system, because that’s just what the American healthcare system. Was built to be, it was built to be this very patriarchal control focused system that ran patients in for profit and were really prioritizing a, their health B their outcomes or their satisfaction.

[00:13:50] And so this moral injury. It just is so much deeper than I think anyone realizes there’s no part of medicine. That’s not untouched by it. And for me, that is the most just shocking part of this. It really shocks me to my core that every single person will be touched by moral injury, whether it be directly or indirectly.

[00:14:21] Sure 

[00:14:21] for sure. And it’s highlighted and been heightened since the pandemic started here. And a lot of things have been uncovered and kind of that underlying day-to-day moral distress. And that’s not saying that everyone has moral distress everyday, but for sure, absolutely. It happened every day continues to happen to, to the pandemic and the.

[00:14:46] Institutions and the systems maximizing profit over people. And I want to go back to something that you said that is a, I think a difference between you and me and our perspectives. So your perspective, looking into the medical system, my perspective, looking out from the medical system is that. And listeners.

[00:15:09] I’m so curious. I want it, I want you to like jump out of your headset. Tell me where, where are you in that system and and what have you, what kind of, what’s your perspective on this? Because, because he, you said that the perpetrator. Don’t hold on to the portrayal and moral injury, moral distresses that betrayal of what’s right.

[00:15:29] Someone doing something, even though it’s not the rightest, the safest, the most ethical, whatever it is. And they’re, they’re perpetrators and they’re this like other person, these others. Right. And there are absolutely others, like. People sick, sickos, not like sick. Like we’re all a little, we’re all a little going through something.

[00:15:55] No, I mean like sickos, like people who attack other people they’re, they’re everywhere. They’re there. That’s not necessarily this, those people maybe don’t know what’s right now. Or don’t care or they’re like above, or they get their shits and giggles out of whatever they’re doing in their job. That’s every job, those are the, to me, those are the others in this scenario, however, and what hurts the most and what.

[00:16:24] Is why they’re kind of looking into a moral injury. Moral distress does not, is not a category in the DSM book of psychiatric diagnoses yet. They do believe it is related to PTSD. And they’re working on studies around, does this cause it is this part of it. Is this a type of like, what is this? How is this related?

[00:16:44] Because it is so similar. And even you, without even noticing pulled up the studies on PTSD and physicians, because they are so very similar. This is an everybody problem. This is an everybody issue, not an other people issue because these aren’t perpetrators that are breaking rules for fun, or for gain or for game or sport.

[00:17:10] These are betrayals of what’s, right? Because they can’t do anything else because they are constrained. And, and I do. And the paper highlights the result of it. And these two trauma experts have discussed a little bit of the results and maybe how you can tell or how you can see this in your place of work and in your life.

[00:17:35] Those who commit those who commit the betrayal, those who are the the people who are not able to do the right thing because of the constraints, the committers internalize feelings of guilt and. Which is not those other people, right? The other people who do harm for sport maybe are not really internalizing feelings of guilt and shame.

[00:17:56] So the committers are actually hurt. And then the witnesses often externalize emotions with anger and resentment, anyone feeling any of these things because. That’s totally normal expected. I can really relate to all of them. And the paper talks about if you’re, if you’re internalizing oftentimes nurses, cause this is a paper written by and for nurses and about nurses are not the committers, but I would actually kind of challenge.

[00:18:29] And and then the paper addresses that often the nurses or the witnesses, because they actually have less power and less authority on that ranking. And they are pretty much oppressed in many, many, many ways by the authority and by the institutions. So. They often feel like and rightfully so they want to do the right thing.

[00:18:49] They know the right thing. They are told to shut up and sit down. So they, they externalize emotions with anger and resentment, which can be really helpful. When you’re looking at a solution. You take that anger and resentment, you funnel it into joining forces together with our powers combined. We are captain planet.

[00:19:08] We unionize. We put our forces together. We change legislation together. Like we can be powerhouses together when we are using these feelings for good, right. Where like putting a goal to them, an example where I would, would like to challenge that these are everyday people and these are everyday situations that just really are shitty and not our fault is considered an example of COVID.

[00:19:34] So. The, there was political and institutional pressures around, you know, how, what they were going to call COVID transfer or I’m getting all my words mixed up, but they were deciding like, what kind of PPE do we have? What kind of PP do our staff? And then they thought, oh my gosh, we don’t have enough.

[00:19:54] Let’s just call it droplet. Instead of airborne let’s de downgrade, all of the all of the research that we know, and we’re going to. Not give out sufficient PPE because we don’t have it because it’s a maximized profit system and they use just-in-time model. So they didn’t have any stores. So a nurse goes to work and the nurse is provided with insufficient PPE during their shift.

[00:20:22] They are experts at what they do, so they know damn well, they need more protection from what’s going on. So. They just don’t get it. They know damn well that they are going to potentially get sick, hurt others. And what are they going to do about it? All their PPE is locked literally behind the door with a key and only management has that.

[00:20:43] They can’t change that fact. They know they need it to protect themselves and they’re juggling. Like, do I keep my job? Do I say, what do I do? My patients need me, you know, that whole, like really toxic story that’s told in the hospital that patients need nurses. And that really is. The hospital needs they’re ours.

[00:21:05] And then they’re actually seeing it spread. So they’re seeing their colleagues get sick. They’re seeing their colleagues die.

[00:21:14] So then they go home and could potentially pass it on to their family. They know they’re contaminating their home because they know it’s airborne because it was said that it was airborne. Or if we don’t know, we always protect one above. You know, if you’re like, oh, we think it’s droplet, but we’re not sure.

[00:21:36] Then you go airborne and you come back down when the health and safety is not at risk, but instead they’re working in risk environments, known risk environments. So they are almost the witness and the commitment. ’cause they, without being able to change their situation, they can’t just materialize respirators.

[00:21:56] They would need hundreds to get through a shift into, to protect themselves on their unit. They can’t change that fact. So if they stay, they are potentially that they are

[00:22:13] witnessing. These things happening to others. They’re witnessing people dying, they’re witnessing problems, but then they also might actually be doing harm by going home. They’re betraying what they know is right. They’re staying in their job and they’re going home to their family and potentially giving them COVID because they know that they’re a known risk, but they have to take care of their family.

[00:22:38] These are impossible situations and it’s similar to. It’s literally what happened and also similar to what happens inside of medicine, as these are everyday people making and knowing the right choice to make, and it being impossible, their arms are literally tied and they’re just, how do I, how do I get through this?

[00:22:59] How do I survive this? How do I help in the most helpful way in these impossible constraints? 

[00:23:07] And how do you not get mad about that? You 

[00:23:09] do, you fucking get so mad. That’s why it’s anger and resentment. Exactly. 

[00:23:15] How do you not feel anger and resentment to this? So, you know, when. When we talk about angry nurses or angry physicians, it’s bigger than anything you can see on the surface level.

[00:23:31] They’re not just having a bad day. They didn’t just not sleep well. Last night they are working in. Shitty unsafe conditions with unfair wages and bonuses that are dangled in front of them, and then never actually followed through on, and they’re answering to upper management that actually doesn’t give a shit about them at all.

[00:23:54] And we saw that play out in COVID. We saw just what our government and our hospital admins thought about our frontline workers. And it’s. Super heartbreaking. So let’s talk about for a second.

[00:24:16] What if and what do you do if you are forced to go from being a wit. To the perpetrator, because it’s an order given to you, you as let’s go to an L and D unit, cause that’s something I’m familiar with and you are as well, Mandy, but easy example for me is your attending physician tells you to go and do this to a patient, you know, and then you’re put in a position of.

[00:24:53] Doing something that you know is morally and ethically wrong, but it was an order from someone higher up. Now, of course, as a nurse, you always have, you know, the fallback, this, the safety net of informed consent refusal and take, explain what you’re doing to your patient. And they do of course have the right to say yes or no.

[00:25:14] But if you’re talking to someone who is not an educated and informed consumer, They may feel that because it’s coming from you, it’s the right choice to make when in your heart, you know, it’s not right, the right choice to make, but that’s what you were told to do. That’s your order, how much trauma and PTSD and just dents to our pants com.

[00:25:47] From that from having your hands forcibly tied behind your back, where you, you really can’t move one way or the other. And now on top of it, you’re told to do something that deep down in your soul and with your medical training, you know, 

[00:26:07] Well, that happens, happens all the time and yeah, you hit the nail on the head.

[00:26:13] I think that that is different than I think the, the good part of that is if that were to happen to me, you know, as the nurse low on the totem pole or as an intern or a resident or student, it feels so I’m, I have the definition of moral distress right here. It feels impossible, but it’s. So the good news is that is not an impossible situation.

[00:26:38] It’s just really, really awful situation. But that ultimately would be because I know there’s like, there’s a reaction. So if I say, oh, no, that’s not that’s not ethical that there’s nothing I can do about that. I’m not gonna be able to do that. And there’s going to be retaliation, right? They’re gonna roll their eyes, whether they’re gonna, I’ll get somebody else to do it, or they’re gone.

[00:27:00] And that. I might be witness. Too, or I might have the choice to try it. You know, then my choice changes from doing the thing to actually whistleblowing about, you know, this is being done and that’s just, it’s just exhausting. Just even thinking through all of those like tree branches of how this can change, but it does feel impossible because okay, the intern is told, go do this exam and we have to know the cervical check and.

[00:27:30] You know, if you don’t like, this is your sole job, like, what are you good for else? If you don’t and the person thinks, you know, the intern is like, well, I can’t just go to a cervical exam. Like it’s either gonna happen or it’s not going to happen because that’s. Birthing person. So then they have that discussion and if they choose not to course and they choose not to pressure and they choose not to intimidate and they’re just like, okay, you don’t want one, you don’t want one.

[00:27:58] Cool. They know probably going back into that room with the attending, it’s going to mean something negative, but it is not necessarily mean that it is impossible for you to make the right choice. You might get hurt. Abuse, assault toxic work environment you know, totally abusive power. Like those are different words for different things of what’s going on, but the, so that’s great because we can work on something totally different.

[00:28:28] That’s internal that’s, you know, the political and cultural parts of working in the hospital. It’s the. Impossibility because of the institution that makes up moral distress and moral injury, like, like patients aren’t turned and get bedsores because the institution won’t purchase equipment to help turn people and they understaffed nurses purposefully.

[00:29:03] So. You know, you’re just, you’re in a system where you’re watching people get hurt day after day after day after day, because of how their treatment plan is limited by the tools, the red tape. Right. And so then your system is like, well, we don’t have money for the equipment. And it’s just this gaslighting, like all these stories happen, but all they need to do is buy the.

[00:29:32] And pay enough hands to help turn this many people. It’s an equation. We know the answer, but it is actually impossible for one human to turn one other human who, you know, like it is impossible. I can’t like, there’s nothing I can do to turn this person by myself. And there are literally three people on the unit dealing with fires.

[00:29:55] That’s where you’re like, oh my gosh, my hands are tied. I literally am just watching this. 

[00:30:02] We don’t have the money, but our CEO is mill. At the end of the year. We hospitals the money to buy well a to staff properly, but then to purchase the tools that are actually needed to properly support our staff to actually properly care for humans, which at the end of the day, 

[00:30:24] Hello, that’s your business license, right?

[00:30:28] That’s what we’re 

[00:30:28] supposed to be. You can’t be all gathered 

[00:30:31] here today. You shut the doors to that facility. You shut the doors to that unit. You shut the doors until you can safely do that. But instead it’s like, oh, well, you know, we got this pizza in the break room and we got. We know we got, we got a bonus coming.

[00:30:50] Like I don’t even know what they give. They don’t give anything. They’re just like, you need the job. Where else are you going to work? Can’t do this anywhere else. And then it’s this like toxic storyline that just keeps going. I think that there are a lot of ways to come by trauma and stress in the workplace.

[00:31:09] And that’s an uncomfortable laugh, not a real laugh. And if you’re watching or I’m sorry, if you’re listening and you’re feeling like, oh yeah, I have externalized, anger and resentment. Fuck them. And I have internalized feelings of guilt and shame time sometimes. Can I be both? Yes. And it’s the institution.

[00:31:25] You are not a bad person. You are not about care provider. Your teammates are always inherently bad. A lot of times you’re literally in impossible situations and it shouldn’t be like that. 

[00:31:36] And we see you. We know that’s not why you got into medicine. We know this is not what you thought it was going to be.

[00:31:43] This is not what you had envisioned. We see you. 

[00:31:48] Yeah. Yep. We’re here for you. This is hard. Yeah. These are hard. 

[00:31:54] It is hard. Okay. So Mandy, where’s the breakdown and maybe this is a great place to wrap up right before we tell people what they can do if they are experienced in this. But where’s the breakdown because we must be seeing clinical outcomes suffer at the hands of understaffed.

[00:32:17] Hospitals and floors that don’t have the tools that they need to properly care for patients. So where’s the breakdown happening where we’re having bad clinical outcomes, but hospitals are not having to do anything. For 

[00:32:37] the hospitals are such a big corporation. Corporate medicine is so huge and powerful because of money.

[00:32:45] They make so much money in all of this. They made money in 2020. They made money, regardless of what they told you, they made money. They walked home with more money than they had in 2019, every single one of them. And they’re just taking over the corporate medicine is just gobbling up all the other hospitals.

[00:33:02] And so it’s turning into a conveyor belt system and that is not made up. I just went to a training on it by, you know national nurses United, it was fabulous. And they’re learning from the car industry, the auto industry about how to cut costs and cut, like work that doesn’t make money. Like turning people doesn’t make money, but beds, we’re sure as all my make money and they call it all of these different things, which sounds great.

[00:33:33] And they say that they’re, you know, our bottom line is patient safety and it’s all BS. And then they lobby for unsafe health conditions and unsafe staffing ratios. And they lobby against equitable pay. They lobby against all of these things. So you just follow the money and the answers are always there with hospitals.

[00:33:52] And they’ll say, you know, we can’t, there’s a nursing shortage and then you see them on Capitol hill lobbying against. Safe staffing so that they don’t have to hire more people. So the breakdown is where in an industry that we think is doing one thing and its goals are completely different than what we think.

[00:34:12] And it’s, it’s meant to look like that. 

[00:34:16] Yeah. It’s a typical. Wolf in sheep’s clothing on the outside. They want to present themselves as this nice cuddly sheep that is here to take care of you. And whether you’re the patient or the provider, we’re here to take care of you. And then whether you’re the patient or the providers at Teresa’s, they’re not here to take care of them.

[00:34:41] Yeah, the bottom line. And if you’re not impacting it positively cancers are you’re going to pay the price for that. 

[00:34:50] Yep. Yup. Yup. You’re going to pay the price for it. And this white paper, man, they have got some and SIRS for this and this is just one side of it. But their answers of joining forces, United fronts and speaking to the bottom line is powerful and effective.

[00:35:12] And they are channeling this anger and resentment. Like if we are all freaking dealing with all of this and it’s all the same everywhere, like we’ve got to get it together and join forces, work together. Nurses, physicians. All of us have to be like, no, this is bullshit. We are smarter than the S you cannot just tell us some lie and then make it go away.

[00:35:36] We are hurting and we are not effective care providers anymore. If this is going on or we’re all gonna be dead and you deserve 

[00:35:45] better and your patients deserve better, we all deserve better when it comes 

[00:35:53] to this. Yeah, so they outline and we’ll continue to discuss this. They outline ways to team up, work together, all speak the same language, get on the same page and support each other in big, powerful, effective ways.

[00:36:08] It’s the only way it’s why you ever talk about any of the. And, and around your hospital, the hospital gets super nervous. Yep. They cut it. They shut it down because that is what they’re afraid of because we are a big, powerful force. We’re very smart. We’re just being oppressed right now. And. Put in impossible situations, but I think once we all acknowledged what that is, and we all agree that it’s nonsense and it’s not for us and we’re not here for it.

[00:36:37] And we’re better than that. And our families are better than that. And our patients are better than that. Then we can get our minds wrapped around what’s next and what’s next is we have to demand change. So I’m glad. I’m glad that we’ve had this, this topic out on the table moral injury, moral distress, and fragmented care affects every single person, whether you’re in healthcare or not.

[00:36:59] And it’s something that we should be talking about. We should be asking questions about. So if you have stories about this, we’d love to hear it. If you are getting some things uncovered in your memories and you’re writing them down, send them on to us. We’d love to hear your, this is, these are just a couple of our perspective.

[00:37:15] W we’d love to hear your stories. 

[00:37:18] We sure would you guys, if you’re out there listening and this resonate with you and you’re like, wow, I think I have some moral injury, please prioritize yourself. Get yourself some mental health support. You are not a broken human. You are working within a broken system and we see you Mandy and I are here for you.

[00:37:39] We started this podcast to help voice these exact situations so that we can. Unbreak healthcare. All right. We will see you guys next time. Bye. 

[00:37:56] If you or anyone, you know, has a story to share, please contact us on Instagram at pulse check dot podcast.

[00:38:03] We’d love to share your story.