Canaries in the health coal mine – moral injury in nursing

Anna Mahne, GPNN Champion, explores the science of creating sanctuary for nurses

At our January 2026 GPNN Spotlight Event we explored moral injury in nursing. It brought us back to our 2025 session on Trauma-Informed Leadership, where Anna Mahne helped us understand how leadership can protect the wellbeing of nurses.
Moral injury and burnout are not failures – they are signals. When we learn to listen to the canary’s song and lead with trauma-informed awareness, we create safer, more compassionate cultures for nurses and patients alike.

Nurses are the modern-day canaries of health care and our voices have fallen quiet as we quit from moral injury, burnout and compassion fatigue. So why are our voices not asked for, listened to or heard? This is wake up call to all who know the power of palliative care to hold space and honour the stories of our dying.

Trauma informed leadership asks what is a leaders work in the contemporary context of palliative care?

The answer is to know their own inner canary and then to sense the song of other canaries. To lead ourselves to safety when working in deeply dysregulated and often toxic work cultures IS the work of attuned leadership. It senses the underbelly of what is driving the quiet quitting and has the courage to attend to the relational fabric with a radical awareness of sensing the nervous dysregulation we all hold when under stress. This is a collective urgency for deep team work and it starts with the quiet awareness of our own nervous systems.

TIL understands that there is an emotional world of experience rumbling beneath the surface. It understands that when emotional responses are triggered in the work place that each responds according to the extent of their emotional scars, traumas and emotional strengths.

Relationship is everything so self-care through knowing what you need, is a professional priority, not an optional extra. 

Healing teams happens in relationship but first we must feel safe to connect and that is where Polyvagal theory offers clarity and hope. It is the art of anchoring the Self in safety by learning how we become hijacked by our autonomic nervous systems which both creates and witnesses our lived experiences.

When we sense we are outside our window of tolerance to our environment, we move into the fight-flight sympathetic drive. It primes us to seek out threat and hyper focus on this. Too long in a chronic state of hyper vigilance leads to disconnect where the external environment and its actors need to be dulled and contained for psychological safety. This is where nurses of all grades have operated for too long and why our voices are muted.

Yet we can move out of this disconnect and find safety in ourselves and our teams when we are attuned to others and our own nervous systems regulation.

We all hold trauma in us and we work in a culture that is preformative, transactional, and where vulnerability is not safe. We have numbed ourselves to the fear we hold in us and our teams. So how do we give space to feelings and create places of emotional safety where the relational fabric is authentic and nurturing? If leadership is paralysed through its own trauma, it cannot guide. We must reimagine through a trauma informed lens, not a critical accountability mindset.

 ‘Be Curious …What happened to us’ not ‘What’s wrong with us?’ 

This is the question we should be asking ourselves and helping others to do so also . We work in living systems that adopt survival strategies, returning to normal once the threat has passed but when under chronic stress, we lose resilience and move into overwhelm. So with compassion and curiosity we should be asking three simple questions before we react: I wonder why they are reacting that way: I wonder why they are feeling that way: and I wonder why I am feeling this way?

Victor Frankl gave us wisdom with
‘between the stimulus and the response there is a space. In that space is our power to choose our response. In that response lies our growth and our freedom’

So my ask of leadership

Dare you be vulnerable first in your team? Can you bring your whole Self to work? What is the quality of your presence ? Do you practice self compassion? Are you known, asked and seen? Where do you feel stuck? Can you recognise your own fear and contraction and who deeply listens? Finally, where does unaddressed trauma sit in your team?

So in caring for our canaries we must listen for their song. Creating space to choose your reactions, and meeting fear with presence and knowing is about honouring and accept our humanity. TIL make self care a priority because trauma is in us all and healing is possible when we are able to be connect in safety to ourselves and others. Trust your nervous system to be your guide and be curious and compassionate when listening for the canary song before it fades too faintly.

Anna Mahne
Registered Nurse and Psychotherapy student
GPPN Champion UK

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