Burnout: A workplace phenomenon that results from “chronic workplace stress that has not been successfully managed [and is] characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and 3) a sense of ineffectiveness and lack of accomplishment.”1

Compassion Fatigue: “Stress resulting from exposure to a traumatized individual. Compassion fatigue has been described as the convergence of secondary traumatic stress and cumulative burnout, a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment.”2 Compassion fatigue and the cynicism dimension of burnout are likely related.  

Health Equity: “Health equity means that everyone has a fair and just opportunity to be as healthy as possible.”3 When applied to the work and learning environments, every employee and learner at an organization has a fair and just opportunity to achieve their best health. Lack of health equity for patients and communities also creates opportunities for moral distress and moral injury among the health and public safety workforce.4

Health Workers: All people engaged in work whose primary intent is to improve health, including health management and support workers.5

Learners: Those in process of becoming health or public safety workers, including students and trainees.

Moral Dilemma: Unavoidable experiences in healthcare and public safety that are difficult and, at times, deeply challenging decisions because more than one answer is morally defensible, but none leads to an ideal outcome.6

Moral Distress: “Results from illegitimate constraints in clinical practice affecting healthcare and public safety professionals’ moral agency.”7 Moral distress is a relational concept that takes into account the contexts of practice and power dynamics.8

Moral Injury: Perceived betrayal by a legitimate authority in a high stakes situation,9 which leads one, through action or inaction, to transgress one’s deeply held moral beliefs and expectations.10 Moral injury occurs when workers begin to question the moral framework of the system and their own moral framework for continuing to work within that system.11

Provider: The Public Health Service Act includes health care institutions and individuals in the definition of "provider."12 To minimize confusion we limit the use of "provider" to institutions, and refer to individuals as health workers (see definition above).

Public Safety Workers: Broad term for those who ensure safety and security, including police, firefighters, ambulance & rescue personnel, communications & dispatch specialists, and others.13,14 

Resilience: The ability of a person, community, or system to withstand, recover, or even grow from adversity.15 Resilience has multiple dimensions, including physical, psychological, social, and moral.16

Safety Net Settings: “Providers that organize and deliver a significant level of health care and other needed services to uninsured, Medicaid and other vulnerable patients”17


  1. International Classification of Diseases, Eleventh Revision (ICD-11). World Health Organization; 2019/2021.
  2. Cocker F, Joss N. Compassion fatigue among healthcare, emergency and community service workers: A systematic review. Int J Environ Res Public Health. 2016;13(6):618. doi:10.3390/ijerph13060618
  3. Braveman P, Arkin E, Orleans T, Plough A. What is Health Equity? Robert Wood Johnson Foundation Library. Published May 2017. Accessed December 23, 2022.
  4. Adapted from: Eisenstein L. To fight burnout, organize. N Engl J Med. 2018;379(6):509-511. doi:10.1056/NEJMp1803771
  5. Adapted from: Occupational health: Health workers. World Health Organization. Accessed August 25, 2023.
  6. Adapted from: Dean W, Talbot SG, Caplan A. Clarifying the language of clinician distress. JAMA. 2020;323(10):923. doi:10.1001/jama.2019.21576
  7. Kolbe L, de Melo-Martin I. Moral distress: What are we measuring? The American Journal of Bioethics. 2023;23(4):46-58. doi:10.1080/15265161.2022.2044544
  8. Adapted from: Varcoe C, Pauly B, Webster G, Storch J. Moral distress: Tensions as springboards for action. HEC Forum. 2012;24(1):51-62. doi:10.1007/s10730-012-9180-2
  9. Adapted from: Shay J. Moral injury. Psychoanal Psychol. 2014;31:182-191. doi: 10.1037/a0036090
  10. Adapted from: Litz BT, Stein N, Delaney E, et al. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clin Psychol Rev. 2009 Dec;29(8):695-706. doi: 10.1016/j.cpr.2009.07.003.
  11. Adapted from: Dean W, Talbot SG, Caplan A. Clarifying the language of clinician distress. JAMA. 2020;323(10):923. doi:10.1001/jama.2019.21576
  12. Public Health Service Act, 42 USC § 300jj. 
  13. Adapted from: Public safety personnel definition. Law Insider. Accessed August 30, 2023.,with%20maintaining%20the%20public%20safety
  14. Adapted from: Public safety personnel (PSP). Canadian Institute for Public Safety Research and Treatment. Accessed August 30, 2023. 
  15. Adapted from: National Academies of Sciences, Engineering, and Medicine. Taking action against clinician burnout: A systems approach to professional well-being. 2019; doi: 10.17226/25521
  16. Rushton, C. H. (Author & Ed) (2018) Moral Resilience: Transforming Moral Suffering in Healthcare. New York: Oxford University Press.
  17. Safety net. Agency for Healthcare Research and Quality. Accessed August 25, 2023.