When I read CRNA Christine King’s recent article, “Why I left health care after almost 20 years,” I saw many parts of my own story overlap with hers. Her story of moral injury and the heartbreak of working within systems that prioritize profit over human well-being is common among health care professionals.
Her decision to walk away to protect her health and peace is entirely valid. I almost did the same thing ten years ago. As I sat with her words, I kept thinking about the thousands of clinicians who would read her article and find themselves asking a different question.
Not, should I leave health care? But rather, how do I stop abandoning myself while I decide?
That is the conversation I want to have.
I believe there is another way of walking this path. We can look directly at the brokenness of health care and still choose to stay, heal, and live our lives peacefully. It begins by recognizing that most health care systems may never love us back, but we do not have to abandon ourselves in order to remain within them.
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I thought calling, skill, grit, and excellence would be enough. I did not understand how deeply taking responsibility for another human being’s life would live inside my nervous system. I thought if I just kept learning more and doing more, I could outrun what the job was costing me emotionally.
We learn how to hold someone’s life in our hands with calm voices and steady hands. What we are not taught is that our nervous systems are quietly keeping score the entire time. We become so accustomed to carrying enormous responsibility that we stop recognizing how heavy it is.
We are not taught what to do when we sit in our cars after a hard shift, staring into the quiet, feeling lost in our own lives. We are not taught what to do when we wake at two o’clock in the morning, replaying three minutes of a day that simply will not let us go.
When the weight of this calling collides with a profit-driven health care structure, moral injury becomes inevitable. Along the way, we begin to believe there are only two choices: continue sacrificing ourselves to stay, or leave to save ourselves.
I don’t think those are our only options. I believe there is another way. I call it boundaried agency.
Recently, a hospital asked me to be credentialed to help cover staffing gaps. Two weeks before my start date, after my credentialing was complete, they abruptly insisted on a chest X-ray because of my history of contracting latent tuberculosis while working in the operating room several years ago. The request ran counter to CDC guidelines for someone with my treatment history and served no purpose beyond checking a compliance box.
I felt absolute, searing rage.
In the past, I might have swallowed the anger, complied, and let the resentment quietly erode my well-being. Or I would have thrown my hands up and quit in disgust. Instead, I practiced boundaried agency.
A practice I have developed over the years is this: if it’s bigger than the short story, check the long story. When my emotional response feels far bigger than what is sitting directly in front of me, I know today’s moment isn’t carrying today’s weight alone. I sat down with a blank piece of paper and wrote three words: anger, fear and grief. Then I got curious.
The anger wasn’t really about the chest X-ray. It was trying to protect something that had been hurt long before that email arrived.
The fear whispered that they care more about checking a compliance box than they care about me. The grief quietly reminded me that the health care system where I contracted tuberculosis devoted more energy to minimizing liability than caring for the human beings who had been harmed.
That was the long story. The chest X-ray wasn’t the injury. It was a second arrow lobbed into an unhealed wound.
I made room for the tears and reminded myself that there is no grief without love. I was grieving because I love being a nurse anesthetist. I love caring for people. I love this profession. But loving health care does not require abandoning myself.
That night I drew a hard line. I quietly told myself, “Darling, you do not have to get a chest X-ray, and I am not going to make you.”
Three days later, the hospital backtracked. Turns out, I never needed the chest X-ray after all.
That is what boundaried agency looks like. While health care systems create many of the conditions that lead to burnout and moral injury, they only hold the power to burn us out if we hand them the matches. Many of us unknowingly did. We let the system determine whether we rested, protected our peace, answered one more portal message before a too-late bedtime, sacrificed time with our families, or ignored what our own bodies had been trying to tell us for years.
Reclaiming the matches is not pretending the fire doesn’t exist. The fire is real. Moral injury is real. Production pressure is real. Grief is real. None of those realities disappear simply because we decide to set healthier boundaries.
Reclaiming the matches means remembering that our humanity was never the health care system’s to negotiate.
Christine chose to leave health care. I chose to stay. Neither path is more courageous than the other. Both require grief. Both require us to wrestle with what it means to love a profession that cannot always love us back.
The deeper question isn’t whether we stay or leave. The deeper question is whether we can stop abandoning ourselves, regardless of which path we choose.
I still believe health care is among the world’s most meaningful professions. I also believe it asks far too much of far too many good people.
Perhaps the greatest act of resistance isn’t leaving health care. Perhaps the greatest act of resistance is refusing to abandon yourself while you remain.
Sarah Bergakker is a nurse anesthetist, educator, speaker, and the founder of MOOXLI, a continuing education organization offering community and a supported path forward for health care professionals. She practices with Just Breathe Anesthesia Staffing and is a repeat invited guest lecturer at Oakland University in Rochester, Michigan.
Rooted in mindfulness, self-compassion, and boundaried agency, her work helps clinicians move their mindset, oxygenate their soul, and live differently without abandoning themselves in the process. Through immersive learning experiences, the MOOXLI Membership, the MOOXLI App, and her writing, she equips health care professionals with practical, evidence-based tools to build sustainable, values-aligned careers.
Her writing on clinical education, simulation training, and clinician well-being has appeared in the AANA Journal, Home Health Care Management and Practice, and The Pulse Magazine. She also writes on the MOOXLI blog and MOOXLI Substack, and shares updates on Instagram and LinkedIn.
