The crisis of public trust in governance and institutions: Implications for nursing leadership

Trust is a valuable social capital, essential for dependable relationships and a healthy society. It is hard earned, not guaranteed and easily lost (O'Neill, 2002). Historically public opinion has held the healthcare system and healthcare providers in high trust. There are indications that this trust may be on the decline—particularly trust in private healthcare. This decline reflects the global trend towards distrust of government and of institutional leadership. In recent years, a number of significant events and crises, such as the European migration crisis, the Brexit vote in the United Kingdom (UK) and the political polarisation of the United States of America (USA) following the Trump election have been characterised as watershed events in public leadership and trust (Brookes, 2017). Public trust in business, government, public institutions and their leadership are at an extraordinary all-time low (Edelman, 2017). In a period when the delivery of healthcare is increasingly under scrutiny, and public trust in institutions is apparently in decay, understanding the contribution nurse leaders make to the public's trust in nursing is important. To date little to no attention has been given to the broader picture of nursing leadership and public trust in healthcare and healthcare institutions. Should nurse leaders be concerned about the erosion of public trust in institutions, what are the implications and what can be done to assure the pursuit of trustworthy healthcare? Most definitions of trust reference a willingness to be vulnerable (Mayer Gallup, 2017). While long-standing, this trust is not immune to erosion. A comparison of results from the British Social Attitudes survey for the years 2002 and 2014 showed that, while nurses remained the most trusted group overall, the proportion of the public reporting that they trusted nurses “just about always” fell 9% over the period (The King's Fund, 2015). What is less clear in these public opinion polls is whether this trust in nurses reflects a similar trust in nursing leaders and nursing management. The UK social attitudes survey reported that trust in NHS managers is much lower than that of nurses, with less than a third of the general public reporting trust in managers most of the time (The King's Fund, 2015). Although trust is recognised as an important feature of nursing practice, less attention has been given to understanding trust in nursing leaders and how this links to nursing practice and public trust in nursing. In their comprehensive review of trust between nurses and managers in the critical care context, Mullarkey, Duffy, and Timmins (2011) report trust is an essential component of nurse-patient relationship, but little attention has been given to trust among staff and management. To date there have been few explicit studies of trust in nursing leadership. From the studies conducted, it is evident that nurses' levels of organisational trust and their citizenship behaviours are linked to trust in nursing management, and is associated with increased conscientiousness and altruism (Altuntas & Baykal, 2010). Whereas Wong and Giallonardo (2013) report that nurses who have higher levels of trust in their managers also report less adverse patient outcomes. Similarly, trust in nurse managers influence the work engagement and voice behaviour of nurses (Wong, Spence Laschinger, & Cummings, 2010). Another study noted that nurses' trust in their manager (measured through two items) was associated with improved safety organizing and reduced medication errors (Vogus & Sutcliffe, 2007). Importantly, widely employed theoretical frameworks and measures of nursing leadership such as transformational leadership do not explicitly foreground trust as a characteristic of leadership. Instead, trust is inferred to develop through the relationship between leader and follower (Bilal & Mariam, 2017). Other less commonly investigated leadership frameworks such as the person-centred situational leadership framework, explicitly describe trust as a feature of nursing leadership (Lynch, McCance, McCormack, & Brown, 2017). The authentic leadership model posits leaders build trust through making just decisions and role modelling honesty, integrity, and high ethical standards in leader-follower relationships (Wong & Cummings, 2009). Similarly, aesthetic leadership is said to involve a trust component. Aesthetic leaders foster trust, which facilitates linkage between nurses and administrators and between nurses and patients (Mannix, Wilkes, & Daly, 2015). When practiced by clinical leaders, servant leadership has also been positively associated with trust in nursing managers and trust in the organization (Bobbio & Manganelli, 2015). Although the evidence for the “crisis in public trust” is far from robust, what we know suggests nurse leaders should heed the warning. There are important trust related issues that are central to the purpose of nursing leadership that require thoughtful debate. Considering the underlying importance of trust in the provision of nursing care, there has been far too little research into understanding how trust can be protected and what can be done to foster trust. Researchers and scholars could give more thoughtful attention to understanding the link between leadership characteristics, the nursing work environment, perceptions of trust (both nurses and the public) and high quality patient care. Nurse leaders would do well to be concerned for protecting the health of the public through enabling the factors that foster trust in nurses and in the system. What we know suggests that trust in nursing is relational and leaders can positively shape the nursing work environment in ways that enable this trust. Leaders clearly have a role in cultivating the right conditions for trust. In a climate where the public are increasingly suspicious of experts and the truthfulness of reported data, the increasing focus in healthcare of audit and compliance may foster suspicion rather than build trust. Leaders may do well to focus less upon central control and perceptions of public accountability, and more on fostering forms of leadership and governance that allow nurses to deliver care in a trustworthy manner.