Trust in Us: A Conceptual Analysis of the Foundations, Erosion, and Restoration of Trust in Nurses

AbstractTrust underpins ethical healthcare, shaping patient-provider relationships, shared decision-making, and quality clinical care. Public trust in nurses has recently declined for the first time in decades, driven by pandemic disruptions, politicized health information, and a societal shift toward institutional mistrust. Chronic understaffing, moral distress, and organizational constraints further strain nurses' ability to provide relational, patient-centered care, compounding this erosion, undermining ethical principles at the point of care, and complicating nurses' capacity to advocate, communicate, and sustain the therapeutic alliances essential to positive outcomes. Nurse ethicists have emerged as pivotal figures, positioned to address and repair trust erosion within healthcare teams and systems through interdisciplinary ethics consultation, navigating complex family dynamics, and shaping policy to sustain ethical standards. Drawing on care ethics, virtue ethics, and professional codes, they help navigate trust-related challenges in morally complex clinical scenarios. This article examines a case in which a nurse ethicist supports nurses caring for an aggressive patient with a mental health disorder, addressing issues of autonomy, equitable access, confidentiality, and professional boundaries. We explore nurses' roles in these issues and how nurse ethicists foster ethical deliberation, affirm nurses' status as moral agents, and safeguard their physical, emotional, and psychological safety-turning potential breakdowns in trust into opportunities for relationship building and ethical clarity. We conclude by calling for expanded ethics consultation, routine ethics rounds, and advanced ethics education for nurses, alongside institutional investment in nurse ethicists as educators, advocates, mediators, and moral leaders-essential to restoring trust in nursing and strengthening the ethical foundation of clinical practice.