LEADERSHIP & TRUST in NURSING
Trust is a key component in all relationships. Have you ever trusted someone only to have that trust broken by catching that person in a lie? Or, had someone make changes related to the project you were assigned to lead, while you were away & not informing you? How about sitting in a meeting & hearing an announcement about the project you were leading with no advance notice? Other examples include someone taking credit for your work, someone making an error & not owning up, cheating, lying, or talking behind your back, just to name a few ways trust can be broken. I’m sure somewhere along the line in your personal or professional life you have had your trust broken. Now ask yourself that tough question – whose trust have you broken?
The Merriam-Webster Dictionary defines trust as:
a: assured reliance on the character, ability,
strength, or truth of someone or something
b: one in which confidence is place
Synonyms could include: integrity, reliance, surety, faith, dependence, belief, hope, care, protection…
Antonyms could include: lie, cheat, steal, deceive, trick, fool, irresponsible…
When I was teaching first year nursing students we discussed how to establish trust with your patients. Maintaining confidentiality; doing what you say you will do, when you say you will (keeping your promises); being a patient advocate (standing up & protecting). If you don’t know an answer, say so, then go find out: admit your weaknesses, be honest. Establishing trust with patients is not different than establishing trust with anyone, except that you might need to do it more quickly. Also, remember, patients & their family members may be frightened & distrustful depending on past experiences with healthcare. One of the things not addressed in any depth in nursing courses is building trust with co-workers, other healthcare professionals, or team building.
Patrick Lencioni (2002) wrote the following about the trust needed in teams
“trust is the confidence among team members
that their peers’ intentions are good,
and there is no reason to be protective or
careful around the group.
In essence, team mates must get comfortable
being vulnerable with one another” (p. 195).
Being vulnerable means team members need to be comfortable admitting mistakes, making suggestions, admitting weaknesses, skill deficiencies, & asking for help without having these held against them. In nursing there is another layer to trust; in nursing we want to be able to trust that our colleagues will always do the same things in certain situations (i.e. code blue) every time: this is the reason patient simulations are used & are important in nursing & healthcare.
Building the vulnerability portion of trust can take time to develop. As a nurse I remember there were some colleagues I would ask for help before others, & only a few to whom I would admit my weaknesses. Admitting weaknesses, & asking for help can be very frightening, especially to new nurses. The statement “nurses eat their young” has been around for many years, & my guess is that most nurses have experienced it at some time, yet it continues. When I was a nursing student we were told about this phenomenon & vowed when we graduated we would never treat nursing students & new nurses with contempt, or disrespectful. The leader has a large role to play to ensure that trust is developed & maintained among team members, & among teams. When you think about this the circle of trust it is huge (Figure 1). Old customs, habits, rituals, & cultures are hard to change; but in this case it would be well worth the effort.
The many roles of nursing leaders must include changing the “nurses eat their young” culture. What can the leaders do to introduce these changes & see them through to fruition? Kouzes & Posner (2016) stated
“Trust is all about openness, and trust building involves
creating an environment in which people can be open and honest
with each other” (p. 163).
One thing that I noticed during my time nursing was the absence of openness & honesty from management; often just an extension of how they were being treated by the executive. Strong leaders are a benefit to any organization. Time spent nurturing & growing those leaders is time well spent. Nursing managers can develop the leadership skills of their direct reports by being open & honest; setting the example & not accepting any less from herself or others. This said, every person can start to build trust in their relationships by being honest & open. Sounds simple, but it is something that must be worked on every day; it requires a lifelong commitment to leadership development.
Kouzes & Posner (2016). Learning leadership: The five fundamentals of becoming an exemplary leader. Wiley. San Francisco, CA.
Lencioni, P. (2002). The five dysfunctions of a team (2002), Jossey-Bass, a Wiley Imprint, San Francisco, CA