Since late last century, nurses have been the most trusted profession in Australia for ethics and honesty.

Ninety four per cent of those surveyed placed nurses at the top of the list of thirty occupations.

Nurses have every reason to feel pride and satisfaction at such high public approval.

Less than a third of people trust ministers of religion and bank managers.

This will come as no surprise when the behaviours of some members of those professions has led to Royal Commissions into their industries.

The regular examples of mistrust and betrayal from these industries has lead to a lack of trust about them as professionals and especially as corporate entities.

There is a modern corporate culture that approves of lying and unfairly ripping off individuals as a price of doing business.

It is no wonder that the public are fed up with them.

Nurses are expected to act in the best interest of their patients.

And we do.

That is why nurses have sky high approval ratings.

People expect that nurses will deal with them fairly and honestly, and not take advantage of them.

And we do.

Wouldn’t it be great if government and the corporate world treated each customer like nurses do?

No gotchas in their contracts that allows the organisation to wriggle out of what they should do to make a matter right.

You would like to think that at all times they would be thinking – What would a nurse do?

The term, fiduciary trust, is derived from the philosophical ethical concept of fidelity.

Fidelity is where you are faithful to a person by demonstrating continuing loyalty and support.

Fiduciary trust is about the patient’s beliefs regarding the nurse’s motivation and intention.

Betrayal occurs when an individual is harmed by someone they trust or depend upon.

Carly Smith has looked at what type of healthcare experiences erode trust.

In the article,First, do no harm: institutional betrayal and trust in health organizations, she assessed the prevalence and impact of institutional betrayal on patient’s trust and engagement in health care.

The majority of participants in the study had experienced both negative medical experiences and institutional betrayal.

90% of hospital errors occur because of system failures and was not because an individual committed an error.

Yet the focus is invariably about the what the individual did wrong, never about the organisational processes that lead to the error.

Like bankers and others, hospital managers need to step up to the plate and respond fairly and honestly with why there are so many systemic errors.

Because hospital managers do not address institutional betrayal, patients who have experienced errors actively disengage from their health care.

They will ignore advice, not keep follow-up appointments, not fill prescriptions, etc.

It is the managers that need to fix this.

The public know that it is not the nurse who is at fault.

They know that the nurse is looking out for their interests.

Here is a piece of advice from one of the most trusted individuals in the country to hospital managers – it is your problem and you have to fix it.

Just ask any nurse what they would do.

To learn more about trust in health,

Smith CP. First, do no harm: institutional betrayal and trust in health care organizations. Journal of Multidisciplinary Healthcare. 2017;10:133-144

We are taking a three week break and will be back in mid-April.

Posted in CPD