"Jenna said she’d help me out with this heavy assignment. Well, it’s noon, and I haven’t seen her once. It’s always this way."
"You can tell Greg about the new medication form if you want. I’m not telling him. He never told me about the change in our discharge policy last week."
"I should never have trusted Brandi. She lied to the manager about me!"
Although polls show the public ranks nurses among the most trusted professionals, many nurses experience mistrust in the workplace. As a result, some dread going to work, feel they don’t fit in, or worry what colleagues will think and say about them.
Broken trust in work relationships can cause significant stress. Simple remedies are rare. Unless addressed, mistrust threatens job satisfaction, potentially jeopardizes clinical decision making, and even impels some nurses to seek new jobs.
Trust and betrayal: Let’s talk
Most nurses have a general sense of what trust is, but they may not fully grasp the language and appearance of trust and betrayal at work. Trust in a work relationship means you believe your colleagues are well intentioned toward you, that they "have your back." You can rely on them to do what they say they’ll do; you believe you’ll have their support in managing the demands you face at work. When you trust your colleagues, you feel accepted and valued by them, even if you’re not perfect.
Trust among coworkers, managers, and other healthcare team members is built, confirmed, weakened, or destroyed every day. Trust increases slowly over time through repeated interactions—but can dissolve in moments from just one bad conversation. As Melissa comments, "I’ve worked hard all summer to fit in with my new colleagues. Then yesterday I had a bad day and got a little snippy, so now I’m on the outside again."
Betrayal occurs when a person’s words or actions indicate he or she lacks good intentions toward another. If a colleague’s decisions hurt you, you’re likely to feel angry, sad, perhaps stunned. You thought that person cared about you, but his or her actions don’t seem caring. You feel betrayed.
Why trust matters
Trust is a key component in a healthy work environment. In healthcare facilities where trusting work relationships exist, more work gets done. Team members work together collaboratively. Job satisfaction, morale, and job retention are high. Absenteeism is low because trust buffers high stress levels.
Tammy, an RN on a busy medical unit, comments, "I couldn’t make myself come to work here if we didn’t all cover each other. The demands are too great to cope with them alone." Patients notice healthy trust among staff. They can sense the difference, and they trust nurses who trust each other. They report having a better hospital experience, which promotes patient loyalty and can bring economic benefits for the organization.
On the other hand, evidence suggests that when employees feel betrayed, they expend energy protecting themselves from colleagues and are less effective and timely in delivering patient care. Worse yet, they begin to misinterpret behavioral cues and personalize information as harmful, causing more anxiety and distraction from patient care. When nurses distrust colleagues, they’re less likely to ask for help or advice—and this can lead to increased errors and ineffective communication that may impair their clinical decision making.
Here’s an example:
A physician rudely criticized Lesley when she called about a patient’s low blood pressure. Until then, Lesley thought she and the physician had a good relationship, but after the phone call she felt betrayed, angry, and embarrassed. The next morning, she avoided him on rounds and missed important information about her patients. Two weeks later, when she needed to contact him again, she hesitated too long—and the result was a failure-to-rescue incident.
How mistrust affects organizations
Broken trust takes both a human and economic toll, and the entire healthcare organization suffers. Incivility, lateral violence, and bullying are symptoms of an environment lacking in trust. These toxic behaviors perpetuate high turnover, absenteeism, low retention, and low satisfaction for both nurses and patients. Betrayal inhibits creativity, information sharing, teamwork, and communication. As absenteeism and staff turnover rise, clinical expertise erodes. Eventually, nurse-sensitive patient outcomes suffer. Consider this scenario:
Two experienced cardiac nurses left their positions after a hurtful disagreement over the holiday schedule. With their exit, newly hired nurses on the unit lacked the staff resources to advise them on clinical questions. As a result, patient satisfaction scores dropped, one new nurse left, and pressure-
ulcer incidence rose. Hospital reimbursements suffered, too, as did patients’ likelihood-to-recommend scores.
Evaluating trust and betrayal
With two simple tools, you can assess work relationships on your unit for level of trust and betrayal risk. (See Rating your relational trust level and Are nurses on your unit at risk for betrayal? by clicking the PDF icon above.) Learning how to recognize trust and betrayal are the first steps toward creating a healthy workplace.
If you scored low on relational trust indicators, you can use various techniques to increase them. For instance, skilled communication techniques help you incorporate trust-related words in work conversations, so others will know trust matters to you. You might tell a colleague, "I want to earn your trust so we can work well together" or "Thank you for trusting me to do that new admission without micromanaging me. Your confidence in me helps my competence to grow."
Be sure to keep even the small promises you make. If you agree to help Shannon reposition her bariatric patient every hour, realize you have a contract of sorts with her. Don’t renege and then hope she doesn’t notice. If you can’t keep a commitment, speak up.
Always be honest. Admit when you’re wrong, and don’t place blame elsewhere. Practice saying, "I’m sorry." Here’s an example of how to say you’re sorry in an emphatic way: "Lynn, when I forgot to chart that the patient fell yesterday morning, I let the physician believe it was your oversight, not mine. I’m really sorry. Would you go with me while I tell the physician the truth? I want to work to rebuild your trust in me, although I know it will take time."
If you’re a manager, you can build trust by sharing information with staff, especially in times of workplace changes, when trust may take a nose dive. Enable them to see the "big picture" to show you respect them and promote their buy-in.
Finally, ask for a peer review about trust-building behaviors. If you’re still struggling, seek a mentor who models such behaviors.
Mending trust when you’ve broken it
What should you do if you break a coworker’s trust? Suppose, for instance, you fail to include a collaborating colleague in your presentation to a council; 2 weeks later, she’s so angry she won’t even look at you. To repair a broken relationship, follow these guidelines:
- Prepare—or even rehearse—before discussing the situation with the colleague.
- Open the conversation by acknowledging what has happened and your part in it.
- Accept her expression of her negative feelings, and take responsibility for your actions.
- Accept the temporary unsettledness. Acknowledge it will take time and consistent behaviors on your part for her to believe you have grown and are well intentioned.
- Set a specific time to let go of the guilt and shame and move on. Tell yourself, "It’s been a month. Things are still tense between us, but I can’t control how she feels. She’s not ready to forgive me, and I understand. But I’m going to stop beating myself up about it."
When you feel betrayed
When you feel hurt by a colleague’s words or actions, first determine if you were indeed betrayed. Consider all possibilities.
- Is it possible the hurt was unintentional? Is your best response to simply accept that we’re all imperfect and let it go?
- Could your feelings result from your tendency to experience relational pain easily? Ask a trusted peer if you seem too sensitive.
- Were your expectations unrealistic? Maybe you assume that because your manager likes you, she’d never deny you the days off you requested. But remember—her job is to run an efficient unit, not guarantee your happiness.
- Do you or the person who hurt you want to have a conversation to try to find a resolution? If so, determine if you’d feel physically and emotionally safe in such a conversation. If not, consider having at least one other person present.
- During this conversation, speak in a professional manner. State what you’d like to happen. "In the future, if you don’t agree with a clinical decision I make, please come to me about it rather than criticize me in front of our peers."
- Extend grace and possibly forgiveness. Give others a chance to change for the better.
- Reject your own tendency to gossip, isolate, or hurt the betrayer.
- Set a time to grieve and rebalance. Then let go and resume your usual conversation and activity with the betrayer. Treat your offender like a guest in your life. Be kind but not overly demonstrative.
How to increase trust on your unit
If betrayal risk scores are high on your unit, you might want the entire unit to make a new start toward establishing a trusting work environment. Set a date for the new environment to begin. Mark its arrival with signs and unit activities. At the designated date and time, end the old norm of backbiting and incivility.
Display available data on measurable outcomes of the cultural change toward trust, including improved nurse satisfaction, reduced staff turnover, and quality indicators for patients, such as falls and hospital-acquired infections. Include unlicensed personnel (for instance, environment service technicians and students) in this culture change.
Finally, show your care for colleagues in tangible ways, such as sending positive e-mails or notes and making sincere compliments. Celebrate each other’s successes publicly—but recognize
this may require you to lose your competitive edge and think less about who’s better or worse than you.
Take the first step toward trust
Trust in the nursing workplace is worth building, safe-guarding, and mending. On units where mistrust prevails, someone has to jump-start change. A wise nurse can venture out and start talking about the risks and benefits of trust, mistrust, and betrayal. That nurse can self-evaluate personal trustworthiness, ask for a peer review, and begin to change individual behaviors and conversations. Colleagues seeking a professional, high-performing workplace will join in.
Expect shifts in the unit’s culture to occur one conversation at a time, as the language of trust becomes commonplace. Norms for relating to each other will increase in civility and warmth. Work will become more meaningful. Stress will decline as the soft sound of humming replaces the loud grinding of teeth around the time clock. Take the first step.
Visit www.AmericanNurseToday.com for a complete list of references. Click the PDF icon above for advice on dealing with a colleague who’s out to get you.
Both authors work at Indiana University Health Ball Memorial Hospital and Ball State University School of Nursing in Muncie, Indiana. Renee Twibell is an associate professor of nursing and a nurse researcher. Terri Townsend is a critical care nurse and faculty member.