J Nurs Manag. 2018;26:83–85. wileyonlinelibrary.com/journal/jonm
© 2018 John Wiley & Sons Ltd
The crisis of public trust in governance and institutions:
Implications for nursing leadership
Trust is a valuable social capital, essential for dependable relation-
ships 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) follow-
ing the Trump election have been characterised as watershed events
in public leadership and trust (Brookes, 2017). Public trust in busi-
ness, 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 contribu-
tion 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?
1 | THE NATURE OF TRUST
Most definitions of trust reference a willingness to be vulnerable
(Mayer & Gavin, 2005), where those placing trust are optimistic that
those they trust will care for their interests (Luhmann, 2000). Trust
can be placed at an individual levels (i.e. in individual nurses) and/or in
the systems individuals represent (the service or health care system).
Applied to service provision, trust involves the belief that service pro-
vides will act with integrity and competence in pursuing the interests
of service users. In a systematic review of building trust in mental
health services Gaebel et al. (2014) reported trust is a pervasive in-
fluence on all aspects of therapeutic relationships, with service users
feeling trust is essential to good service. Trust has also been described
as an enhancer of the patient experience and linked to overall patient
satisfaction (Naylor et al., 2013). In the UK, public perceptions of trust
in nurses is higher amongst those who have had recent contact with
a healthcare service, suggesting public trust in nursing is relational
(The King’s Fund, 2015). Similarly a Canadian study reported that in-
dividual experience and personal anecdotes are used by the public to
form generalisation about trust in the health system (Abelson, Miller,
& Giacomini, 2009). Thus, interpersonal trust with individual care pro-
viders is an important cornerstone of trust in the system.
2 | A CRISIS IN PUBLIC TRUST?
In 2017, the Edelman barometer reported credibility for company
Chief Executive Officers was at an historical low (Edelman, 2017).
In two- thirds of the countries surveyed, less than half of respond-
ents trusted business, government, non- government organisations
or the media to do what is right. Alongside the erosion of trust in
institutions, the credibility of experts also declined, with technical
experts rated equally with peers as a credible source of information,
and peers rated as more credible than a CEO or government official
(Edelman, 2017). In the USA, the crisis in trust in healthcare reflects
repeated scandals, rising costs and the large numbers of people
without health insurance (Gille, Smith, & Mays, 2015).
Built upon instrumental conceptions of trust, ensuring and re-
building trust in healthcare has largely become a project of clinical
governance and audit. In the last decade we have seen a revolution
in accountability, control, and audit and performance scrutiny. At the
same time, public mistrust in healthcare has grown. O’Neill (2002)
earlier suggested that this culture of audit driven accountability may
damage trust by fostering a culture of suspicion rather than trust.
Importantly, audit and accountability cultures in healthcare fail to
acknowledge that trust goes beyond a rational appreciation of sys-
tem performance. Instead, trust is dependent upon the nature and
quality of interaction with care providers (Brown, 2008).
3 | PUBLIC TRUST IN NURSES
Against the backdrop of eroding trust in political and institutional
leadership, the public’s trust in nursing and nursing leadership is
vital. Surveys of consumer sentiment conducted in Australia, the
United States and United Kingdom (UK) have for many years re-
ported that nursing is the most highly trusted profession in terms
of honesty and ethical integrity (Morgan, 2017; Gallup, 2017).
While long- standing, this trust is not immune to erosion. A com-
parison 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