“Written by Ellen Olshansky, DNSc, RN, WHNP-BC, FAAN”

OUR PROFESSION IS regularly rated as the most trusted profession, and because we have received this rating often, we may take it for granted. I write this column to emphasize how significant this rating is and how important it is that we maintain this coveted status. Trust involves integrity and honesty; it involves the ability to rely on someone or something; and it is fundamental to a healthy society. Regrettably, however, there is good reason for a lack of trust in our society. Recent news reports of politicians’ scandals, and their subsequent lying to cover up their scandals is evidence of this assault on trust. In health care, we emphasize safety and quality. Delivering safe and high-quality health care depends upon honesty and trust.

For example, if an error is made in the hospital, the best approach to managing the consequences of the error and minimizing anything untoward is to identify that an error, in fact, has occurred. If someone attempts to “cover up” the error due to fear of retribution (or for any other reason), there is high probability that the outcome for the patient will be worse. The ethical and trustworthy approach is to directly address the error, keeping in mind that it is most important to attend to the health of the patient. Developing trusting relationships within the health care environment will be conducive to honesty and straightforwardness in regard to health care practices.

In health care policy, trust is essential as groups of people come together to make constructive change. We are on the brink of many changes in health care, although there is a lot of uncertainty aro3und what these changes will look like and what the implications of these changes will be. One thing is certain, however, nurses will have a key role in health care reform. Of course, we in the nursing profession must maintain our assertiveness in making sure that we are “at the table” with our colleagues in other health care disciplines to have a strong voice in reform. It has not always been easy to have that place at the table, but through our perseverance and honesty, we will be successful in this endeavor. As we maintain our status as the most trusted profession, our interprofessional colleagues will be more inclined to listen to us and respect our opinions, and by listening and trying our best to understand our colleagues’ various points of view, we will enhance a trusting relationship.

Moreover, our patients will continue to feel supported and cared for by us. Patients need to trust their nurses as their advocates, with their best interests at heart. If a patient trusts the nurse, the patient will be more apt to reveal important information in the patient history, allowing more accurate assessments and treatment plans. We know that it is often difficult for patients to divulge personal aspects of their lives and they may feel embarrassment or shame about certain things, such as suffering abuse from a spouse or drinking too much alcohol or taking drugs inappropriately. There may be situations in which a stressed new mother feels negativity toward her child and fears that she may hurt the child but is too embarrassed to discuss these feelings. We also know that to provide comprehensive health care we need to know about these issues. By creating a trusting environment, there is a greater chance that the patient will open up honestly to the nurse. Ultimately, trusting relationships will engender the ability to provide higher quality and safer health care.

In health care, we talk a lot about ethics. The field of bioethics is an important part of our work. In nursing, we follow the Code of Ethics for Nurses with Interpretive Statements. This Code of Ethics consists of guidelines for quality nursing care. Trust is a key component of ethics because ethical behavior in a very simplistic way means doing the “right thing.” Doing the right thing certainly involves honesty and being able to trust in our colleagues and our fellow human beings.

Going back to the premise of this editorial, the fact that nursing is consistently ranked as the most trusted profession is of great importance. We as a profession should take great pride, and we should take seriously the responsibility to maintain this “vote of confidence.” In fact, in academia and in health care, rankings are critical factors that reflect the success of organizations. There are rankings for “best hospitals,” “best doctors,” “highest level of funding,” and other rankings. For nursing to be ranked as the most trusted is very meaningful and important.

As we continue to provide health care to patients, teach nursing students, collaborate with health care leaders at the policy level, and work in many other capacities, it is imperative that we maintain trust among all our constituents, stakeholders, and colleagues. We need to transcend the negative climate in our society that has resulted from lack of trust of many of our prominent leaders. We need to continue to embrace our consistently ethical, honest, and trustworthy approach to our important work of improving the health of the public. Perhaps we can improve the climate and contribute to a more effective, higher quality, and safer health care system. Trust is an essential ingredient to make such improvements.