Building Trusting Organizations

The person who is trustworthy in very small matters is also trustworthy in great ones; and the person who is dishonest in very small matters is also dishonest in great ones. If therefore, you are not trustworthy with dishonest wealth, who will trust you with true wealth? If you are not trustworthy with what belongs to another, who will give you what is yours? No servant can serve two masters. He will either hate one and love another, or be devoted to one and despise the other. You cannot serve both God and mammon [money]. Luke 16:1-13

The task of building trusting organizations has challenged nurse leaders in all practice environments for several decades. The first issue of Nursing Administration Quarterly, Leadership in Nursing Administration, Volume 1:1, Fall 1976, contains an article entitled "Shared Leadership-No Head Nurse." In this article, the authors discussed three concepts: accountability, group support and cohesiveness, and self-motivation. Probably most poignant to the concept of building trust was the following statement:

We keep each other in control by a check and balance system, for we are quite verbal and oftentimes critical with each other. However, since we have already acknowledged individual worth as an integral part of our system, we can communicate without playing "games." More importantly it is an unbelievably honest peer review system.

Is this not what trust is all about? I reflect on more than 25 years of nursing administration leadership and the continuous striving to build trusting organizations, even in places where distrust is prevalent. Our great country, these United States of America, was built on the greatest trust of all. Yet the events of September 11, 2001, created fear, distrust, and trepidation among all of us, and with good reason. On October 7, 2001, we entered into the horrific attack on terrorism and are now cautioned to be sensitive to our surroundings and people, especially as we travel at home and abroad.

There is an exemplary amount of trust among the countries that have pledged support and are actively participating in this attack on terrorism. We see the leadership of President Bush, Prime Minister Tony Blair, and others as a positive handling of interaction among many countries, based on knowledge, skills, experience, attitudes, responsibility, accountability, and autonomy. I am proud to be an American and know how difficult it is in many countries for nurse leaders to be creative and innovative, with the courage of their convictions and concerns for all people. Societal forces and constraints often prevent organizational development in a trust-building way.

Tim Porter-O'Grady, RN, EdD, PhD, FAAN, senior partner of an international health care consulting firm focusing on restructuring services for a changing environment, is issue editor and has assisted many organizations in building trust. His work has led to many collaborative, self-governing practice models. Aurora Health Care, the On-the-Scene facility for this issue (NAQ 26:3), demonstrates through several research studies the effect of organizational change.

As we are confronted with the greatest nurse shortage ever, we are constantly challenged to recruit nurses who meet the essential skills and knowledge to care for patients in a high-technology, stressful environment, with a sense of calmness, serenity, and gentleness. Will this war bring more nurses? When I was involved in the Gulf War as Associate Executive Director at the King Faisal Specialist Hospital in Riyadh, Saudi Arabia, an Arab News article indicated that, when surveyed, 57% of Saudi Arabian women thought that they would consider nursing as a possible way of helping the nation. Before that time, maybe 8% or 10% thought nursing was a suitable career. During crisis, people behave differently and are more sensitive to the needs of others. Time revealed that the attitude toward nursing as a career did not change but circumstances did. Arabian women have not entered nursing careers in large numbers.

As we continue to be a country in crisis, what can we do to keep building positive, energizing, trustful organizations? We will always need alternative workforce plans and will learn to be as creative as possible in allocating what resources we have. Sharing the responsibility and accountability with the entire workforce has usually been beneficial; however, during a war, many good workers are displaced. I had more than 100 Yemenis in the workforce in Riyadh, who were forced to leave because of the political situation. They were excellent ward clerks, transporters, and even security guards. The tragedies of war, aside from loss of lives, are the thousands of displaced persons and the distrust that develops in those who seem to be from countries of Islamic practice and tradition.

As soon as I was able to return home after the September 11th terrorism attack, I went to church and now see more people returning to the faith of their choice. We can build trust, but only with a true dedication to respect, acceptance, and cherishing each human being, no matter what their beliefs. I was not allowed to practice Christianity when living in an Islamic country, but let us allow all religions to walk among us in peace. We can be trustworthy in our nursing leadership and continue to provide environments for practice of nursing where each person is valued, patient and staff alike.