So much change is underway in the transformation of health care that it is easy to get lost in the challenges these many changes bring. Furthermore, it is easy to lose track of some of the fundamentals of leadership along the way.

As the role of the nurse executive changes and broadens in both scope and accountability, it is good to be reminded of the tremendous importance of trust and building trust in the organization. Nothing can be sustained if the relationships that underpin all human activity are not preserved and advanced. If anything has emerged over the last 30 years of organizational research, it is the understanding that effective human relationships in the workplace are essential to sustaining the purposes and agenda of the organization. For some inexplicable reason, however, this truism is one of the first things that gets forgotten in times of great stress or change. The health care literature is rife with the decimating results of the lapse in this understanding that underpins the principles of trust.

Trust is an elusive concept. One cannot create trust. Trust is evidentiary; it is simply the witness to what has been created, which results in positive, open, and engaging relationships in the workplace. It is perhaps one of the strongest testaments to the import and implications of shared governance and other shared decision-making strategies that so few organizations have been able to both support or sustain them. The degree of openness, honesty, and trust that must be continuously present in these approaches creates a huge challenge for leadership. Few organizations have the kind and depth of leadership that can manage and embrace partnership, equity, accountability, and ownership to the extent necessary to truly empower people. The simple truth is that if leaders could easily accomplish these goals, more organizations would reflect these empowered approaches and the trust they engender in all their participants.

One such trust-based organization that has struggled to be faithful to shared decision making, empowerment, and sustaining trust is Aurora Health Care in Milwaukee, Wisconsin. Under the able and persistent leadership of Vicki George, PhD, RN, the nursing organization has remained strong, involved, and engaged, and the health system remains a positive place in which to practice nursing. Throughout the organization is evidence of nursing's strength and engagement in the critical decisions affecting the operation and future of the health system. Trust is evidenced at every level of the organization, from the mission of the system to the language of the CEO, Ed Howe, who unequivocally announces his support for nursing. He has imbedded this belief in the operating systems and processes of the organization. As the "On the Scene" section of this issue points out, ensuring that the environment, behaviors, and interactions of nurses at Aurora remain empowered is a critical part of the priorities of nursing leadership throughout the system. With the many accolades the system has received and as the only health system to obtain the American Nurses Credentialing Center's "Magnet Award" for the entire system, the success of their effort is obvious. The shame for nursing is that so few other health systems in the United States are like this one.

Joining the many authors from Aurora in this issue are Crow, Malloch, Miller, Newhouse, and Mills, all of whom build on the basic requisites of trust and the elements of trusting organizations. I hope readers will be informed and edified by the concepts of trust and the efforts of a complex health system to continually assess whether the conditions and circumstances are present in a way that positively affects building and sustaining trust in the practice of nursing. I thank these issue authors for their efforts and appreciate their willingness to share their insights and work with us. It is my hope that this material will inspire and encourage others who are struggling to build trusting organizations and advance the value of nursing in health care.