Rebuilding Staff Trust

Rose O. Sherman, EdD, RN, NEA-BC, FAAN


Am Nurs Journal. 2021;16(11) 

In This Article

Abstract and Introduction


A healthy emotional bank account and eight pillars can facilitate the process.

Ray* recently accepted the role of director in an emergency department (ED) that's been a COVID-19 hotspot throughout the pandemic. He's the third director in 4 years and was hired from outside the hospital. Ray has previous ED management experience but has found it hard to gain the trust of his new staff. Nurses are hostile and angry about the many changes in policies and practices their health system put in place as the science and understanding of the coronavirus evolved. They question the competence of their health system's leaders and are now upset about staffing shortages. Ray recognizes the fragility of his ED team and that rebuilding trust with them won't be easy.


Ray isn't alone in his need to rebuild trust with staff after the challenges experienced during the pandemic. In a 2021 American Nurses Association survey of more than 22,000 nurses, 46% either disagreed or were neutral about whether their employer valued their mental health during the pandemic. For Ray, the staff's mistrust is related to rapid cycle change that's been further complicated by leadership turnover on the unit. Trust builds over time and when a leadership churn occurs, staff are less likely to believe that new leaders will be reliable and trustworthy. The loss of a leader who's stayed only a short time frequently is seen as a betrayal.

Ray understands that trust is foundational to effective teamwork. To successfully lead in the ED, the staff must trust him and each other. Cultures of mistrust are toxic and result in staff turnover, disengagement, and patient safety issues. Patrick Lencioni, a pioneer of the organizational health movement, describes an absence of trust as the key dysfunction seen with ineffective teams. When distrust exists, team members assume negative intentions about one another, don't provide team backup, and don't communicate with each other constructively. Steven Covey notes that a lack of trust makes everything harder and slows down work on teams. Low trust places a hidden "tax" on every transaction, every communication, every interaction, and every decision.

During the pandemic, nurse leaders have learned that trust isn't static. Instead, it's similar to a forest that grows over time but can easily burn down with acts of carelessness. Even high-functioning organizations have struggled with maintaining staff trust in this turbulent environment of surging patient volumes and staffing shortages. The complexity of the pandemic experience has caused policy missteps and communication failures that have eroded staff confidence in their leaders. Nurses want certainty and a level of control that leaders haven't always been able to provide. Trust can take a long time to cultivate, but it can be quickly eroded if staff perceive that leaders don't have the best interests of staff at heart. Ray can rebuild trust on the team, but it will be challenging and take intentionality.

*Name is fictitious.