Every year or so, a nursing organization or some polling group commissions a poll on which profession ranks highest in the public’s esteem. And each year, nurses win the trust, ethics and honesty sweepstakes. Just the other day I received yet another press release– this one from the American Nurses Association — entitled “Public Ranks Nurses as Most Trusted Profession–11th Year in Number One Slot in Gallup Poll” telling me how much the public values nurses. http://www.gallup.com/poll/112264/nurses-shine-while-bankers-slump-ethics-ratings.aspx. It was one in a long string of such announcements. With the exception of a poll commissioned post 9/11, in which fire fighters ranked number one, nurses always head the list. And immediately, nursing organizations like the American Nurses Association send out press releases announcing that nurses have once again won the trust sweepstakes. And many nurses smile happily because they believe they are trusted by the public.
You may sense a certain skepticism in my tone. And indeed, you are right. I am getting tired of these trust rankings. In fact, I’ve come to think of them as THE TRUST TRAP or THE TRUST PARADOX. Why a trap? Why a paradox? Because these rankings may lull nurses into believing that they really don’t have to inform the public about their work, because everybody trusts them. So they don’t have to go out of their way to do what my colleague Bernice Buresh and I have written about in our book, From Silence to Voice: What Nurses Know and Must Communicate to the Public, http://www.amazon.com/Silence-Voice-Nurses-Communicate-Public/dp/080147258X/ref=sr_1_1?ie=UTF8&s=books&qid=1291934526&sr=1-1 which is to talk, in detail, about what they do in their daily work. Indeed, people have told us that they don’t think they need to work harder to communicate their work to the public because they are so highly trusted. So that’s the trap.
Now here’s the paradox. If you’re a nurse, ask yourself the following two questions. Do you really believe the public trusts nurses? If you reply in the positive, then ask yourself the following question. Do you think members of the public — the same folks whosay they trust nurses — understand what nurses do? Really. If you answer in the negative, as many nurses do when I ask them those two questions, then you’ve stumbled over the paradox. I believe it’s true that many members of the public think nurses are trustworthy, ethical and honest. I also believe very strongly that most members of the public don’t have a clue what nurses do. So if people don’t know what nurses do, but think they are hyper trustworthy, why do they trust them? Because they are nice? Because they are, as nursing organizations constantly proclaim, “always there?” Like the chair? Or because they are a matter of life and death, the difference between hope and despair, because they are critical to patient rescue, coping, recovery, or a decent death? Because they are knowledge workers or because they are sentimental workers?
I am getting tired of these polls that try to assuage nurses and stroke them and make them feel better. Why? Because the very same people who apparently believe that nurses are so trustworthy, ethical, and honest also seem willing to tolerate consistent and relentless attacks on the profession. In every country I know, nursing is continually fighting both rear and front guard actions against assaults on nurses ability to do their work. In the US, hospitals aren’t hiring new grads and claim that the nursing shortage is over even if they have nurse-patient ratios of 1-6, 1-7, or even higher. They don’t want the public to understand that you can fill all your FTEs at those ratios and patients can still experience a shortage of nursing care. In Canada, provinces are instituting new — actually old — models of care, where they are replacing RNs with LPNs. But everyone still loves and trusts nurses.
I think it’s time we moved beyond trust and asked the public — and particularly health policy makers and administrators –to put their money and resources where their trust is. Trust is a great foundation upon which to build an accurate understanding of the importance of nursing but without that understanding, trust is definitely not enough. Nursing organizations have to move way beyond trust and so do nurses. They’ve got to go out and tell the public what they do so that patients can actually get the benefit of their expert care.