Will Nursing Continue as the Most Trusted Profession? An Ethical Overview

Fiduciary Trust

The notion of trust has been closely aligned with concepts including one called fiduciary trust. This terminology is derived from the philosophical ethical concept of fidelity. The term is conceptualized as the belief that multidisciplinary healthcare providers will act in the patient’s best interest, and not take advantage of their vulnerability. According to Smith (2017), fiduciary trust is primarily about the patients’ beliefs regarding the physician’s motivation and intention rather than concrete outcomes of treatment. Professional nurses also have the duty and obligation to act with fiduciary trust. The trust-mistrust rhythm may be viewed and illustrated through the nurse-person relationship, nurse-group relationship, and the nurse-community organizational relationship.

The goals or purposes of nursing as a professional healthcare discipline stress human rights’ protection with the duty to uphold the values and ethics of the profession. According to The American Nurses Association (2015), respect for the inherent dignity, worth, unique attributes, and human rights of all individuals is a fundamental principle for the discipline. Nurses must establish “relationships of trust and provide nursing services according to need, setting aside any bias or principle” (American Nurses Association, 2015, p. 1).

The possibilities of mistrust and betrayal occur when individual(s) are harmed by those whom they have trusted or depended on. In establishing a professional relationship with another, there is always a possibility for mistrust. An example is when the healthcare professional chooses to act counter to other(s)’ specified preferences or desires for healthcare and the healthcare recipient receives services that are unwanted. Mistrust with the ever-present possibility of betrayal surfaces for individuals if wishes and desires for living quality are unmet. For the author, nurses choosing to act with prescribed standards of practice and provide nonnursing medical services without the expressed consent of the individual being served constitutes a violation or breach of fiduciary trust. From a humanbecoming ethos of understanding (Parse, 2014), the concept of trust is inextricably intertwined with reverence and human dignity while living in community.

Trust-Mistrust and Living in Community

Betrayal arises as a violation of fiduciary trust in relationships. Professional nurses may violate community trust if they fail to develop nurse-person relationships and focus on machinery, robotics, and computer technology rather than the person who is receiving healthcare and is living quality as they define it. Shifting priorities in healthcare as a business may strain professional relationships as well as nurses’ personal commitments in serving others with dignity and respect.

One need only reflect on the shifting landscape of healthcare priorities and the clarion call for affordable healthcare insurance and the possibilities of single-payer national healthcare as an example of trust-mistrust rhythms mingling with feelings of betrayal. Communities share their frustration in town hall meetings with their government officials and they are demanding reducing the cost of healthcare insurance while increasing the scope of healthcare services. The discipline of nursing is entangled amid the demand for increasing cost-efficient health outcomes through agendas of big data analysis and the desire to maintain its priorities as a practice discipline whose purposes are to be in nurse-person relationship as persons receiving nurse services are living quality. These are vastly different value priorities with disclosed and undisclosed opportunities and restrictions. It is the author’s view that professional nurses must be at the table in boardrooms and policy tables where these important decisions and priorities are emerging. However, it is imperative that the members of the discipline of nursing remember who they are and whom they are serving while remaining true to their calling within organizations as well.

Betrayal and Fiduciary Trust in Healthcare Organizations

Examples of violations of human dignity and trust abound in healthcare organizations. Conflicting business priorities amid turbulent medical healthcare priorities are reflected within all types of healthcare institutions, groups, and organizations. The historical education and practice of nursing undergirded by philosophical and theoretical models of nursing is going away. What theories will guide the practice of nursing? Will it be medical models or business models? Or will big data tell us what to do for people? These questions are disturbing and disruptive. As nurse practitioners and other advanced practice nursing organizations choose medical and other models as the basis for practice, what will the future of nurse practice look like? Will there be feelings of betrayal and mistrust as other healthcare disciplines determine what nursing practice will be and what it will not be in future healthcare organizations.

Betrayal and trust of the discipline may be eroded as what is kept and what is sacrificed by practicing without a theoretical guide potentially changes the identified and hidden meanings for what it means to be a nurse. How will members of the community we serve identify who is a nurse and who is just another healthcare worker? These are questions of fiduciary trust that challenge the very essence of the discipline of nursing.

With healthcare government goals attempting to keep persons out of institutional healthcare facilities and reduce the amount of services to be provided, members of society struggle with unanswered questions of how they will receive healthcare and who will provide it. The very conditions or situations where trust is needed are now the settings for mistrust and potential betrayal. The possibilities for betrayal are inevitable as violation of personal expectations for living quality collide with business practices, limiting the amount and quality of services that can be provided. Members of the discipline of nursing who work in institutions where there is power in position may encounter shifting priorities and must choose different ways of being with others as there is a shifting of valuing priorities with the certainty-uncertainty in conforming-not conforming with healthcare and institutional policies that may be disrespectful to human beings. Nurse leaders must seek clarity in this pivotal time for doing what is right. They must attempt to fortify the trust that the public has for the discipline of nursing. Will nursing continue to be the most trusted profession? The verdict is still out.