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Does trust matter?: Perceptions, trust and job satisfaction of hospital nurses.

Article Excerpt
ABSTRACT

Attraction and retention of nurses is critical to the effective functioning of hospitals. This paper presents quantitative and qualitative data on issues related to hospital nurses' trust in management and supervisors and its relationship to job satisfaction. Most nurses' stories of trust reflected aspects of managements' and supervisors' ability, benevolence or integrity. Exemplars are presented. Treatment by management, fairness of policies and safety of the workplace were related to nurses' trust in management. Treatment by supervisors and fairness of policies were related to trust in supervisors. Trust in both management and supervision was related to nurses' job satisfaction.

Keywords: Trust, Job Satisfaction, Nurse, Hospital Management

1. INTRODUCTION

Hospitals are one cornerstone of an effective health care system and nursing is a critical skill set required to operate hospitals. Nurses are assuming greater levels of patient care responsibilities necessitating augmented training and greater specialization. Concomitantly, a shortage of nurses exists in North America (Hyde-Price 1998; Aiken et al. 2001). In order to function effectively, hospitals must attract and retain sufficient numbers of qualified nurses to serve the needs of the patients and the hospital. However, Canadian hospitals have some disadvantages in attracting and retaining nursing staff. They are managed by government agencies and are unionized making them fairly bureaucratic in nature. Wages, benefits and working condition are negotiated provincially eliminating a hospital manager's ability to use these facets as tools for attracting and retaining nurses. Hospital managers, and particularly those in smaller centers, must look to other means to retain their staff. Improving trust and job satisfaction may be ways of doing so.

There is ample evidence that job dissatisfaction is linked to employee absenteeism and turnover (Mobley et al. 1978; Tett and Meyer 1993; O'Brien Pallas et al. 2004; Aiken et al. 2001). An antecedent to the development of employees' job satisfaction is the level of trust that employees have in management and in their supervisors (Dirks & Ferrin, 2002). An area of research that has not been examined is the extent to which nurses' trust of management and their supervisors is related to their job satisfaction.

Hospitals and the role of nurses in the hospital provide a unique context for the examination of trust and its impact on job satisfaction versus most other organizations. Although nurses have supervisors, they are considered to be professionals and conduct their work with high levels of autonomy. To a large extent the role of the supervisor is that of an experienced coach or mentor to the nursing staff rather than that of a traditional boss. Nurses have high levels of task significance as defined by Hackman and Oldham (1980). In addition, they typically work collaboratively with and take direction from physicians who are independent of the hospital. In many cases, nurses will work in teams of health care professionals where each member has a specific role. A nurse's actions are controlled and directed collaboratively by the team rather than by the nurse's management or supervisor. Unlike many other jobs, nurses have ample opportunity to develop job satisfaction independently of their supervisor, management or the work environment. For example, Newman, Maylor and Chansarkar (2002) found that the three factors influencing nurses' job satisfaction were patients, the inherent characteristics of nursing and the nursing team. Trust in management or the supervisor may not play as big a role in nurses' job satisfaction as it does in most organizations.

The context for this study was particularly relevant for the study of trust. A few years ago, the provincial government created large regional health authorities. As a result, hospitals and their employees experienced significant amounts of change in the organizational structures under which they worked. At the time of this study, that organizational change was continuing. In the past, regional hospitals had a fair degree of autonomy with a clear local hierarchy compared to the present where centralized control and decision making have been imposed. These changes produced a significant erosion of moral and trust in employees. The situation provided a very good opportunity to examine the relationships between hospital nurses' perceptions of management behaviour towards nurses, their trust of management and supervisors and their job satisfaction.

The purpose of this paper is to examine the relationship of four antecedents; treatment by management, treatment by supervisors, fairness of policies and the safety of the workplace, with nurses' level of trust and the relationship of that trust to job satisfaction. I will also examine whether or not the three factors proposed by Mayer, Davis and Schoorman (1995) appear to influence nurses' level of trust.

2. TRUST: ITS ANTECEDENTS AND OUTCOMES

Mayer, Davis and Schoorman (1995) define trust as "the willingness of a party to be vulnerable to the actions of another party based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control that other party (p 712)." They propose in their model of trust that there...