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
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 are three factors, ability, benevolence and integrity,
which determine whether or not the trustor trusts the trustee. Mayer,
Davis and Schoorman (1995) define these factors as follows. Ability is a
group of skills, competencies and characteristics that enable a party to
have influence in some specific domain. Management and supervisory
abilities of primary concern to hospital nurses would be the effective
management of human resources and interpersonal relationships and the
provision of the physical resources necessary for them to function
successfully in their jobs. Benevolence is defined as the trustor's
belief that the trustee wants to do good things for the trustor and has
an attachment to the trustor. Benevolence from a hospital nurses'
perspective would involve management policies and practices that
demonstrated caring and support. The third factor is integrity which
involves the trustor's perception that the trustee follows a set of
principles which the trustor finds acceptable. Management and
supervisory integrity are demonstrated by consistency of actions,
truthful communications, congruence between words and deeds and acting
with justice towards nurses. Observation of these behaviours will
develop trust in nurses. Mayer, Davis and Schoorman (1995) propose that
these three factors all have to be present for trust to develop. If one
factor is deficient, trust will not develop or be limited. In a study of
the development and erosion of trust, Lapidot, Kark and Shamir (2007)
found that participants were able to identify specific incidents where
trust was built or eroded. Most of these incidents could be categorized
as ability, benevolence or integrity.
Hypothesis 1. Nurses' descriptions of their trust in
management and their trust in supervision will involve perceptions of
management's ability, benevolence or integrity.
Research has supported the proposition that employees trust their
leaders based on their perceptions of their leader's ability,
benevolence and integrity and that these perceptions are influenced by
their leader's behaviour (Dirks & Ferrin, 2002; Lapidot, Kark
& Shamir, 2007; Mayer & Davis, 1998, 1999; Mayer & Gavin,
1998). Leaders can be direct supervisors or organizational management as
employees distinguish between levels of management in their trust (Dirks
& Ferrin, 2002; Perry & Mankin, 2004). In this study, nurses
would develop trust based on their perceptions of how management and
supervisors behaved towards them and other nurses. Nurses'
observations of behaviour would direct perceptions of how they are
treated by management and by their supervisor. Perception of treatment,
through cognitive evaluation of leaders' ability, benevolence or
integrity, will relate to nurses' trust of those leaders.
Williams (2005) found that policies directly related to
nurses' organizational trust. Organizational policies and their
application are manifestations of management and supervisory attitudes
towards employees. In their meta-analytic review of trust in leaders,
Dirks and Ferrin (2002) found strong correlations between distributive,
procedural and interactive justice. Policies may violate employees'
perceptions of justice in their own right if employees regard the
wording or specifications of the policy to be unjust. If this was the
case, one would expect that employees' trust of management, as
authors of the policy, would be influenced but trust of supervisors
would remain unaffected. However, organizational policies are written in
order to specify how particular situations are to be handled. Because
policies are generally written or at least well publicized, employees
are in a position to judge management and supervisor behaviour against
their interpretation of the policy. Judgments of management and
supervisory behaviours may lead to perceptions of justice done or not
done as the case may be. Beliefs about the fairness and justice of
policies will influence nurses' perceptions of the ability,
benevolence and integrity of their management and supervisor,
influencing their levels of trust.
Nursing is a hazardous occupation and many nurses are subject to
violent behaviour in their jobs from patients or patients' families
(Duncan S, Hyndman K, Estabrooks C, et al, 2001). It is the
responsibility of management and supervisors to provide a safe work
environment for employees. Although hospital management and supervisors
are not in complete control of those who enter a hospital, their
policies and attitudes towards employee safety will influence the degree
of risk faced by nurses. Perceptions of the safety of the work
environment will influence nurses' perceptions of the ability and
benevolence of management and supervisors which will in turn influence
the development of trust.
Hypothesis 2. Trust in management and supervisors will be directly
related to nurses' perceptions of how they are treated, the
fairness of policies and how safe they feel at work.
Dirks & Ferrin (2002) in there meta-analysis of trust
relationships report on a number of studies involving 34 samples of
participants relating trust to job satisfaction. The mean weighted
correlation for this relationship was reported as .52. It is not clear
who was the referent of that trust. Past research indicates that trust
in leaders or, for our purposes, trust in management and supervisors is
related to job satisfaction (Dirks & Ferrin, 2001, 2002).
Hypothesis 3. Nurses' level of trust in their management and
supervisor will be related to their job satisfaction.
The participants in this study were 122 nurses in 13 hospitals in
Western Canada. Participation was restricted to nurses who were working
full-time or at least half-time in the hospital and who had worked in
the hospital for the previous three months. Participant demographics
were as follows: 95.1% were women; 89.3% were 31 years old or older;
24.6% held a university degree; 75.4% were married; 67.2% were full
time; 80.3% had been with the organization for 5 years or longer; 92.6%
had been in nursing for 5 years or longer. Due to a variety of tape
recorder problems, six of the interviews were not properly recorded
leaving data from 116 interviews.
Participants were recruited via request for participation letters
circulated in the workplace and flyers posted on bulletin boards. As
participants were not approached directly, participation rates are not
known. Based on data on the number of registered nurses in the area from
which our sample was drawn (Canadian Institute for Health Information,
2003), I can estimate that our sample represented approximately 11% of
the population. Participants contacted the author directly and were sent
a package of questionnaires. Data was collected using two methods. One
was survey questionnaires that were returned directly to the author. In
this questionnaire, respondents scored each question on a five point
Likert type scale ranging from strongly agree to strongly disagree. The
other data collection method was a structured interview conducted
separately from the questionnaire. All participants completed both the
questionnaires and structured interviews. This study used data from
3.2 Study Variables
3.2.1 Safety and Policies. Participants' perceptions of the
safety and policies of the workplace were assessed through two questions
on safety and one on policies. The questions were "The policies of
the organization are fair and just", "I feel safe in my
job", and "This is a safe place to work". They were asked
to respond on a five point Likert type scale ranging from 1 = Strongly
Disagree to 5 = Strongly Agree. The two safety questions were combined
to form this measure. Reliability for this measure was .74.
3.2.2 Job Satisfaction. Job satisfaction was assessed in the
questionnaire using two questions drawn from Hackman and Oldham's
(1980) general satisfaction measure in their Job Diagnostic Survey. The
questions used were "Overall, I am satisfied with my job" and
"Generally speaking I am satisfied with this job". Reliability
for these two questions was .93.
3.2.3 Treatment by Management and Supervisor. Participants were
asked to respond to the questions "How does management treat
you" and "How does your supervisor treat you" in the
structured interview. Quantitative data had to be constructed from the
interpretation of individual answers. In order to do so, I used a five
point scale for scoring participant answers. The scale was based on
scoring answers from 1 = 'very poorly' to 5 = 'very
well'. The structured interview data was transcribed and the
transcriptions were independently coded by the author and two research
assistants. Reliability calculations were made for the three sets of
coded data. The interrater reliabilities for the questions "How
does management treat you" and "How does your supervisor treat
you" were both .91. As the interrater reliability of the data was
good the average score for the data was used.
3.2.4 Trust. Trust in management and supervisors were measured in
the structured interview by asking participants "How much do you
trust management" and "How much do you trust your
supervisor". Participants were asked to elaborate on their answers.
I used these questions rather than a survey trust measurement in order
to obtain richer data on why a person might or might not trust the
trustee. Scoring for the answers was on a five point scale from 1 =
'I don't trust them (him/her) at all' to 5 = 'I
trust them (him/her) in all things. Interrater reliability for the two
questions was .95 for trust of supervisors and .94 for trust of
Hypotheses 1 stated that nurse descriptions of trust in their
management and supervisor will involve perceptions of managements'
and supervisors' ability, benevolence or integrity. As shown in
Table 1, the mean for nurses' trust in management is very low at
2.34 whereas their trust in their supervisors is relatively good at a
mean of 3.73. As I asked nurses about their level of trust in the
structured interview, I was able to analyze their reasons for trusting
or not trusting management and supervisors. I used QSR's N6
software to analyze the qualitative data from the interview to determine
the extent to which ability, benevolence or integrity was cited as a
reason for trusting or not trusting management and supervisors.
In the case of trust in management, 74 or 64% of the 116 responses
were scored below 3.00. Of those, 30 responses contained a reference to
a lack of integrity, 24 contained references to a lack of benevolence,
14 referred to concerns about ability and 6 indicated other reasons. The
other 42 responses were scored by the raters at 3.00 or above. Of these,
17 related to managements' integrity, 11 related to benevolence, 5
related to ability and there were 9 other comments.
Integrity is the trustor's perception that the trustee follows
a set of principles which the trustor finds acceptable. A major theme in
the negative comments was that management had not been truthful. Typical
"I don't know where they are coming from. We've been
lied to in the past and if they tell us something, we wonder if we are
being lied to again."
"I don't trust management. I've been lied to and
threatened. I'm not the only one. You could ask any nurse in that
hospital. It's pretty poor that just about every nurse in that
hospital has been lied to at one time or another to meet one
circumstance or another."
Another theme under integrity was that management had an agenda
that did not consider the needs of the nurses or the patients. Typical
"I think they will do what they have to, to meet their
"Management works in its own best interest. I don't trust
management to be consistent, to follow-up on their promises, or to make
my job easier."
On the positive side under integrity, there were beliefs that
management was trying its best to improve communications at the
hospitals. A typical supportive comment was:
"There was a period of time where it seemed like things were
happening very secretively. I don't sense that any more. Management
is much more open. The communication is much better."
There were also comments under integrity that management was trying
to do the right things.
"I trust management will do the right thing if they have the
Benevolence is defined as the trustor's belief that the
trustee wants to do good things for the trustor and has an attachment to
the trustor. One theme was a belief that management did not develop
relationships with employees. As a result, management was perceived as
not caring for employees. Typical comments were:
"Generally they don't know who you are. You are a name, a
number, so they don't care."
"It's like we're a non-entity. I would have to say
not very much and not so much for the fact I know they are not
trustworthy but because I have no relationship with them."
There was also concern that management would not support nurses
generally or in a difficult situation. I heard comments like:
"I sometimes feel like they are not fighting for the nurses,
that our concerns are not given the weight that they should have."
"They would not back us up. If there was a problem with a
patient that they knew about or whatever, you could let them know but
they wouldn't back you up."
There were a number of comments related to management not listening
to nurses such as:
"Decisions are always being made without us that directly
impact us. They don't ever seem to care what kind of effect it has
on the workers."
On a more positive note under benevolence, there were others who
had received support and recognition from management when they asked for
it. A typical comment was:
"The administration seems to be fine. They seem to be on the
level. As far as them seeming to be supportive and stuff, yes they
The third category I expected to hear about was issues related to
ability which is a group of skills, competencies and characteristics
that enable a party to have influence in some specific domain. Negative
comments on ability revolved around managements planning and knowledge
of the operation and nursing. Typical comments were:
"They're in crisis management and they are constantly
putting out fires. There is little planning done on how we will
"Because there are so many non-nurses in management, they
really don't understand the profession or the challenges that we go
through on a day-to-day basis."
Comments on supervisors were much more positive than those for
management. The raters scored 27 of 116 responses or 18% below 3.00. Of
those, 13 responses contained a reference to a lack of integrity, 5
contained references to a lack of benevolence, 7 referred to concerns
about ability and 2 indicated other reasons or did not elaborate on
their initial answer. The other 89 (82%) responses were scored by the
raters at 3.00 or above. Of these, 27 related to supervisors'
integrity, 26 related to benevolence, 25 related to ability and there
were 11 other comments. Typical positive responses for integrity were:
"She has come a long way. It took her a long time, thirteen
years, but she made it. I think that I can believe what she says and I
think she listens."
"Her primary interest would be for the good of the patient but
she is also very good at recognizing the staff needs, limitations, the
burnout risks, all that kind of stuff as well. If I had to rank them I
would say the patient is ahead and I don't fault her for
Responses that related to benevolence were:
"I think she sincerely wants us to feel happy and positive
about our work."
"I trust her to back us up. I know she respects us all and she
relays her respect of us to others."
"I think she would do the best for the whole organization but
would also consider us as a group and me as an individual."
Supervisors also received many positive comments regarding their
"I trust her very much for doing the best she can, for getting
certain jobs done. I trust her judgment for the care of the
As I was able to categorize most responses to the trust questions
under ability, benevolence or integrity, hypothesis 1 is supported.
Hypotheses 2 states trust in management and supervisors will be
directly related to nurses' perceptions of how management and
supervisors treat them, the fairness of policies and how safe they feel
at work. These hypotheses were tested using regression analysis. The
four independent variables of nurses' perception of their treatment
by management, their treatment by their supervisor, the fairness of
policies and the safety of the workplace were entered into the
regression analysis as a block. Means, standard deviations and
correlations are shown in Table 1 and the regression analyses are shown
in Table 2.
As can be seen in Table 2, both models of nurses' trust in
their management and supervisors were significant with 49% and 53% of
the variance explained by the respective models. Table 2 also shows that
trust in management is directly related to how nurses perceive
managements treatment of them personally ([beta] = .41, p < .001),
the fairness of the policies ([beta] = .28, p = .001) and the safety of
the workplace ([beta] = .24, p = .003). Nurses' perceptions of
their treatment by supervisors did not affect their trust in management.
Nurses' trust in their supervisors were directly related to their
perceptions of how their supervisor treated them ([beta] = .61, p <
.001) and the fairness of policies ([beta] = .25, p = .002).
Nurses' perceptions of their treatment by management and the safety
of the workplace did not affect their trust in their supervisors.
Hypothesis 2 is supported by the data.
Hypothesis 3 states that nurses' job satisfaction will be
directly related to their trust in their management and supervisors.
Table 3 shows the regression analysis for this hypothesis. As can be
seen in Table 3, job satisfaction is significantly related to both
nurses' trust in management ([beta] = .32, p < .001) and their
trust in their supervisor ([beta] = .19, p = .04). The model is
significant at the p < .001 and explains 16% of the variance in Job
Satisfaction. Hypothesis 3 is supported.
The purpose of this study was to examine the relationship between
management behaviour, trust and job satisfaction in hospital nurses
experiencing extensive organizational change. When nurses were asked to
explain their level of trust, their explanations and stories of their
trust reflected positive and negative aspects of their perceptions of
the ability, benevolence and integrity of their management and
supervisors. There were a number of aspects of the responses that were
consistent with past research. Although it was difficult at times to
decide if a comment was an integrity or benevolence issue, the negative
comments were more focused on one characteristic of the trustee whereas
many positive comments manifested elements of two or three
characteristics. This is consistent with Mayer et al's (1995)
theory that all elements must be present for trust to develop and the
deficiency of one element will result in a loss of trust. Lapidot et al
(2007) examined critical incidents that either enhanced or eroded trust
in a supervisor. They found that integrity, benevolence and ability
represented 34%, 31% and 17% respectively of the incidents reported with
19% being other factors. I found a similar pattern in this study as
integrity, benevolence, ability and other represented 38%, 28%, 22% and
12% respectively of incidents.
The organizational changes appear to have had an impact on
participants' trust in management. Many of the stories reflected a
deep distrust of management to manage change in a way that demonstrated
their interest, caring, truthfulness and trustworthiness. The low level
of trust in management and the relatively higher level of trust in
supervisors likely reflect the nature of the changes taking place in
this organization. Most of the changes were structural and directed at
upper level reporting relationships. There was a significant loss of
autonomy and sense control at the local level as a large number of
independent health organizations were merged into a single organization.
The relationship between floor nurses and their supervisors were not
affected to a large extent by these changes.
As expected, how nurses perceived managements' treatment of
them related to their trust in management as did their perceptions of
supervisor treatment with their trust of supervisors. The results
indicate that participants distinguished between management and
supervisory treatment in making judgments about trustworthiness with no
spill-over effects to the other. These results are consistent with past
research that indicates that employees distinguish between levels in
organizations in their trust relations and that trust refers to specific
actors (Dirks & Ferrin, 2002; Ferres, Connell & Travaglione,
2005; Perry & Mankin, 2004; Schoorman, Mayer & Davis, 2007).
Management is responsible for the development of organizational
policies and one would expect that any issues with the fairness of
policies would be directed at management. However, in this study,
nurses' perceptions of the fairness of organizational policies were
related to the level of trust for both management and supervisors. This
result suggests that it is not so much the wording of the policies that
employees regard as fair or unfair but it is the application of the
policies that is being judged. Further research would be needed to
clarify this finding.
Nurses' perception of the safety of the workplace was only
related to trust in management. It appears that management is being held
responsible for any safety issues that might exist. There are the known
physical safety issues for nurses such as violent patients or family. It
may be that some participants do not believe management is spending
sufficient resources in the way of security or assistance for nurses to
adequately deal with these issues. From the stories about trust that I
heard, there were significant concerns about management being uncaring
and non-supportive. There are many risks for nurses beyond the physical
risks in the hospital. Although not reported here, I heard stories from
the nurses that if some doctors made an error, they would almost
automatically blame a nurse. Nurses worry that if an error is made and a
nurse is blamed, they can be sued or loose their nursing license if they
do not have support from management. I also heard about appalling
behaviour by doctors, supervisors and managers that is perceived to be
ignored by management out of concern that the person could not be easily
replaced. These types of issues may have resulted in the connection
between nurses' perceptions of workplace safety and their trust in
A strength of the study is that data was collected using two
different methods separated by time. However, there were some
limitations to the interpretation of the data in this study. The
cross-sectional nature of the study means causal relations cannot be
established as the time difference in data collection was not sufficient
to allow relationships to develop. There was also a problem of
self-selection bias as participants approached me rather than being
selected by me. Demographically, participants appear to mirror the
population of nurses in the area but attitudinally they might not.
There are some implications for management in this study. As with
other organizations, nurses' trust in management and supervisors is
significantly related to their job satisfaction. Management needs to
build nurses' trust in itself and in its supervisors. This study
suggests management can do so by ensuring its policies and their
applications are fair to employees. Management needs to review its
practices related to all aspects of safety for nurses. Ensuring nurses
feel safe may help build their trust in management. Most of all
management needs to look at its behaviour. Does it have strong, clearly
articulated principles regarding the treatment of staff and patients? Is
it consistent in following those principles? Does it care for and
support its staff generally and in difficult circumstances? Does it
provide the training and development needed for its supervisors and
managers to function humanely and effectively? Is management completely
open and candid with employees? Addressing these issues will convey to
nurses that it cares and over time improve nurses' perceptions of
management's integrity, benevolence and ability.
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Dr Rick Tallman completed his PhD at the University of Manitoba in
2001. He is an assistant professor of Organizational Behavior at the
University of Northern British Columbia. He conducts research in work
environments and employee attitudes with a focus on health care
Rick Tallman, University of Northern British Columbia, Prince
George, British Columbia, CANADA
TABLE 1 MEANS, STANDARD DEVIATIONS AND CORRELATIONS OF VARIABLES
Variable Mean SD 1 2 3
1. Trust Management 2.34 1.04
2. Trust Supervisor 3.73 1.14 .20 *
3. Treatment by Management 3.18 0.95 .58 ** .16
4. Treatment by Supervisor 4.03 0.97 .16 .68 ** .18
5. Safety of Workplace 6.03 1.98 .45 ** .32 ** .25 **
6. Fairness of Policies 2.79 0.98 .53 ** .40 ** .39 **
7. Job Satisfaction 7.54 1.69 .36 ** .34 ** .34 **
Variable 4 5 6
1. Trust Management
2. Trust Supervisor
3. Treatment by Management
4. Treatment by Supervisor
5. Safety of Workplace .25 **
6. Fairness of Policies .23 * .42 **
7. Job Satisfaction .24 * .46 ** .34 **
Note: * p < .05, ** p < .01
TABLE 2 REGRESSION ANALYSIS OF TRUST IN MANAGEMENT AND SUPERVISOR
Model [R.sup.2] .49 0.53
F statistic 24.5 28.7
Significance of F < .001 < .001
Variables Beta Sig. Beta Sig.
Treatment by Management .41 .00 -.07 .34
Treatment by Supervisor -.04 .63 .61 .00
Fairness of Policies .28 .00 .25 .00
Safety of Workplace .24 .00 .07 .34
TABLE 3 REGRESSION ANALYSIS FOR JOB SATISFACTION
Job Satisfaction Beta Sig.
Model [R.sup.2] .16
F statistic 10.60
Significance of F < .001
Trust in Management .32 .000
Trust in Supervisor .19 .040