Does trust matter?: Perceptions, trust and job satisfaction of hospital nurses.
Article Type:
Author abstract
Job satisfaction (Analysis)
Nurses (Services)
Hospitals (Administration)
Hospitals (Analysis)
Tallman, Rick
Pub Date:
Name: International Journal of Business Research Publisher: International Academy of Business and Economics Audience: Academic Format: Magazine/Journal Subject: Business, international Copyright: COPYRIGHT 2007 International Academy of Business and Economics ISSN: 1555-1296
Date: July, 2007 Source Volume: 7 Source Issue: 4
Event Code: 360 Services information Computer Subject: Hospital/clinic administration software
Product Code: 8098040 Hospital Management; 8043100 Nurses NAICS Code: 56111 Office Administrative Services; 621399 Offices of All Other Miscellaneous Health Practitioners SIC Code: 8741 Management services; 8049 Offices of health practitioners, not elsewhere classified
Geographic Scope: Canada Geographic Code: 1CANA Canada

Accession Number:
Full Text:

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.


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.


3.1 Participants

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 both.

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 management.


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 comments were:

"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 comments were:

"I think they will do what they have to, to meet their budgets."

"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 right information."

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 are."

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 cope."

"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 that."

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 abilities:

"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 patients."

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 management.

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 settings.

Rick Tallman, University of Northern British Columbia, Prince George, British Columbia, CANADA

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


                           Trust         Trust
                           Management    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


                       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
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