Institutional Courage: An Antidote to Institutional Betrayal and Broken Trust

Abstract

An emerging area of interest is how institutional betrayal among nurses might lead to issues of nurse well-being, such as burnout and turnover. In this phenomenon, the organization, whether by explicit actions or the abstract ethos of the work environment, can become a contributing factor to psychological well-being. Within health care, the systemization and corporatization of medical services has contributed to a more institutional identity. Institutional actions that defy the expectation for safety and violate relationships between individual and institution are termed institutional betrayal. In any case or among any population of nurses, the key element of institutional betrayal is a violation of trust. If trust is lacking and the relationship with the organization is broken, then the person would feel a psychological weight or some sort of strain on their ethos that wears on their resilience. For nurses, this fractured relationship then makes patient care feel more like work than caring, which then cascades to burnout. In a system depleted of institutional trust, nurses might feel useless and wasted in the churn of the “system,” so they become depersonalized and bitter. Building back institutional trust becomes a pivotal way to counteract the trauma of betrayal. Rebuilding trust takes acts of courage. It is not easy for an organization or institution to admit it harmed people, and likely even more difficult as public relations and brand image become critical factors in health care business practices. But to admit these faults and take bold action is an act of institutional courage, one that can help heal the wounds experienced by nurses and larger society.