in nursing as professional rather than personal trust. There is a tendency for trust to be
categorised as trust in persons (personal trust) or trust in institutions4 but trust in nursing
seems not to fit either description.
The idea of professional trust offers a way of thinking about nurse-patient relationships
that allows for elements of both trust in persons and trust in institutions. Nurses can be
trusted (or not) both as individuals (with qualities we associate with personal trust) and
as representatives of nursing as an institution (with, for example, a healthy dose of
distrust under relevant circumstances). This recognises one tension for nurses in the face
of sometimes competing demands: that is, tensions between the demands of the
profession, the employer, the patient, the relatives of the patient and so on. One thing
that acting as a professional requires is that each individual nurse must negotiate a way
through tensions of this nature. These sorts of tensions seem to be an inevitable part of
the work of nurses and are as relevant in matters of trust as any other aspect of a nurse’s
professional activity.
Competence and professional trust
It might be suggested that trust is not needed because reliable nurses and confidence in
systems can assure safe care, but this would merely be a threshold of care. Of course,
such a threshold of safe care is important in itself and if one had to choose between
being cared for by a trustworthy yet incompetent or a competent but merely reliable
nurse one would tend to choose the latter for obvious reasons. Yet this categorisation is
false for, as we shall see, a trustworthy nurse is one who is at a minimum both
competent and reliable. So choices might be more accurately described in a different
way. One choice might be between the incompetent and the competent nurse and one
would normally choose the competent nurse in order to ensure a threshold level of care;
this together with reliable systems to ensure practising nurses are competent serves to
inspire confidence in nursing as an institution. Thus the minimum requirement for
reliance is met. A second choice, if there is one, might be between a merely competent
nurse and a trustworthy nurse. This distinction is one that hinges on the character of the
nurse and on her or his propensity to engage with nursing as a practice (as defined in
Chapter 3). It is unlikely that when one becomes a patient one will know very much
about the character of the nurse(s) providing care so at this point one may either rely on
4 For a useful exploration of the relationship between personal and institutional trust see White (1996).
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