Paper Title An exploration of the antecedents, attributes and consequences of trust amongst nurses and nurse line-manager Authors

Our paper addresses this conference stream by considering how trust is developed and discussed between nurses and their line managers, and how this might influence leadership and management development. It does so through an exploration of the antecedents, attributes and consequences of trust. Research discusses the centrality of trust in nurse-manager relationships, and suggests that high levels of trust can provide benefits to the providers of care and those they serve (Halliday, 2004; Peter and Morgan, 2001; Thorne and Robinson, 1988; Walsh, 1995). It is linked to organisational performance, service quality and turnover amongst nurses (Cunningham and Hyman, 1996, Newman et al., 2002; Williams, 2005). It has been suggested that trust in management is necessary if health service organizations are to maintain service quality and successfully manage organizational change (Skinner et al., 2004). Research conducted by Laschinger and Finnegan (2005) found that nurses who were less trusting of their managers, were less likely to contribute towards organizational goals relative to managers with high trust levels. In this context trust was found to be a significant ‘leader activity’ in determining positive organizational outcomes. Attributes that influenced trust amongst nurses included; ‘confidence’, ‘dependability’, ‘consistency’ and ‘predictability’ (Meize-Grochowski, 1984). This paper reports the main findings from a qualitative study conducted within the British National Health Service (NHS). This involved conducting forty semi-structured interviews with nursing staff, from acute and community hospitals. The study explores the antecedents and the attributes of trust, from the perspective of nurses and their linemanagers. It examines the consequences of trust, and explores possible outcomes associated with high and low trust relations. In order to create and establish a degree of coherence around the concept of trust, a concept analysis framework (Walker and Avant 1988, Rodgers, 1989) was used. ‘Grounded theory’ (Glaser and Strauss, 1967), and a ‘constant comparative approach’ (Glaser, 1965), were also used in analysing the data. The emerging analysis explores the antecedents, attributes and consequences of trust, with implications for leadership and management development. The interview findings suggest that while nurses did not trust senior level management, they did however trust their line-managers. The antecedents, required for trust to develop included: the immediate work environment and the role of line manager, leadership and management style, time and reciprocity. Key attributes of ‘trustworthy’ managers included: communication, leadership and management style, professional nursing standards, teamwork and support, confidentiality and discretion. The consequences of low trust included: breakdown of teamwork and associated benefits such as support, communication, confidentiality and efficiency, the emergence of ‘destructive conflict’ and lower standards of patient care. Further consequences of low trust included increased labour turnover and workplace absenteeism.