Organizational Trust and Burnout Among Registered Nurses and Patient Care Aides: A Qualitative Study
Abstract
Background: Healthcare worker wellbeing has emerged as a pivotal topic in workforce research. Organizational factors may impact well-being as much as individual and personal factors. One organizational determinant of well-being includes institutional trust; specifically, how the relationship between clinician and employer influences well-being (e.g., burnout). Institutional trust is an important factor in human caring professions, due to the moral and emotional nature of the work and the expectation for safety and provision among clinicians by employers. Existing clinician well-being research rarely studies institutional trust among registered nurses (RNs) and patient care aides (PCAs), despite their important frontline role in patient care delivery.
Purpose: This qualitative study explored perspectives of PCAs and RNs of organizational actions or behaviors that may damage or break trust and subsequently contribute to suboptimal emotional, attitudinal, and/or behavioral workforce wellbeing outcomes.
Methods: A qualitative grounded theory design was used. PCAs and RNs working within an academic hospital system in the Northeastern region of the U.S. were recruited for participation. Using an open-ended interview guide, a trained researcher conducted focus group sessions between mid-October and mid-December 2022. Morrison and Robinson’s Model of Psychological Contract informed interview questions and subsequent transcript coding by two researchers.
Findings: Twelve RNs and PCAs participated until data saturation was reached. Following coding and categorization by two researchers independently, two themes emerged: 1) breach of organizational trust; and 2) emotional or psychological impact. The overarching finding was the importance of relational and financial value investment that clinicians desired yet lacked from their organization. Both PCAs and RNs identified authenticity, respect, and congruent employee-organizational values as foundational to their trust in the organization.
Interview participants described organizational actions that eroded trust in their relationship with their employer, which resulted in negative feelings. Organizational actions appeared to diminish their affective and psychological commitments to the organization and potentially damaged their personal and professional identities.
Discussion: This current study emphasizes the importance of an employee’s sense of value, recognition, belonging, and mission congruence from their employers. These factors appear to contribute to an RN’s and PCA’s sense of trust and resilience. Much of the literature describes individual strategies to improve clinician resilience and reduce burnout, such as interventions aimed at mindfulness, meditation, and yoga. Other strategies aim at increasing an individual's sense of value include provision of appreciation tokens, such as hero paraphernalia and snack carts. However, these efforts might not adequately address the organizational factors that can impede clinician well-being and prompt intent to leave or actual turnover.
Notes
References:
Action Collaborative on Clinician Well-Being and Resilience & National Academy of Medicine. (2022). National Plan for Health Workforce Well-Being (V. J. Dzau, D. Kirch, V. Murthy, & T. Nasca, Eds.; p. 26744). National Academies Press. https://doi.org/10.17226/26744
Henderson, K. E., & O’Leary-Kelly, A. M. (2021). Unraveling the Psychological Contract Breach and Violation Relationship: Better Evidence for Why Broken Promises Matter. Journal of Managerial Issues, 33(2), 140–156.
Klest, B., Smith, C. P., May, C., McCall-Hosenfeld, J., & Tamaian, A. (2020). COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S159–S161. https://doi.org/10.1037/tra0000855
Action Collaborative on Clinician Well-Being and Resilience & National Academy of Medicine. (2022). National Plan for Health Workforce Well-Being (V. J. Dzau, D. Kirch, V. Murthy, & T. Nasca, Eds.; p. 26744). National Academies Press. https://doi.org/10.17226/26744
Bachem, R., Tsur, N., Levin, Y., Abu-Raiya, H., & Maercker, A. (2020). Negative Affect, Fatalism, and Perceived Institutional Betrayal in Times of the Coronavirus Pandemic: A Cross-Cultural Investigation of Control Beliefs. Frontiers in Psychiatry, 11, 589914. https://doi.org/10.3389/fpsyt.2020.589914
Silver, S., Boiano, J., & Li, J. (2020). Patient care aides: Differences in healthcare coverage, health-related behaviors, and health outcomes in a low-wage workforce by healthcare setting. American Journal of Industrial Medicine, 63(1), 60–73. https://doi.org/10.1002/ajim.23053
Brewer, K. C. (2021). Institutional betrayal in nursing: A concept analysis. Nursing Ethics, 28(6), 1081–1089. https://doi.org/10.1177/0969733021992448
Sigma Membership
Iota Epsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Grounded Theory
Research Approach
Qualitative Research
Keywords:
Well-Being, Registered Nurses, Home Health Aides, Professional Burnout, Organizational Culture, Home Health Care
Recommended Citation
Brewer, Katherine C.; Dierkes, Andrew; and Norful, Allison A., "Organizational Trust and Burnout Among Registered Nurses and Patient Care Aides: A Qualitative Study" (2026). Creating Healthy Work Environments (CHWE). 86.
https://www.sigmarepository.org/chwe/2024/presentations_2024/86
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-24
Organizational Trust and Burnout Among Registered Nurses and Patient Care Aides: A Qualitative Study
Washington, DC, USA
Background: Healthcare worker wellbeing has emerged as a pivotal topic in workforce research. Organizational factors may impact well-being as much as individual and personal factors. One organizational determinant of well-being includes institutional trust; specifically, how the relationship between clinician and employer influences well-being (e.g., burnout). Institutional trust is an important factor in human caring professions, due to the moral and emotional nature of the work and the expectation for safety and provision among clinicians by employers. Existing clinician well-being research rarely studies institutional trust among registered nurses (RNs) and patient care aides (PCAs), despite their important frontline role in patient care delivery.
Purpose: This qualitative study explored perspectives of PCAs and RNs of organizational actions or behaviors that may damage or break trust and subsequently contribute to suboptimal emotional, attitudinal, and/or behavioral workforce wellbeing outcomes.
Methods: A qualitative grounded theory design was used. PCAs and RNs working within an academic hospital system in the Northeastern region of the U.S. were recruited for participation. Using an open-ended interview guide, a trained researcher conducted focus group sessions between mid-October and mid-December 2022. Morrison and Robinson’s Model of Psychological Contract informed interview questions and subsequent transcript coding by two researchers.
Findings: Twelve RNs and PCAs participated until data saturation was reached. Following coding and categorization by two researchers independently, two themes emerged: 1) breach of organizational trust; and 2) emotional or psychological impact. The overarching finding was the importance of relational and financial value investment that clinicians desired yet lacked from their organization. Both PCAs and RNs identified authenticity, respect, and congruent employee-organizational values as foundational to their trust in the organization.
Interview participants described organizational actions that eroded trust in their relationship with their employer, which resulted in negative feelings. Organizational actions appeared to diminish their affective and psychological commitments to the organization and potentially damaged their personal and professional identities.
Discussion: This current study emphasizes the importance of an employee’s sense of value, recognition, belonging, and mission congruence from their employers. These factors appear to contribute to an RN’s and PCA’s sense of trust and resilience. Much of the literature describes individual strategies to improve clinician resilience and reduce burnout, such as interventions aimed at mindfulness, meditation, and yoga. Other strategies aim at increasing an individual's sense of value include provision of appreciation tokens, such as hero paraphernalia and snack carts. However, these efforts might not adequately address the organizational factors that can impede clinician well-being and prompt intent to leave or actual turnover.
Description
This qualitative study seeks to seeks to develop a grounded theory of how organizational actions and behaviors that damage or break trust contribute to emotional, attitudinal, and/or behavioral workplace well-being outcomes among RNs and patient care aides.