Wisconsin Nurse - September 2020
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<strong>September</strong> <strong>2020</strong> The <strong>Wisconsin</strong> <strong>Nurse</strong> Page 11<br />
Trust and the Professions<br />
Dr. Mary Ellen Wurzbach<br />
When we enter into a relationship with our<br />
patients in a variety of settings we form a tacit<br />
contract. We agree to protect their physical,<br />
psychological and social well-being.<br />
Physically we agree not to harm our patients.<br />
When we perform treatments or prescribe<br />
medications we agree that we understand the<br />
burden and benefits of what we are suggesting or<br />
doing to our patients. We agree to be responsible<br />
and accountable for the outcome. The same is<br />
true of psychological and social interventions<br />
including everything from mental health treatment<br />
to working with insurance coverage or in an<br />
administrative capacity in a health care institution.<br />
Some of us are direct care providers; some are<br />
faculty, researchers or administrators. All of us<br />
have tacit contracts with our students, participants,<br />
policy holders or patients.<br />
We usually think of individuals as having<br />
responsibilities and accountability in health<br />
care. We think of ourselves as individual nurses,<br />
not necessarily team members or agents of an<br />
organization. We have individual liability insurance<br />
plus possibly an institutional policy. We believe<br />
we are accountable for our actions and that<br />
currently we practice under our own licenses.<br />
Thus, as individuals, we have formed a bond with<br />
our patients, policy holders, students, research<br />
participants or subordinates.<br />
All of these beliefs about responsibility and<br />
accountability are writ large in the health care<br />
organization – the clinic, hospital, insurance<br />
company or government agency. Without this<br />
commitment to accountability and responsibility<br />
accompanying the authority to make choices and<br />
decisions in health care, trust - the silent contract -<br />
suffers.<br />
Trust is essential. <strong>Nurse</strong>s and pharmacists are<br />
seen as the most trustworthy of the professions<br />
by the public. Even the word profession means<br />
that one belongs to a group that can provide a<br />
valued service to society and be a self-monitor<br />
of its own behavior. By definition a profession<br />
agrees to accountability to society and the control<br />
of its own practice. Years ago Amitai Etzioni called<br />
nursing, social work and teaching semi-professions.<br />
Through the years we have become a full fledged<br />
profession as well as an academic discipline.<br />
Without trust think of what the health care<br />
system would be. Why would a patient, student,<br />
subordinate, research participant or policy holder<br />
follow the directives of a person with authority<br />
in a technical sense but no moral authority, no<br />
accountability or responsibility?<br />
What are accountability, responsibility and<br />
moral authority? They have various characteristics,<br />
including legitimate concern and caring, the<br />
knowledge to perform certain health care<br />
functions and prudence. This concern and caring,<br />
knowledge and, above all, prudence support moral<br />
authority conveyed by society to the professional.<br />
Teaching, research and administration are more<br />
disciplinary functions but they too entail trust and<br />
professionalism in the practitioner.<br />
What seems to be happening today in health<br />
care is the abdication of this moral authority based<br />
on trust: practitioners not knowing, for example,<br />
the side effects of a medication or not offering, if<br />
known, informed consent; record keeping that<br />
seems to be paramount, but not protecting these<br />
records; teaching that does not instill a true feel for<br />
the patient’s experience; research that abrogates<br />
the rights of the participants and administrative<br />
lack of due diligence.<br />
The health care system is growing and more<br />
organizations are becoming members of a<br />
giant complex of functions. Unless we actively<br />
demonstrate concern and caring, knowledge and<br />
prudence, all of which support out moral authority<br />
conveyed by society, our societal function will<br />
descend into chaos. Without these attributes of a<br />
committed human being why would our clients,<br />
whether patients, students, participants, or<br />
subordinates, trust us?<br />
Most professionals feel concern and caring<br />
and believe themselves to be knowledgeable.<br />
But with the burgeoning data base it is difficult to<br />
remain current with all knowledge no matter how<br />
concerned and caring.<br />
This raises the issue of prudence and not<br />
expecting our clients to assume risks we would not<br />
assume ourselves. Many of us would be horrified if<br />
we knew the results of well-meaning but misguided<br />
health care interventions. Prudence may alleviate<br />
some of these iatrogenic outcomes. Prudence<br />
entails planning. It entails, more than anything,<br />
anticipating the possible outcomes of a treatment,<br />
medication, advice, teaching or simply technology.<br />
Anticipation means thoughtful consideration<br />
of what might be detrimental to our clients if a<br />
particular course of action is instituted. It means<br />
taking precautions to prevent an unanticipated<br />
treatment, drug reaction or technological problem.<br />
It means considering consequences before they<br />
occur and working diligently to prevent side effects<br />
of our actions.<br />
Trust is the tacit (silent) contract we enter into<br />
with our clients. The entire health care enterprise<br />
is based on this trust. Unless the professions meet<br />
this societal obligation to be caring and concerned,<br />
knowledgeable and prudent why would society trust<br />
us anymore than our individual clients do? At some<br />
point the moral authority society has invested in us<br />
may be revoked and much of our unflagging effort<br />
to be seen as trustworthy will be diminished.<br />
There are actions that can be taken which include<br />
anticipating possible outcomes, following up on<br />
interventions, being responsible for the result and<br />
offering informed consent so that clients can assist<br />
us in monitoring the side effects of interventions.<br />
Assiduously acquiring new knowledge and<br />
remaining current with therapeutic norms is critical<br />
- talking with our clients and offering advice and<br />
appropriate education and reciprocity.<br />
Authentic caring and concern, constant<br />
knowledge acquisition and prudent anticipation<br />
of consequences all will amplify and support our<br />
client’s trust in us and in health care. Trust is the<br />
bond we have with our clients. It is also the bond<br />
that holds health care together. We must not<br />
squander it.<br />
Iowa County<br />
Registered <strong>Nurse</strong>/LPN<br />
Full Time Night Shift<br />
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$3,000 RN/$1,500 LPN<br />
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Apply online at<br />
www.iowacounty.org<br />
or by calling (608) 935-0374
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