Institutional betrayal in nursing: A concept analysis

Abstract

Background: Ethical relationships are important among many participants in healthcare, including the ethical relationship between nurse and employer. One aspect of organizational behavior that can impact ethical culture and moral well-being is institutional betrayal. Research aim: The purpose of this concept analysis is to develop a conceptual understanding of institutional betrayal in nursing by defining the concept and differentiating it from other forms of betrayal. Design: This analysis uses the method developed by Walker and Avant. Research context: Studies were reviewed using health literature databases with no date restrictions. Ethical considerations: Analysis was conducted using established guidelines for ethical research. Findings: Although institutional betrayal is a concept applied in the literature, there was a paucity of studies exploring the concept within nursing. Examples of the concept in the literature include violation of trust between organization (i.e. employer) and nurse, such as provision of inadequate workplace protections, ineffective or hostile management, and gaslighting of those who experience negative events. Examples of institutional betrayal have become more visible during the COVID-19 pandemic. Discussion: A conceptual definition of institutional betrayal is a deep violation of trust or confidence or violation of moral standards committed by an institution toward a nurse. This definition incorporates experiences and issues suggested by the literature. Outcomes are likely negative, including impacts on nurse psychological and workplace well-being. This concept likely fits within a framework of ethical workplaces and has conceptual relationships with moral distress and moral resilience. Further studies can help qualitatively explore and empirically measure this concept. Conclusion: In the pursuit of improving the ethical culture of healthcare workplaces, this concept can provide meaningful insight into organizational behavior and its consequences. Naming and describing the concept can promote conceptual clarity and equip researchers, nurses, and leaders to identify and mitigate the issue.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Another PMIDE category that emerged as global in scale involved a “Perceived lack of support and unfair treatment of HCWs by their organization.” This category highlights the inadequate protection and support, as well as hostility, that some HCWs encountered from their organizations. Taken together, these findings may represent the institutional betrayal associated previously with MD ( 39 ) and MI ( 114 ), where institutional betrayal has been described as a violation of trust by an organization toward an individual who identifies with it ( 39 , 115 ). Here, it is possible that COVID-19 has exacerbated and highlighted similar issues that existed pre-pandemic ( 116 ).…”

“…Here, it is possible that COVID-19 has exacerbated and highlighted similar issues that existed pre-pandemic ( 116 ). As described in the articles included in this review, betrayal may take various forms in the healthcare setting, including inadequate workplace protections, disregard for HCW and patient needs, and gaslighting ( 39 ). These experiences have been linked to feelings of anger or frustration and thoughts of leaving the profession, and are thought to exacerbate the physical and psychological impacts of stressful events ( 39 , 114 , 117 ).…”

“…As described in the articles included in this review, betrayal may take various forms in the healthcare setting, including inadequate workplace protections, disregard for HCW and patient needs, and gaslighting ( 39 ). These experiences have been linked to feelings of anger or frustration and thoughts of leaving the profession, and are thought to exacerbate the physical and psychological impacts of stressful events ( 39 , 114 , 117 ). For example, a recent study on betrayal-based MI during the COVID-19 pandemic indicated that HCWs commonly reported feeling abandoned and treated as dispensable by leadership, who were perceived as detached and dishonest at times ( 114 ).…”

“…PMIDEs included events where HCWs or PSP performed, witnessed, or were placed in situations that forced them to engage in acts violating deeply held personal or professional moral beliefs or expectations ( 19 , 27 ); experienced moral uncertainty due to constraints within or outside of their control (internal or external) ( 15 ); or experienced organizational betrayal ( 39 , 40 ).…”

“…Emotional, psychological, behavioral, social, spiritual/existential, or functional outcomes, including, but not limited to, moral emotions such as shame, guilt, and anger, betrayal, anhedonia, inward hostility, social alienation, loss of trust in self or others ( 20 , 39 ), and mental health diagnoses such as PTSD or major depressive disorder ( 23 , 25 ).…”