The Leadership Relationship. Part I: Understanding Trust Jo Manion, PhD, RN, NEA-BC, FAAN

LEADERSHIP EXISTS ONLY within the context of a relationship. It is an intensely personal process

of relating to another person who, if influenced,

becomes a follower. If there are no followers, there

is no need for a leader. It makes sense, then, that leadership is accomplished most effectively from

the base of a positive and healthy relationship

with others. And, in fact, without positive relation-

ship and people skills, it is very hard to be an effec-

tive leader.

This column is based on the premise that having

positive relationship skills is an essential compe- tency for all nurse leaders. This is true whether

your followers are your patients, coworkers on

the committee you chair, or employeeswho report

to you. Of course, a toxic and punitive leadership

relationship can also influence the follower but

not in a positive way. Our focus is on healthy and

empowering partnerships with others to achieve

the key results needed in the department.

This can be difficult news to hear for those who

aspire to lead, yet have few natural people skills,

or actual problems relating to other people. We

all know managers or supervisors who rely solely

on the legitimate authority of their position to

give direction and influence others. They expect

compliance to their directions simply because of the positional authority they hold. Developing re-

lationships with others is not a priority for them,

and little care is taken to establish a positive rela-

tionship. It is seen as unnecessary or wasted

time. However, these leaders are unlikely to be as

Jo Manion, PhD, RN, NEA-BC, FAAN, is the Owner and Se-

nior Consultant, Manion & Associates, The Villages, FL.

Conflict of interest: None to report.

Address correspondence to Jo Manion, Manion & Associ-

ates, 873 Greenwich Place, The Villages, FL 32163; e-mail

address: jomanion@sprintmail.com.

� 2015 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00


Journal of PeriAnesthesia Nursing, Vol 30, No 2 (April), 2015: pp 153-156

fully effective as they would be with positive inter-

personal skills.

Some fortunate people seem to have been born

with good people skills imbedded in their person- ality. It is much easier for them to develop good re-

lationships with others. Other people feel good

about working with them, and they often establish

healthy and trusting relationships with others.

These individuals often move into leadership roles

(not necessarily management) as opportunities


If people skills are not as natural for you, do not

despair! This does not mean you are incapable of

becoming a good leader, but it does mean that

you will need to develop these skills. I once

worked with a nurse executive who had little to

no inherent people skills in her basic personality

makeup. However, she was a very effective nurse

leader. Over the years, she had developed and honed her people skills to a fine degree. Relation-

ships took more energy on her part to maintain

because these skills did not come naturally to

her. However, because she was deliberate and

conscious about cultivating her leadership rela-

tionship with others she was an extremely effec-

tive and successful nurse leader.

To some of you, talking about relationships may

feel like going back to Psych 101 because it seems

so basic. However, every one of us would benefit

from consciously examining the quality of the rela-

tionships in our lives, both personal and profes-

sional. It is an aspect of our lives that has a

tremendous potential for creating great outcomes

or significant issues and difficulties! The first step is to spend some time reflecting on and assessing

your relationships with others.

To do this in a meaningful way, you need clarity

about what a healthy relationship is. There are at

least four essential components that characterize

a positive and healthy relationship. The absence



of any one of these elements damages a relation-

ship. The four are trust, respect, support, and

communication. This column explores the

concept of trust, and the next column will explore

the remaining three elements.


Trust is the foundation necessary for any relation-

ship to form and flourish. It is a necessary condi- tion before a sense of connection can take place

between people. According to the dictionary, trust

means you can rely on the integrity, strength, or

ability of a person or thing. This confidence

implies that we trust because of good reasons, def-

inite evidence, or past experience. If a colleague

assures you that he will reciprocate with you for

future schedule changes if you change days off with him this time, you trust that he will do so

because he has lived up to that promise in the

past. When a new nurse joins the staff, we trust

that she or he has the competence to do the job

for which she or he has been hired.

Trust is absolutely crucial in the leadership rela-

tionship. Without trust or confidence in the leader, people will not follow. Confidence is a reliance and

dependence on the person to obtain the results

that will benefit everyone. The leader may be

very articulate, charismatic, and personally liked.

However, if there are no results or improvements

because of the leader’s efforts, trust wavers.

Warren Bennis, a noted leadership scholar, offers a concrete and applicable framework for under-

standing trust within the context of the leadership

role. He believes there are three essential ingredi-

ents for trust to occur: competence, congruence,

and constancy. Consider these in your assessment

process to understand why you are experiencing

trust or mistrust from others.

Competence is the possession of a required skill,

knowledge, qualification, or capacity. As a leader,

this means youmust have the skills and knowledge

required to do the job, whatever it is. Confidence

in the leader develops from working with that per-

son and seeing evidence of the leader’s past perfor-

mance demonstrating competence and ability.

Both skill and knowledge are included in this defi- nition of competence. Knowledge alone is insuffi-

cient. For example, you may know that your

followers need accurate information and clear

communication. If you are not able to articulate

clearly, you can have the best intentions in the

world and yet your effectiveness will be reduced.

On the other hand, you may be an articulate and charismatic leader able to communicate beauti-

fully with others, but if you are unable to back

up your rhetoric with performance and outcomes,

you will not have the trust of your followers.

Qualifications are an interesting factor in compe-

tence. For many nurses, there are very specific ex-

pected qualifications for the leader, and, if not present, they will not follow that leader. For

example, most nurses would expect that the man-

ager in the department has a clinical rather than a

business background. Whether the actual qualifi-

cation prepares the individual for the role or not

is a moot point; to the follower, it is a critical issue

with significant repercussions. In one organization

I worked with recently, the nurse executive had not attained her professional certification,

whereas many of her clinical directors had done

so. This individual was a very capable executive

and was producing solid results for the organiza-

tion. Most of the directors reporting to her recog-

nized and appreciated her skills and the results

they were able to attain together. However, one

of the clinical directors was absolutely adamant that this nurse executive did NOT have the correct

qualifications for the position because she had not

yet achieved certification, and the clinical director

basically refused to follow the nurse executive’s

lead. She repeatedly engaged in behavior that sabo-

taged the leader. It became a very destructive situ-

ation within this leadership team and resulted in

the director’s resignation.

Capacity is another issue related to competence.

Many leaders today are overwhelmed with respon-

sibilities, overscheduled with meetings, and

fraught with frustration around navigating their

system to achieve meaningful results. Followers

see this, and it naturally raises questions of trust

in terms of whether the leader has the capacity to handle the current situation. If there has been

frequent turnover of leaders, there is the added

worry: ‘‘How long will this leader stay? Can she/

he handle the stress of the job?’’ A leader who ap-

pears frazzled and out of control creates uneasy fol-

lowers. Inadequate capacity on the part of the

leader is not a personal incompetence to do the


work; however, it creates the same sense of

distrust that would result from the lack of skills

or knowledge.

So all these four aspects (skills, knowledge, qualifi- cations, and capacity) influence a sense on the part

of the follower that the leader is competent to be

effective in their leadership role. It is possible for

the leader to overcome the mistrust of followers

by behaving in an obviously competent manner.

Let us take for example the dynamics that occur

when a new and relatively young staff member is

asked to accept leadership for a key staff commit- tee. There may be a healthy amount of skepticism

on the part of other staff members. The new leader

will be tested repeatedly but can overcome the

mistrust by being well prepared and skilled at man-

aging the committee meetings and by involving

and seeking input of those in the group. It may

be a difficult challenge for the new leader but is

certainly doable.

Congruence is the second element that creates a

sense of trust within a relationship. This means

that there is a consistency between the verbal

and written messages and the actual behavior of

the leader. When what a leader says is highly

congruent with her or his behavior, people

perceive the leader as honest and trustworthy. If the leader says one thing and does another, the

result is an enormous credibility gap and trust is

severed. As a leader, your integrity and character

are critically important. Others do not necessarily

need to agree with everything you believe, but

they have to believe that you will be honest with

yourself and them as well. If you say you value

your people, you need to behave in a way that demonstrates this value, otherwise you will lose

their trust.

One of the most serious problems with incon-

gruent behavior is that it is inadvertent and often

goes unrecognized. As a leader you do not intend

to behave in a way that contradicts your previous

messages, but it can happen. For example, perhaps you have told your staff that you will involve them

in decisions that are made in the department. At

the next department meeting, you make an

announcement about the new parking policy. Sud-

denly you are faced with push back and angry

resistance from the staff. ‘‘You told us we were

going to be involved in making decisions in this

department, and now you’re telling us we need

to park where?’’ When you become aware that

you are being seen as incongruent, this is an oppor-

tunity for you to either clarify or apologize. So in

this example, you might say something like: ‘‘You are right, I did tell you I would involve you in deci-

sions. However, I should have been clearer. I

meant that I would involve you in decisions that

are within our authority to make. The decisions

about parking are made by other people in this or-

ganization, not us.’’ So you have offered more

clarity. They still might not like the decision you

have announced, but they can clearly see it was not your or their decision to make.

If, however, it is a decision where it would have

been reasonable to include them, you may need

to apologize. ‘‘I am sorry, and you are right. I am

so used to making these decisions that I didn’t

even think about asking you. Let’s back up and

take another look at the decision.’’ Although it is uncomfortable to realize that you have been incon-

gruent, when people give you this feedback, see it

as a gift. It gives you the opportunity to address

their confusion. Otherwise, they will simply see

you as not being trustworthy, and it will damage

your leadership relationship.

If your relationship with your followers is not one based on trust, when you behave incongruently

they may assume it was intentional on your part.

If you have a relationship built on solid trust, the

people you work with will tell you when you are

being incongruent because they trust that you

did not mean to contradict yourself.

Constancy is the third and final essential ingre- dient of trust identified by Warren Bennis. It

implies that as a leader you are reliable, depend-

able, and consistent. If you make a promise or a

commitment, you follow through with it or you

immediately let the other person know why you


For many followers, constancy also implies avail- ability and accessibility. We have all had the expe-

rience of working with someone who assures us

they will be available if we need help and then

cannot be found when needed. Tight work sched-

ules and overwhelming demands in the workplace

certainly reduce availability. However, an effective

leader has away of being present for others, even if


it is for very short moments of time. Taking a

moment to really tune in and listen to an individ-

ual, stepping in and helping for a short time at a

critical point, and offering a reassuring presence

is very powerful in communicating availability.

Accessibility means other people know how to

find you and contact you if needed. Today’s work

world can be overwhelming with the constant de-

mands and rapidly unfolding situations. Our

improved communication technology assists in

increasing accessibility and creating more prob-

lems because of increased accessibility. Electronic mail, instant messaging, and texting have all

increased our ease in being available to others

while also creating a sense of urgency and overload

that causes stress to skyrocket. I have colleagues

whom I text to tell them I have sent an e-mail

that they need to read!

Managing accessibility is a key competency for any leader. Physical accessibility is important, and the

most effective leaders find a way to provide it

even in today’s overcharged world. Letting people

in the department know where you are and when

you will return is helpful if you attend many meet-

ings. Posting your schedule on the office door and

setting a specific time every day when you will be

available in the office are also helpful. Giving com- mittee members your personal e-mail so they can

contact you with questions helps them feel like

you are accessible. Setting realistic boundaries

while maintaining a sense of accessibility for

others is a challenge, but effective leaders find a

way to do so. Although physical presence is most

powerful, even a short and quick response to a

text or e-mail can be reassuring to your follower who has a question or is dealing with an issue.

Constancy in our behavior is also crucial, and it re-

fers to a stability of personal characteristics. A

leader who experiences extreme fluctuations of

mood, is quick to anger, or responds with knee-

jerk reactions has more trust issues with others.

Although none of us is completely predictable,

the less volatility in the leadership relationship,

the more likely trust will develop.

Trust is the first essential component in establish- ing a positive and healthy relationship with others

from which you can effectively lead. To evaluate

the level of trust in your relationships with others,

ask yourself these questions:

1. Am I competent to do this work? Do others

see me as competent? Do they see me

achieve needed results? What has been my

track record? In what areas do I need to in-

crease my skills and/or knowledge? Do I

have the qualifications needed for the

work, or do any of my followers question

that I am qualified? Do I have the capacity to do what is needed?

2. Am I congruent in what I say and what I do?

Do others see me as trustworthy? Where

have I been incongruent? Has anyone told

me that I have been incongruent? Would

they feel comfortable telling me so? Do I

invite this kind of feedback? How have I re-

sponded in the past to this feedback? 3. Am I seen as constant by others? Have I been

available for my followers or am I so busy

that I am exhausted by the time I return to

the department near the end of the day?

Do people say they have a hard time finding

me? Do I respond promptly to messages

frommy followers? Am I so frazzled and over-

whelmed that listening to onemore problem will push me over the edge?

Trust is the solid foundation in any relationship,

and without the trust of your followers, your abil- ity to influence them in the direction needed is

significantly impaired. The next column explores

the remaining three essential elements of a healthy

relationship: respect, support, and communica-

tion. Although these concepts seem simplistic,

they have a tremendous impact on your leadership


  • The Leadership Relationship. Part I: Understanding Trust
    • Trust

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