Institutional betrayal in nursing: A concept analysis

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.