Every nurse is likely familiar with the oft-cited data that nurses consistently rank as the most trusted professional, according to the annual Gallup poll. This trend has persisted since nurses were first included in the survey in 1998. Interestingly, while physicians have been part of the survey since 1976 and pharmacists were added in 1981, nurses were not included until much later, for reasons that remain unclear. The latest survey, conducted via telephone interviews from December 1 to 20, 2023, sampled 1,013 adults across all 50 states and the District of Columbia. Respondents were asked to answer the question: “Please tell me how you would rate the honesty and ethical standards of people in these different fields – very high, high, average, low, or very low?” The interviewer would then randomly call out the title of 23 professions, from advertising practitioners to veterinarians.

Is honesty the same as trust?

The survey question probes the public’s perception of nurses’ honesty; how this gets reported by nursing organizations that nurses are the most trusted of professionals remains an enigma. I have often wondered why the report doesn’t say nurses are the most honest. Trust frequently is conflated with honesty, as honesty is the bedrock of trust. The public places their trust in nurses because they expect them to act truthfully, transparently, and with integrity. Imagine you’re a patient and your nurse is going to insert a urinary catheter into you for the first time ever. As a patient, you trust that the nurse will do the right thing. Consequently, it’s imperative for nurses to be honest with themselves, ensuring they can competently insert a urinary catheter. Although it’s not a given that the public trusts nurses, the Code of Ethics for Nurses with Interpretive Statements underscores the importance of nurses establishing trust-based relationships with their patients. However, without honesty, trust can’t endure. In essence, dishonesty and lack of integrity erode trust.

Why “trust” nurses?

While brainstorming this essay with a colleague, she wondered whether the relational, as opposed to transactional, nature of bedside nursing (RNs don’t charge the patients directly for care rendered) might partly explain why nurses are seen as more ethical than physicians, stockbrokers, and car salespeople. But then, how do we account for veterinarians who received the second highest rating for honesty and ethics, given that veterinary care is primarily a pay-for-service profession? Another reason why I think nurses are highly rated in honesty and ethical standards is that they spend a considerable amount of time with patients, giving them the opportunity to build trust. I should like to know what the Gallup survey participants were thinking as they rated nurses; I imagine they were thinking of scrubs-clad nurses, not of nurses in academia or any other role beyond the bedside. For nurses, like myself, who no longer practice clinically, I feel like I am riding on the coattails of hardworking bedside nurses; I have no rightful claim to the public accolade of being highly rated in ethical standards. This realization lends me a certain humility—don’t take credit for something I didn’t earn.

Incidentally, college professors (I’m a nursing faculty) received only a combined 42% of “very high” and “high” ratings; 36% lower than nurses.

Who loves nurses more?

It’s often said that the devil is in the details, so I delved into the specific data regarding the 2023 Gallup ratings on nurses. Here are some noteworthy findings: men tended to give nurses higher ratings compared to women; Democrats rated nurses as “very high” or “high” more frequently than Republicans (85% and 74% of respondents, respectively); Whites were more likely (82%) to rate nurses as “very high” or “high” compared to Blacks (73%); individuals with a college education (31%) gave nurses a “very high” rating more often than those without (25%); and respondents with a household income exceeding $100,000 were more inclined (33%) to rate nurses as “very high” compared to those with a household income below $50,000 (22%). I’d like to see an explanation as to the nuances of these data, but alas, Gallup didn’t offer any. What might experts or typical nurses make of this? Do the variations in ratings across ethnicity and socioeconomic status imply that, on the frontline, nurses still face significant challenges in addressing health disparities, implicit bias, and healthcare equity?

The 1% who rated nurses “very low”

For years, about 1% of the Gallup survey participants rated nurses “very low” in honesty and ethical standards, and this year is no exception. Negative feedback plays a crucial role in enhancing performance. What image do the respondents conjure when they imagine a nurse who isn’t honest and lacks ethical standards? In the spirit of quality improvement, I think there’s diagnostic value in learning more about the reasons for the negative rating. How can nurse managers and leaders implement strategies for service recovery to regain the trust of dissatisfied patients or their families?

The craze of ratings comes from the business world. Given that healthcare is a colossal enterprise, it has become a commodity to be bought, sold, and rated like someone’s latest shoe purchase. Although nurses continue to receive high ratings, the 2023 Gallup rating is 11% lower than the peak rating observed in 2020, when nurses garnered 89% “very high” and “high” ratings, likely due to their extraordinary efforts during the height of the COVID-19 pandemic. Is it possible that the rising job dissatisfaction among nurses negatively impacts the quality of nursing care delivered? I hazard to speculate that it may somehow account for the notable dip in the public’s rating of nurses, although we may never know for sure. Notwithstanding ratings, I’m optimistic that nurses will continue to earn a position of honor in the public’s imagination based on their enduring social contract with the public they serve.

Fidelindo Lim, DNP, CCRN, FAAN, is a Clinical Associate Professor at New York University Meyers College of Nursing.