Healing the Social Covenant: Rebuilding Trust and Re-humanizing Healthcare

Cynda Hylton Rushton, Anne & George Bunting Professor of Clinical Ethics & Nursing, Johns Hopkins University, Baltimore, MD 21202Follow

ORCID

Cynda Hylton Rushton: https://orcid.org/0000-0001-7582-5849

Abstract

Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of Trust (2021), we examine how fractured relationships among clinicians, healthcare organizations, patients, families, and communities have weakened the moral infrastructure that supports healing.¹ We suggest that reframing healthcare as a social covenant, rather than a transactional contract, offers a stronger ethical foundation for restoring mutual responsibility, accountability, and shared purpose. Within this framework, trust becomes a collective responsibility.This commentary describes two public engagement initiatives developed through the R³: Renewal, Resilience, and Retention of Maryland Nurses Initiative—Humanizing Healthcare and A World Without Nurses—that strengthen dialogue between healthcare professionals and the public. These initiatives illustrate how structured dialogue, storytelling, and community engagement foster empathy, rebuild trust, and promote shared responsibility for creating safe, humane healthcare environments. Renewing the social covenant between healthcare professionals and the communities they serve may be an underrecognized strategy for restoring trust, sustaining the workforce, and advancing more humane healthcare.

Recommended Citation

Rushton C. Healing the Social Covenant: Rebuilding Trust and Re-humanizing Healthcare. Patient Experience Journal. ; 13(2):5-10. doi: 10.35680/2372-0247.2119.