A Crack in Confidence – What Healthcare Strikes Teach Us About Trust

William R. England, Ph.D., Strategic Advisor, Research, NRC Health

Ashley Nelson, MS, BSN, RN, Strategic Advisor, Nursing, NRC Health

Trust is foundational in healthcare. And because it connects reputation, safety, quality, experience, and loyalty, trust deserves close study, even in difficult and controversial contexts.

This month’s nSight examines healthcare strikes through that lens. We analyzed data from 11 communities affected by strikes, asking consumers about their trust in the organization before and after each event

Strikes do not occur in a vacuum. They stem from understandable issues such as workload, burnout, safety, and compensation – concerns that are shared by both caregivers and leaders, all of whom are pursuing safe and sustainable care environments. At the same time, strikes provide a clear opportunity to measure how visible disruptions affect trust and how quickly it returns once stability is restored.

Across the communities in our data, top-two-box trust scores (“trust completely” or “trust mostly”) moved from around 55% before to about 40% after the strikes. Encouragingly, we also found evidence that trust among both patients and consumers can recover within a few weeks or months as services stabilize. This pattern of erosion and recovery helps explain how patients and consumers respond when care is disrupted, and it helps us identify things leaders can do to soften the impact and shorten the path to recovery.

Throughout 2025, NRC Health surveyed consumers in 11 U.S. markets (n = 1,725) where nurse strikes occurred. Among other questions, we asked respondents about their involvement in the strike, their relationship to the impacted organization, whether they supported the strike or not, trust before and after the labor action, and to what extent their intended future use was impacted.

• 78% did not participate directly or indirectly in the strike
• 72% were not affected by the strike
• 62% strongly or somewhat supported the strike
• Who’s responsible for the strike?
  • 54% said the healthcare organization was responsible
  • 31% said the workers and the organization were equally responsible
  • 8% said the workers alone were responsible
  • 6% were unsure

Across all markets, respondents saying they “completely trust” or “mostly trust” the organization with striking employees dropped roughly 15% after a labor action. This pattern was broad, but not uniform. One organization saw a drop in trust of 4%, while another saw trust erode by nearly 30%.

We also found a clear, significant relationship between the loss of trust and reported likelihood of returning following a healthcare strike. Each bubble below represents a market that experienced a strike in 2025. Markets with larger declines in trust (“Trust Before/After”) also report higher percentages of consumers who say they are “less likely to use” an impacted organization in the future. The relationship is moderately strong (r² = .45), suggesting that nearly half of the variation in reduced intent to reutilize can be explained by changes in trust levels.

Importantly, the relationship is logarithmic, meaning that a loss of trust disproportionately drives even larger declines in the likelihood of future use. In other words, once trust drops 15-20%, much of the damage has already been done, pushing otherwise loyal consumers to reconsider using the organization in the future.

Finally, we looked at potential causes of lost trust among consumers who said they were personally affected by the strike. Trust declined the most when access was disrupted, not necessarily when quality and safety were questioned. Trust dropped 28% for longer wait times, 21% for delayed appointments, and 20% for anxiety about access in general, compared to 16% for perceived declines in safety or quality. This finding may imply that patients are more likely to expect healthcare organizations to provide high quality, safe care – strike or no strike.

Regardless, people seem to lose trust fastest when access falters, more than when they worry about how well care is delivered. Meaning access, not just quality and safety, is a fragile dimension of trust, especially during a healthcare strike.

The key takeaway is that trust does not completely collapse during a strike, but is highly sensitive to disruptions that patients and consumers experience directly. Losses are steepest when wait times are long, and access is limited. Still, these effects are not permanent. As the case study below shows, trust can recover quickly when leaders communicate clearly, protect access, and resolve disputes in a timely manner.

A hospital that is part of a large organization experienced a five-day nursing strike in spring of 2025. Trend data for the impacted hospital showed a short-term dip in patient experience scores, followed by a steady return to baseline. “Trust in Care Providers” top-box scores consistently ran in the high 80s in the weeks and months before the strike and then fell by roughly 10 to 15%, leading up to and during the event. The strike ended after five days, and trust scores immediately started recovering within weeks of resolution.

Consumer trend data showed similar patterns. Even in markets beyond the affected facility, the entire organization was impacted. Consumer top-box scores for quality, image/reputation, and trust related not just to the facility with striking workers, but the whole organization declined through June, then returned to baseline by September 2025. The combined picture is straightforward. Patient experience and consumer perceptions – even for one facility – impact brand sentiment for the entire organization during labor disputes.

In these same markets we also found that competitors of the organization impacted by the strike saw a 12–17% improvement in quality, image, and trust in the wake of the event, followed by a return to baseline. Though the spike was temporary and scores across studied markets appear to have stabilized, this finding may mean that the longer negotiations persist, the more potential there is for competitors to convert formerly loyal patients to their organization and services.

These data suggest that the magnitude of trust loss and brand damage depend less on the existence of a strike and more on how an organization manages its impact. The stakes are high, especially because patient loyalty isn’t a given, and a strike-driven erosion of trust in one organization may mean an increase of trust in others. This means a focus on communicating clearly with patients and consumers, protecting access, and resolving disputes quickly is paramount – with these conditions in place, the erosion of trust can be temporary, and recovery can occur within a few weeks or months.

Context: These comments come from patients who received care during an active nursing strike. They describe a complex mix of empathy, disruption, and gratitude – recognizing the tension between supporting striking nurses and the real challenges of care delivery during those events.

Strikes are temporary. Trust and sentiment can be, too. They move when care feels uncertain, and they recover when care feels reliable again. The goal for leadership is to make sure that recovery occurs quickly and is as visible as possible. The combination of continuity planning, timely resolution, and transparent communication gives patients and communities what they need most: confidence that their care is safe, accessible, and trustworthy.