position will be uncomfortable expressing issues to someone in a higher position. If, however, subordinates have close, positive, interpersonal relationships with their supervisors, chances are higher that they will choose to communicate honestly. It comes down to the basic principle of trust and mutual appreciation, which is difficult to obtain in a bureaucratic structure. Willman, P. et al. (2006) present evidence that any hierarchical organization tends to support what its leaders already think is true more than it challenges them to think differently. The levels below the leaders are more interested in keeping their jobs than in telling the truth. But once a relationship is established, and the lines of communication are open, it is undeniably easier to have others on your side and others who are willing to help you out, both professionally and personally. Pfeffer (2010) acknowledges the dynamic relationship among trust, relationships, and power when he says, “Sometimes building a relationship so that others will help you requires nothing more than being polite and listening... Being nice to people is effective because people find it difficult to fight with those who are being polite and courteous.” When that key component of mutual understanding is absent in an organizational setting, however, silence comes into play, and a myriad of power schemes and competing agendas can influence the decision of whether or not to communicate concerns. Donaghey, J. et al. (2011) suggest ways in which management, through agenda-setting and institutional structures, can perpetuate silence over a range of issues, thereby arranging employees out of the voice process. When a dominant group voices certain opinions, these perceptions become the dominant ideologies that float across the organization. The subordinate viewpoints are therefore never brought to the forefront because they are inevitably silenced. Tangirala and Ramanujam (2008) conducted research on nurses in Midwestern hospitals to study employee silence in health care. With lives at stake every day, the notion of employee silence in such an industry is a particularly devastating one due to its potential implications. Their research showed that the more power a supervisor is perceived to have, the less likely it was that nurses would share critical information. They did not want to cause unnecessary tension and sever professional bonds with their bosses. They didn't want to cause a stir; in their minds, it was better to remain silent than address conflicts and clear up confusion. The research also found