integrity in nursing essay

Integrity in Nursing: What’s It All About?

The concept of integrity is a difficult one to define, especially in medicine. As nurses, we have a duty to act ethically according to our professional duties, but where does that meet with our personal integrity? Or does our personal life need to stay completely out of our professional dealings?

There are a lot of questions surrounding this concept, and you’ve likely had a few of these questions cross your mind once or twice. Let’s take a deeper look at just what integrity in nursing means and how you can practice it each day.

What is Integrity?

The dictionary definition of integrity is: “the quality of being honest and having strong moral principles; moral uprightness.” A lesser-known definition is: “the state of being whole and undivided.” Both of these are suitable definitions that are applicable to the nursing world.

At its very heart, integrity insists that we act according to the values upheld by the nursing profession. It is entirely possible to have personal integrity in accordance with your own personal morals and values, especially as they relate to your own religious or spiritual leanings, that might differ from the integrity expected of you as a nurse. If we look at the second definition of integrity above, we want to maintain a state of actions that are undivided from our beliefs. As nurses, we take on the beliefs and values as set out by regulatory organizations and must act accordingly, to keep the foundation of our profession “whole and undivided.” In our personal lives, we do the same, though these actions may look different.

It is important to note that integrity relates more closely to the reasoning behind our actions, and not necessarily the actions themselves. In other words, intent matters.

The Benefits of Having Integrity

At the core of the concept, having integrity means that you are truthful and honest in your intent. This means that whether you are alone or surrounded by people, your actions will be the same. It doesn’t matter if people are watching; you will do the right thing regardless. Even when people expect you to be dishonest or encourage silence when saying something could get you in trouble, if it is the right thing to do, you will speak.

The great thing about this is that having a personal policy to always do the right thing means that you are dependable and trustworthy. Even in situations where someone else might get reprimanded because you spoke the truth, you will still be respected as a person that will do the right thing. For employers and managers, this is an unbeatable trait in a person that they might want to hire or promote.

Another benefit of showing integrity is that people are more willing to forgive minor missteps on your part. If you have shown consistently that you always try to do the right thing and then make a mistake, your coworkers will understand that it was not your intention to hurt anyone or cause problems. Because of your longstanding reputation as someone who does the right thing, even when things go a bit wrong, you’ll receive the benefit of the doubt.

How Can I Practice Integrity at Work?

You might have a very clear vision of what integrity means in your personal life. It could mean doing household chores without being asked or always giving your friends an honest, yet tactful, answer when they ask a question. But how does one practice integrity as a nurse? Here are some ideas to consider:

• Say what you mean. At a busy hospital, there’s no time to mince words, so it’s especially important that you are able to say exactly what you mean. Leaving room for interpretation could potentially allow others to misunderstand you and form incorrect opinions or ideas. If it helps, ask your listener to repeat what you said in their own words to check for understanding.
• Mean what you say. On the other side of the coin, make sure that you follow up with things that you say you’ll do. If you make a promise, keep it. If you aren’t sure you’ll be able to keep a promise, don’t make it! Instead, let the other person know you’ll do your best to follow through but that you can’t make any promises. This way, people will know that when you say “I promise” that you really mean it.
• Be open with praise. Let others know when you appreciate their hard work. Recognizing the efforts of others goes a long way. If you do this consistently, even if you don’t necessarily get along with the other person, they will at least know that you are fair in appreciating hard work, regardless of who does it.

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Putting the I in integrity

Ridge, Richard A. PhD, MBA, RN, CENP, NEA-BC

Richard A. Ridge is the director of Nursing Innovation and Outcomes at Texas Children's Hospital in Houston, Tex.

The author has disclosed that he has no financial relationships related to this article.

Integrity is often mentioned as a requirement for leaders, in general, and healthcare and nursing leaders in particular. Since 2005, at least 80% of Americans responding in the annual Gallup poll on perceived honesty of professions and occupations have ranked nurses at the top of the list for honesty and ethics. 1 The nursing profession has taken great pride in this consistent finding, which is being reinforced this year as the American Nurses Association (ANA) launches its “Year of Ethics” to coincide with the revision of the Code of Ethics for Nurses. 2

Yet, how we define integrity? Often, how our definition of integrity and morality relates to our understanding of ethical behavior isn't well identified or clearly defined. Integrity is viewed as an essential component of professional nursing and a core value for nurses at all levels and in all specialties. We provide a framework for defining and understanding integrity in nursing practice so you can be better prepared to assess your own integrity and the integrity within your organizations.

How do you define integrity?

Integrity is adherence to the interrelated sets of standards, values, and principles derived from the three domains that affect our decisions and behavior: personal, professional, and organizational. (See Figure 1 .) The extent to which a leader adheres to the standards or codes that emanate from each of these domains defines the integrity of the individual. Integrity isn't a value by itself, but rather the level of fit between an individual's decisions and behaviors and his or her relationship to the values and morals of the communities in which he or she lives and works. 3

Our personal values are grounded in the moral framework that we were raised to believe and integrate into our decision making and behavior. Many of us have faced and resolved challenges of varying degrees of severity related to our own integrity. Often, the issues at the lower end of the severity scale are forgotten, whereas more serious issues may lead to significant crises with high levels of moral distress and negative personal, professional, or organizational outcomes. Moral distress results from value conflicts; moral courage describes the ability of an individual to speak up and alleviate or reduce moral distress experienced by others. 4

The ANA Code of Ethics recognizes that nurses face threats to their integrity in any healthcare environment. 2 Organizational pressures to perform may motivate nurse leaders to violate their own personal moral code to accomplish specific goals and objectives. These situations may result in significant moral distress for the nurses and nurse leaders. The undesired result is when the individual rationalizes his or her behavior to mitigate the moral distress, violating the personal, professional, or organizational framework.

Healthcare organizations have a defined mission, vision, and values statement to provide additional guidance to leaders and staff regarding the overall aim and purpose of the organization and the values that must be considered when making decisions regarding ethical behavior. The values statement describes the organization's core principles that support the overall vision and mission. Ethically sound organizations have leaders and employees who are aware of these values and integrate them into their decision making. When the organization's actual practices conflict with the stated values, staff morale is undermined, cynicism develops, and the risk of unethical behavior increases. 5

Integrating integrity

So what can we do to foster a practice setting that values integrity?

1. Model appropriate behavior .

“Do as I say, and not as I do” is a classic idiom used to characterize hypocritical behavior that contradicts a leader's mandates and expectations. As leaders, our behavior is closely scrutinized and modeled by others on our teams; our behavior influences team member behavior. Verbalized expectations aren't as strong as behaviors that are modeled. For example, if a senior leader is observed misrepresenting a situation either in person or on a report, others are given the message that deception is acceptable under the correct circumstances.

When a leader during The Joint Commission or other regulatory review asks a direct report to deliver a set of completed records that meet the requirements, is the leader implying that it's all right or even mandated that the individual correct these before handing them off to the surveyor? Where does one draw the line? For example, when annual performance evaluations need to be completed, is it expected that the manager signs and dates an evaluation that has been inadvertently unsigned by the employee? If a leader asks for this behavior, most would see this as unacceptable. If the leader tells the manager that he or she really doesn't want to know how the manager came up with the results but he or she is pleased with the outcome, is this acceptable?

2. Ensure comprehensive ethics education for nurses at all levels .

Education on compliance, organizational values, and acceptable behaviors should be completed on an annual basis for all staff and leaders. In nursing, significant attention should be paid to an in-depth review and understanding of the ANA Code of Ethics. Use interactive learning methods that focus on the application of the Code of Ethics within the context of your specific organization. Disseminate clear expectations about acceptable behavior related to falsifying documents.

A robust educational program for nurses would be based on three foundation documents published by the ANA. In addition to the Code of Ethics, “Nursing: Scope and Standards of Practice” and “Nursing's Social Policy Statement: The Essence of the Profession” should be included. Knowledge of the standards drives professional practice and sound decision making consistent with the values and expectations of the nursing profession. The codified standards of practice and ethical behavior are one of the primary elements that define us as a profession. By ensuring that our staff members are knowledgeable about these standards, we're strengthening the profession for the present, as well as for the future. The Social Policy Statement is important because this provides the foundation for connecting nursing's value and accountability to society. By better understanding nursing's social context and contract with society, as manifested by state nurse practice acts, nurses are better prepared to practice in highly volatile and rapidly changing healthcare environments.

3. Create effective structures and processes to support transparency .

Practicing at a high ethical level is embodied within the ANA's Standards of Practice, in general, and nursing administration in particular. 6 The nurse leader has the additional responsibility to ensure that effective structures and processes are in place to support an ethical practice environment. The Ethics Resource Center, in its 2014 National Business Ethics Survey, identifies three factors that employees use to judge their leaders' character. 7 All three factors relate specifically to transparency. Employees draw conclusions about their leaders' character based on (1) their personal interactions, (2) how the leaders handle crises, and (3) the policies and procedures that the leaders adopt to guide their organizations.

In order to be fully transparent, the effective nurse leader interacts consistently and regularly in a manner that exposes the leader's values and decision making for the critique of his or her team members. In crises, employees notice whether leaders hold themselves accountable or shift blame to others, thus damaging their integrity. Employees assess the extent to which leaders recognize and reward ethical behavior or whether bending or violating rules is preferentially rewarded and/or recognized. By being transparent, employees are able to adequately and effectively judge these three factors.

4. Promote systematic ethical decision making .

The American College of Healthcare Executives' Policy on Ethical Decision Making for Healthcare Executives offers guidance on leadership decision making in an increasingly complex healthcare environment. 8 Leaders are expected to establish a sound decision-making framework so that highly complex decisions aren't made by a single individual. Ethical decision making includes insight and perspective from those affected by the decision; a full depth and breadth of information to support the decision; and a process that ensures beliefs, ideals, and principles are consistent with team member and organizational values.

Provision 5 of the ANA Code of Ethics specifically addresses character and integrity of nursing practice, but with regard to the preservation of integrity, nurse leaders have additional responsibilities. Nurse leaders are obligated to respond to the ethical and moral concerns of nurses and ensure that these concerns are resolved in a manner that preserves the integrity of the staff members.

5. Promote accountability .

Don't express performance expectations in a manner that emphasizes the results at the expense of how to reach those results. Expectations expressed too forcefully imply permission to do whatever is necessary to accomplish the goal. Phrases such as “I don't care how you get it done,” “get the results no matter what,” and “don't come back next month without the results we need” may create incentives for employees to “game the system,” withhold or misrepresent information, or “fudge the numbers.”

Accountability is also established by identifying and addressing deviations from acceptable practice. Perceptions that leaders look the other way provide the slippery slope for further transgressions. Zero tolerance for unethical behavior sends a consistent message to leaders and staff that even the seemingly least significant transgression is unacceptable when establishing a culture of high integrity.

The value of integrity

Nurse leaders' integrity is of the utmost concern in today's highly volatile, competitive, and high-stakes environment. Nurses, in general, and nurse leaders in particular are faced with difficult decisions every day and, as identified by the Gallup survey, are typically held in high regard by the public. By understanding the personal, professional, and organizational standards that form the basis of our integrity, we can be better prepared to promote high levels of integrity within our organizations.

1. Riffkin R. Americans rate nurses highest on honesty, ethical standards. http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx.

2. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association; 2015.

3. Tyreman S. Integrity: is it still relevant to modern healthcare. Nurs Philos . 2011;12(2):107–118.

4. Edmonson C. Moral courage and the nurse leader. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Moral-Courage-for-Nurse-Leaders.html.

5. Nelson WA, Gardent PB. Organizational values statements. Healthcare executives need to lead the organization's culture in reviewing and implementing values statements. Healthc Exec . 2011;26(2):56, 58–59.

6. American Nurses Association. Nursing: Scope and Standards of Practice. Silver Spring, MD: American Nurses Association; 2010.

7. Ethics Resource Center. Ethical leadership: a research report from the National Business Ethics Survey. http://www.ethics.org/nbes/wp-content/uploads/2014/12/ExecSummaryLeadership.pdf.

8. American College of Healthcare Executives. Ethical decision making for healthcare executives. http://www.ache.org/policy/decision.cfm.

American Association of Critical-Care Nurses. The 4 As to rise above moral distress. http://www.aacn.org/WD/Practice/Docs/4As_to_Rise_Above_Moral_Distress.pdf.

American Nurses Association. Ethical issues. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources.

Ethics Resource Center. http://www.ethics.org/.

National Center for Ethics in Healthcare. Integrated ethics. http://www.ethics.va.gov/integratedethics/.

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30 Examples of How to Demonstrate Professionalism in Nursing

Whether you are a nursing student or a nurse with several years of experience, you know that professionalism is a significant trait all nurses should have. While nurses are referred to as healthcare professionals, many do not understand the concept of what true professionalism encompasses. Maybe you have asked yourself, "What is professionalism in nursing?” In this article, you will find information about nursing professionalism, including 30 examples of how to demonstrate professionalism in nursing. As you continue reading, keep in mind that each nurse is responsible for developing professional characteristics and implementing those characteristics into daily practice.

What is Professionalism in Nursing?

Who determines the standards of professionalism in nursing, 10 reasons why professionalism is so important in nursing, what are the 7 key elements of professionalism in nursing, 1. leadership:, 2. professional values:, 3. professional development:, 4. basic care competency:, 5. altruism:, 6. social justice:, 7. human dignity:, how to demonstrate professionalism in nursing, example #1: learn effective communication, how to demonstrate it in nursing practice:, why is it important in nursing:, example #2: show compassion, example #3: participate in interdisciplinary collaboration, example #4: be accountable, example #5: never stop learning, example #6: have a positive attitude, example #7: provide high-quality patient care, example #8: dress the part, example #9: be ethical, example #10: practice cultural awareness, example #11: have a “patients first” mindset, example #12: mentor other nurses, example #13: practice integrity, example #14: be detail-oriented, example #15: become a critical-thinker, example #16: help resolve conflicts, example #17: be adaptable, example #18: lead by example, example #19: make yourself a priority by practicing self-care, example #20: show respect and appreciation to your co-workers, example #21: be a faithful patient advocate, example #22: show up for work, example #23: promote safe nursing practices, example #24: pursue personal growth and development, example #25: be willing to show empathy, example #26: be sympathetic to others, example #27: practice resilience, example #28: exercise your right to practice autonomously, example #29: be confident in your abilities, example #30: be willing to accept constructive criticism and advice, what are some examples of unprofessionalism in nursing, 1. participating in or causing conflict among team members:, 2. missing work unnecessarily:, 3. not protecting patient privacy and confidentiality:, 4. taking credit for someone else’s work:, 5. avoiding responsibilities:, 6. providing misleading or false information:, 7. abandoning patient care:, 8. accepting an unsafe patient assignment:, 9. failure to maintain professional boundaries with clients or their families:, 10. using unsafe practices:, consequences of unprofessional conduct in nursing, 1. increased absenteeism:, 2. hostility among staff:, 3. disciplinary action:, 4. loss of license:, 5. damaged professional reputation:, 5 most-common challenges to professionalism in nursing practice and how to overcome them, challenge #1: maintaining positive relationships with unprofessional peers, what is it:, how to overcome:, challenge #2: knowing where to draw the line with nurse-patient relationships, challenge #3: dealing with rude patients, challenge #4: unprofessional work environment, challenge #5: emotionally charged situations, 5 tips to enhance professionalism with patients in nursing practice, 1. make patient care a priority., 2. take time to hear what your patient needs to say., 3. speak up on your patient’s behalf., 4. protect your patient’s privacy., 5. demonstrate high standards of care., 5 tips to enhance professionalism with co-workers in nursing practice, 1. be honest with yourself., 2. encourage and participate in team collaboration., 3. recognize the accomplishments and contributions of your co-workers., 4. be accountable to your team members., 5. invite co-workers to join professional nursing associations with you., bonus useful resources to learn more about professionalism in nursing, blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. does nursing require a higher level of professionalism compared to other healthcare careers, 2. what are professional boundaries in nursing, 3. why nurses should set boundaries to maintain professionalism in nursing, 4. what is professional presence in nursing, 5. what is professional misconduct in nursing, 6. what is personal and professional development in nursing, 7. what is professional caring in nursing, 8. what is professional communication in nursing, 9. what is professional competence in nursing, 10. what is professional advocacy in nursing, 11.what is professional accountability in nursing, 12.what is professional socialization in nursing, 13.how does professionalism in nursing influence health policy, 14.how complaining in the nursing profession hurts professionalism, 15.how should professionalism be evaluated in nursing, 16.how do nursing schools teach professionalism, 17.what are the top 3 professional goals every nursing student should aim for.

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Academic integrity in nursing: What nurse leaders and faculty need to know now

Affiliations.

• 1 Tennessee Technological University, P.O. Box 5001, Cookeville, TN 38505, USA. Electronic address: [email protected].
• 2 Tennessee Technological University, P.O. Box 5001, Cookeville, TN 38505, USA. Electronic address: [email protected].
• 3 Tennessee Technological University, P.O. Box 5001, Cookeville, TN 38505, USA. Electronic address: [email protected].
• PMID: 37775224
• DOI: 10.1016/j.profnurs.2023.07.002

Integrity is a foundational characteristic of the nursing profession. Ensuring academic integrity in nursing education is critical. The responsibility for academic integrity is shared among students, faculty, and administrators. Using a case scenario, the purpose of this manuscript is to identify and suggest administrative practices that create, maintain, and sustain a climate of academic integrity. This case scenario exposes some points of the inconsistencies in the policies and practices related to academic integrity while identifying best practices for administrators to employ and promote academic integrity at their respective institution. The authors address the inherent complexities of student due process, procedural fairness, faculty role confusion and confidentiality when working through academic integrity violations. As nurse leaders in an academic setting, the authors also share suggestions on how to improve the academic integrity process.

Keywords: Academic integrity; Faculty role confusion; Procedural fairness.

Copyright © 2023 Elsevier Inc. All rights reserved.

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Academic Integrity in Nursing School

Professional honesty in medicine is a vital factor in providing high-quality healthcare. Trusting clinicians and nurses with health, the patient must be sure that medical care will be provided at the highest level. In order to prepare high-quality medical professionals, the principles of honesty and integrity should be inculcated during the education period. Nursing students gain a clear understanding of the level of honesty, integrity, and professionalism that they will be supposed to show during their future practices through academic integrity.

The future integrity in the professional activities of nursing students is directly connected with the academic integrity they show in completing their assignments. Academic integrity is a set of values and principles that express a student’s honesty in learning when doing written work, answering exam questions, and researching particular issues (Chin & Devine, 2018). Based on the practical experiments, students often have an unclear perception of academic integrity and its role in their future professional development (Chin & Devine, 2018). Students often lack a clear understanding of why they should develop academic integrity in their works. As a result, they try different cheating methods to avoid complicated study-related activities. Such a perception of academic integrity is believed to be developed in schools (Barbier et al., 2019). Therefore, nursing schools should provide unique strategies to provide the students with a clear understanding of integrity principles and their role in the nursing profession.

From the professional nursing perspective, the violation of integrity is related to the non-compliance to the license responsibilities. Academic integrity violation of nursing students is defined differently. Within the scope of the scholarly works, it can be identified as an “honorable choice of students” (Chin & Devine, 2018, p. 135). In other words, the academic integrity of nursing students includes honest classroom, clinical, and interpersonal behaviors (Chin & Devine, 2018). The first aspect addresses the conscious preparation for classes. The second emphasizes the responsible managing of clinical practices. The last one highlights the respect for the rights and freedoms of students in interpersonal communication. Nursing schools help students develop the discipline and responsibility necessary for future practice.

There are various possibilities and methods to enhance academic integrity in nursing schools. Barbier et al. (2019) believe that the teachers’ special training and constant support is a minimum that should be provided in nursing schools. Such an approach can be realized through the implementation of discipline, where the principles of academic integrity will be discussed (Barbier et al., 2019). Moreover, the researchers highlight that nursing schools should help students to comprehend the importance of integrity in their profession (Chin & Devine, 2018). Therefore, it should not be presented as a mere set of rules to be followed. Barbier et al. (2019) offer to advance the teachers-students discussion on the topic of academic and professional integrity. The thoughtful analysis of the rules and their usefulness in nursing practice can contribute to the creation more honest educational culture.

It is also vital to provide a positive learning environment to keep students motivated to study. The integrity violation within the educational process is less severe when students have advanced learning opportunities and a structured curriculum (Barbier et al., 2019). Thus, nursing schools are responsible for evaluating the academic integrity of students. Moreover, the education organizations should provide a good learning environment for the realization of academic integrity.

There is a direct correlation between academic integrity and the professionalism of licensed nurses. The practical research showed that the lack of intellectual integrity provokes severe violations in the future practice (Barbier et al., 2019). Such a situation leads to significant problems in the healthcare sphere. Scientists believe that such a situation is caused by the students’ wrong perception of academic integrity (Barbier et al., 2019). Based on that, the researcher pointed out that the education sphere, in general, is perceived as having a low level of significance. Students often correlate medical sciences with other disciplines (Barbier et al., 2019). This means that the whole academic education integrity should be enhanced. The integrity support in the medical sphere may also be efficient. However, maximum productivity can be gained through the collaborative development of academic integrity in general.

The principle of academic integrity should take a central place in the value system of any educational institution, especially in the field of medicine. This principle is extremely positive, forming proper behavior of students and teachers. Academic integrity allows teachers to give knowledge based on honesty, independence, and respect for students, which will lead to substantial positive results in medical treatment outcomes. In order to minimize the lack of professional integrity of nursing practitioners, changes in academic and educational fields should be made. Nursing schools should pay special attention to the topic of academic integrity, providing training and support for the students. The rational choice will be to implement the professional integrity and ethics disciplines into the curriculum. Therefore, enhancing academic integrity contributes to better nursing practice and the development of healthcare in general.

Barbier, M., Ingles, J., Keener, T., Peralta, M., Smith, L., Swager, L., & Wen, S. (2019). Student and faculty perceptions: Appropriate consequences of lapses in academic integrity in health sciences education. BMC Medical Education, 19 (209), 1–9. Web.

Chin, E., & Devine, C. (2018). Integrity in nursing students: A concept analysis. Nurse Education Today, 60 , 133–138. Web.