Martha E. F. Highfield, PhD, RN, is Professor of Nursing at California State University, Northridge. She has worked as a staff nurse, faculty, staff development instructor, and administrator. Her research focus is spiritual care. She has held leadership positions in the Oncology Nursing Society and is involved in international healthcare to Nigeria.
“The [nurse] of integrity walks securely” (Proverbs 10:9a).
Even casual observation shows that nursing practice turns out differently depending on who is doing the practicing. This is because nursing is carried out by real human beings who bring all their strengths and weaknesses to patient care. Those strengths and weaknesses include not only discipline-specific skills and knowledge, but also personal integrity: a “firm adherence to a code of … values: incorruptibility … honesty” (Merriam-Webster, 2007).
Skillful and knowledgeable nurses with integrity promote good care. Those without integrity jeopardize care. Character matters. Take, for example, these journal entries from registered nursing (RN) students in the state university where I teach.
* Jamie*: “Someone in authority asked me to lie…. I said ‘no’.”
* Paul: “No other nurse was around to double-check the insulin. I thought, ‘It's only 1 unit; why do I need to check it’? But my conscience got to me. I went to find another nurse who checked it.”
* Mariana: “Today was the worst day ever. I made a medication mistake…. The patient was fine. And for a minute I thought, ‘Why go to all the trouble to report this. I'll get in trouble. It will be a lot of work’. But then I decided that reporting it was the right thing to do. The other nurse called the physician, and I filled out the paperwork.”
These RN students acted admirably. Their honesty and incorruptibility promoted trust and safety.
In contrast, what if these nurses had acted without integrity? What if Jamie had lied? What if Paul had decided not to check the 1 unit, and the next time not the 3 units, and then the next time not the 5 units? What if Mariana hadn't reported the error, and the patient had not been “fine?” Such actions would have undermined trust and endangered patients.
If integrity is so critical to practice, then shouldn't we be teaching it? The answer is “yes!” And although teaching integrity may be challenging, it is not impossible. Consider these suggestions.
First, nurture your own integrity so you are in the habit of doing the right thing even when it is inconvenient or hard. Begin by thinking of a person whose integrity you admire and then practice emulating that person's morality until it becomes second nature to you. Do “not imitate what is evil but what is good” (3 John 1:11). Students will observe and remember your actions long after they forget your words, and in imitating you, they may learn not only sterile technique but also sterling character.
Second, use your university's own mission, vision, and values to help students reflect on what it means to be a good person. My school's catalog states that students should respect everyone, work collaboratively, seek excellence, develop values, not cheat, not steal (i.e., plagiarize), not harm others, and so on.
Third, use reflective student journaling. I assign an everyday ethics journal (Figure 1). I want students to consider and self-correct how they act toward peers, patients, and supervisors. The journal is not for venting frustrations or for raging against others. I write a few questions, but almost no comments in their journals, in order to keep students on track and encourage self-honesty.
In these ways and others, we and our students can learn to cultivate the integrity that makes a positive difference. (To discuss these issues with the author, graduate students, and other educators, e-mail your comments or questions to firstname.lastname@example.org.)