A Question of Nursing Ethics... by.Raconte

A Question of Nursing Ethics By Genevieve M. Clavreul, RN, PhD (Raconte@AOL.com)

There is a French saying “qui vole un oeuf, vole un boeuf,” which translates, “if one can steal an egg, one can steal a cow.” This phrase came to mind as I read recent news coverage about 11 nursing school students caught cheating during their comprehensive nursing school exam at the Prairie View A&M University School of Nursing in Texas. Ethics is one of the cornerstones of our profession, and a cheating scandal like this should concern all nurses, healthcare professionals, patients, and their families.An article in the Houston Chronicle reported how a group of final year nursing students sat for a comprehensive nursing exam, their last step towards graduation. The students were permitted breaks throughout the four to five-hour exam. During the test taking, several nursing students reported to the monitors that they observed others texting on their cell phones during the exam.11 students were identified as participants in this cheating scheme, which included texting others who had completed the exam. They were called before the student court for their punishment. They were prohibited from graduating but would be allowed to return the following school year. After completing an ethics course, they could re-take the comprehensive exam. So far, 0 of the 11 have announced their intentions to return to school.Was it 'Just Cheating on a Test'? Does the punishment fit the crime? I think not. You may wonder why I take it so seriously-some say it was, after all, “just cheating on a test.” It's not like they altered medical records, forged prescriptions, or failed to follow procedures that led to a negative outcome for a patient. So why don't I think an ethics course should suffice? Consider the following. In this class at A&M, there were approximately 56 nursing students, all in their final year of their Bachelor of Science in Nursing (BSN) studies. If 11 were caught cheating, that means approximately 20 percent of the class was involved. Since BSN nursing programs typically take four to six years to complete, one can conclude that most, if not all, the students involved in this cheating scandal were not newbies. Indeed, these were seasoned students who, in addition to their academic studies, were involved in the clinical aspects of the program. If they felt that cheating on the final exam was acceptable, did they also treat their clinical and patient care in the same cavalier manner? A blogger recently posted in response to the A&M scandal that cheating was so commonplace now that she was not surprised to learn about the nursing students. However, a majority of other bloggers, many of them RNs, were not so forgiving. Many expressed concern at what appeared to be a rather light punishment for what many, myself included, viewed as a serious breach of integrity and ethics.There have been calls for sanctions against the A&M School of Nursing. In addition, many called for the Texas Board of Nurse Examiners (BNE) to prohibit these students from sitting for the NCLEX-RN altogether, or to place some type of prohibition on their license for an indeterminate number of years, or to issue a list of the offenders to all the other 49 State Boards of Nursing.
Philippine Nursing Board Scandal: Some of you may remember a past column “A Breach of Integrity,” where I discussed a 2006 scandal involving the sale of test answers in the Philippines. In this incident, an unknown number of graduate nursing students accessed the answers to the Philippine Board of Nursing exam. Nearly a year passed before the Philippine government ordered a mandatory re-test of the suspect class. They did so only after the Chief Nursing Officer (CNO) organization and several others applied pressure for a re-test.The final straw seemed to be when the CNO organization issued a written recommendation that no person who sat for the suspect exam should be hired. After this edict, the Philippine government accepted the earlier concerns of various parties and held a re-test. (This article is archived on WorkingNurse.com.)
Why I Believe a Stronger Punishment is Needed Unfortunately, it will take a lot of pressure before A&M steps up and does the right thing. Here are some reasons why I believe stronger punishment is needed.
o It was a well-coordinated cheating effort. This wasn't the spontaneous act of a student sneaking a peak at the test of the student in the next seat. It involved the active participation of students cheating on the exam and those who already completed it and agreed to share the answers. I hardly think one course of ethics would help correct the lapse that occurred.o Deterrent effect. We must also consider the impact on those who may contemplate cheating in the future. Will this punishment serve as enough of a deterrent? 11 A&M students cheated and an unknown number of Filipino nursing school graduates bought answers to their RN licensure exam. These examples illustrate that we must be vigilant.
o The effect on other nurses and patients. Can you imagine being an RN, wondering if the A&M graduate you are working alongside was one of the 11 caught cheating? Or worse still, one who had cheated but wasn't caught? I recently saw another blog post suggesting that before booking a procedure, patients should be allowed to ask whether any of the RNs had attended Prairie View A&M School of Nursing as a way to choose their medical facility.
Excusing Poor Behavior Nursing has displayed somewhat contradictory behavior, usually in the name of the nursing shortage. It isn't uncommon to make excuses when nurses exhibit poor, unacceptable or even dangerous behavior. Often, such behaviors are brushed off due to the nurse being overworked or the hospitals understaffed. Though these are often the realities of nursing, many RNs resist the urge to cut corners and most display the highest of work ethics. For this reason, a cavalier attitude toward the A&M cheating scheme should not be allowed to take root and flourish in either our nursing schools or workforce. Since RNs are entrusted with the health and lives of others, we should be held to the highest level of ethical standards. As the story of the A&M 11 travels the country by word of mouth, printed word, and the internet, in all likelihood, it will take on a life of its own. This makes it imperative that both Prairie View A&M School of Nursing and the Texas BNE take decisive action. In my opinion, A&M's actions seem to fall far short; especially in light of an additional Houston Chronicle article that reports that one of the students alleged that the nursing school faculty encouraged the cheating. At this time, there are no additional reports as to whether or not the BNE or another accreditation body will take action against either the school or the 11 students. My mother's favorite saying “qui vole un oeuf, vole un boeuf” seems to have played out in the case of Prairie View A&M School of Nursing cheating scandal, as it would appear that the cow was indeed stolen.
Geneviève M. Clavreul RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.