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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 

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Integrity

Updated: Oct 5, 2023


Integrity is an essential characteristic of a professional nurse. Dr. Richard Ridge (2015) defines integrity as, "...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 ". How a nurse adheres to those standards will determine how much integrity they possess but sometimes our integrity is tested. Like when a patient spits in your face when you are trying to get their vitals. Or when a patient calls you every curse word in the book when you are trying to admit them to the unit. Our first response is to fight back but our integrity stops us from doing those things. These times that test our patience have been referred to as moral distress or emotional labor.




My concept of integrity is like the animated characters who sit on my shoulder with the devil on one side and the angel on the other side. But I add a third, a hidden camera above my head. Remember, nurses are one of the most trusted professions year after year after year. How did we earn that trust and how do we keep it? Integrity. There are so many times that we could pretend to give a medication or a treatment. Who would know if the patient were unconscious or cognitively impaired? And there are nurses who struggle with addiction and take the patient's medications and give the patient aspirin or something like it. I heard a podcast recently where a nurse at an outpatient fertility clinic took the fentanyl that was meant for patients during an egg retrieval. I tried to stay non-judgmental and give her the benefit of the doubt. Before hearing why she did it, I made up these scenarios in my head like, her kids would be killed by a gang if she didn't steal the fentanyl for them to sell. Or her son was addicted to the drug, and she stole it to help him kick his habit. Or she was giving it to homeless people who were suffering from fentanyl withdrawal.


"Approximately 75% of all the fentanyl given to patients at Yale REI from June 2020 to October 2020 was adulterated with saline. Some of these bottles contained diluted fentanyl, while others contained no drug at all and contained just saline,” Miller said in the plea agreement. “The defendant knew that the adulterated vials of fentanyl she replaced at Yale REI would be used in surgical procedures and that the absence of an anesthetic during an outpatient procedure may cause serious bodily injury to the patient.”



The most horrendous part of this story, to me, is that the nurse knew these patients were not getting the fentanyl because she was in the room during the egg retrievals. (FYI: I am not using her name because I do not want to give her any further "press".) And she answered phone calls after hours from women who were in horrible pain from no anesthetic during the procedure and told them that they were probably "opioid tolerant". Many of these women never returned to the clinic because they did not want to experience that pain again. So, this nurse not only impacted innocent women but their unborn children! Where was this nurse's integrity during those years that she stole the vials and replaced them with saline? Her excuse was she used the drug for herself and to sell to pay a lawyer to keep her ex-husband from taking her children. The 6-episode podcast tells a sad story about how a world class infertility clinic attached to a world class university, Yale University, not only allowed it to happen but then never took responsibility for the failure. All of the blame was placed on the nurse which was unfortunate because nurses are humans just like every other human being. There should have been safeguards in place to prevent the theft. Do you know how the physicians and managers of the clinic found out the fentanyl was being replaced with saline? One of the caps was not sealed correctly. An investigation revealed that the nurse responsible for ordering the vials was tampering with the vials. My question is how did no one see her drug use? She was going to her car or the restroom 10-15 times a day. The nurse got weekends in jail only and did have her license suspended but was able to petition to get it back!!!!


Where was her integrity? Where was her professionalism? Where was her moral code? But I think the more important questions is why were none of the patients believed when they said they were having excruciating pain? Why were they labeled "fentanyl tolerant" with no follow-up? Why did the physicians during the middle of the procedure not pay attention to the patients' pain? Is it because the patients were women? In the podcast one of the women who was an addiction researcher guessed that the nurse was stealing and using the fentanyl! But she did not have proof of it, so she said nothing. Did the nurse get away with it because nurses are the most trusted profession? I am not condemning this woman because I was not in her shoes and did not know the battles that she was fighting. Hopefully she got the help she needed to get off the fentanyl. There have been more stories in the news with made-for-TV- movies and series about terrible things that a nurse has done. But are we any less human than a physician or a physical therapist or anyone else in the medical profession. We are all humans carrying around a great deal of baggage that can cloud our vision of right and wrong. I certainly am not condoning any of it. My point here is to stress that integrity starts and ends with every one of us. If you work with an angel and devil on your shoulder and you cannot decide what to do then put that hidden camera on your head and then ask the question, "is this right or wrong?" If you knew that someone was watching, would you change your behavior?


Research shows that people behave in a nicer way when they know they are being watched. Indeed, even a poster with eyes on it changes how people behave. And it seems when the chance of being observed is low, people are more prone to evade a moral code (Li & Ju, 2019).




(In progress)


Ridge, R. A. (2015). Putting the I in integrity. Nursing Management (Springhouse), 46(4), 52–54. https://doi.org/10.1097/01.numa.0000462381.26593.91


Li, J., & Ju, Y. (2019, July 2). Moral science confirms people behave better when they think they’re being watched. The Conversation. https://theconversation.com/moral-science-confirms-people-behave-better-when-they-think-theyre-being-watched-114384#:~:text=This%20finding%20echoes%20observations%20from%20social%20psychology%20that



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