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Recently a nurse manager in the hospital where I work, who openly shares her faith in Christ, was found to be falsifying her time sheet. Previously, we had shared our faith and love for Christ. Now her colleagues know that she was behaving contrary to what she said she believes. Why? What made her do such a thing? Her credibility as a manager and as a Christian is lost.
Are you a person of your word? Do you give honest answers when challenged or questioned? Are your actions consistent with your words? Do you take longer breaks than allowed? Do you steal time through socializing on the job or wasting time?
It is becoming increasingly difficult to be people of integrity, to consistently live what we believe. Yet, Scripture calls us to be a people set apart, a people of integrity. Are we people of integrity?
Integrity comes from the word integer, which means to be whole, complete or intact. Dr. David Jeremiah, in his book Turning Toward Integrity, asserts, "In its most simple form, integrity means wholeness, completeness, entireness. It comes from a root word that means 'intact.' If we have integrity, our heart is not divided. We have no hidden agenda!!"1
Scripture defines integrity as being upright, blameless, honest and truthful and as having "singleness of heart." Integrity involves a deep sense of right and wrong. It means avoiding the wrong and the willingness to stand up for what is right, even if it is costly.
Someone said that people watch Christians six days a week to see if we mean what we say on the seventh. What do people see when they watch us? Are we people of integrity? Do we walk our talk?
Years ago, the RNs where I worked became increasingly frustrated with the hospital administration. The nurses did not believe the hospital administrator listened to their concerns or valued and respected them as professionals. They decided to bring in the state nurses' association as their collective bargaining agent. After long and frustrating negotiations, they voted to unionize. Shortly thereafter, the nurses notified the hospital of a strike. Thirty days later, the strike began.
Many nurses struggled with whether or not to join the strike. Several chose not to join. They crossed the picket lines, believing it was the right thing to do. Making that decision was costly. Every day, as they crossed the picket line, they were harassed by their striking coworkers. Many had been friends prior to the strike. For days, I watched these nurses coming to work, knowing they would suffer as a result of crossing the picket line.
When the strike was over, tension was so great that many left. All faced tough decisions. Nurses on both sides had to determine what they valued and what was right for each of them. It cost everyone involved.
For the striking nurses, it was a matter of clarifying their beliefs and values, and then acting. That is the heart of integrity: living according to our standards and core values. Living with integrity means that character becomes the basis for actions. Therefore, we must have clear, well-defined values. Without them, we will be confused, indecisive and inconsistent in difficult times.
What standard do we use to determine values? For believers in Christ, the standard is God, revealed through Scripture. God has given us principles that define right and wrong, and he has placed them in our hearts. In Jeremiah 31:33, the Lord says, "I will put my law within them, and I will write it on their hearts; and I will be their God, and they shall be my people." However, biblical morality goes beyond obedience to a list of rules. It is an inner attitude, a desire to be like Christ in his holiness, his justice and his love.
Using God's standard, how, then, do we live as people of integrity? Three steps guide us.
First, determine your core values. These are values that don't change over time, values that you won't compromise, regardless of the circumstances. Daniel, from the Old Testament book that bears his name, provides a good example. He determined his core values early in life. When taken into captivity by King Nebuchadnezzar of Babylon, Daniel knew what was right and did it. He would not compromise, even for the king, even when faced with a blazing furnace or a den of lions.
Unless we determine our core values and beliefs before finding ourselves in a moral or ethical dilemma, the easy way becomes most attractive when confronted with a dilemma. The clearer you are about what you value and believe, the more likely you are to respond consistently with your convictions. If the staff where you work decided to bring in a union, or if they decided to go on strike, what would you do? What core values would help you make that decision?
Second, communicate your values, even if it costs you. Once you have shared your values and beliefs with others, they will hold you accountable to that standard of conduct. The nurse manager who falsified her time sheet communicated her faith in Christ to others, but she didn't live it out in a manner consistent with what she said she believed. She reaped the consequences.
We need to be like Daniel, having the courage of our convictions, to be willing to act and speak of what we know to be right. Because Daniel had clearly defined his standard and values, he remained steadfast against a law demanding that he compromise his faith to save his life. The government officials tried without success to find corruption in Daniel, but they couldn't, so they tricked the king into establishing a law that required everyone to pray only to the king for thirty days. Daniel did not compromise. He went to his house and prayed to God as usual, just as they expected. At Daniel's house, they found him praying and went directly to the king, informing him that Daniel had broken the law. Daniel was thrown into the lions' den.
Daniel could have died, and I believe he thought he would, but God chose to deliver him. Rarely do the moral or ethical dilemmas we confront threaten our lives, but living with integrity often holds serious consequences.
Third, align your life with your core values. This is where our talk becomes our walk. It may be easy to talk about God and what we believe, but harder to put that into practice consistently, day after day.
I have seen situations where nurses stood by what they believed, unwilling to give in to peer pressure, and suffered as a result. For example, Jennifer consistently gave superb care to her patients and went out of her way to help coworkers. A peer told her to back off because she was making them look bad. When Jennifer chose not to change her work ethic, she was shunned and ridiculed.
In another situation, Debbie was late for work, so she called the nurses' station, asking a friend to clock in for her. With a history of tardiness, Debbie was afraid of being fired if she was late. What would you do? Would you clock her in? Would you explain that you would like to help but could not because it wasn't right and honest? What standard and values have you established that would help you make this decision?
Every day we face ethical and moral dilemmas in health care that stress our roles and our responsibilities. As people of integrity, what tools are available to help us resolve dilemmas?
Ethical systems provide a decision making process for resolving ethical and moral dilemmas. However, ethics is not an exact science and does not provide a standard formula for every situation. Rather, ethical thinking provides a framework for determining the best course of action in the face of conflicting alternatives. When we confront tough situations at work, our coworkers may have different standards and values and may utilize a different ethical framework for resolution. Ethical theories influence how people think and make decisions.
Some examples of ethical theories that have impacted our society and the way we view situations are listed here:
Ethical Relativism asserts that there is no objective, universal standard that can be applied to moral judgment. All conduct is relative to the circumstances. Thus every individual must decide what is moral or immoral in a given situation. Ultimately, every person judges the matter according to personal preference. This theory states: An action is not wrong unless I get caught.2
Deontology argues that we are not morally obligated to seek the best overall outcome by our actions; rather, we are obligated to perform those actions that are in accord with our moral duty. This theory is concerned with right actions, not the consequences of those actions and says: Do what is right, though the world should perish.3
Utilitarianism says that an action is judged as good or bad based on the consequence, outcome or end result. An action that is good or right produces the greatest good for the greatest number. This theory appears to justify imposing suffering on a few for the benefit of the many (majority).4
Ethic of Care asserts that an action is right if it involves an empathic understanding of the person and the complex situation. Moral decisions should consider the people involved. Empathy and caring are key concepts.5
Judeo-Christian ethic is based on God's holy, unchanging character. The standard of right and wrong is taught in Scripture and based on the holy, just and loving character of God.6
Examining and deciding on an ethical framework helps us to understand ourselves and others, and the values that distinguish us. Ethical theories help us determine appropriate responses and to decide what warrants our passion, energy and efforts.
The Codes of Ethics published by the American Nurses Association and the Canadian Nurses Association are concise summaries of moral principles in nursing.7 Throughout modern nursing history, various nursing codes have been developed to provide ethical guidance to practicing nurses. The summaries speak to the integrity, dignity, respect and worth of nurses and those in our care. They guide nurses in ethical decision making and provide an important means for us to exercise professional self-regulation. Even though we may utilize a code of ethics as a guideline, we must be prepared to give reasons for our decisions. We must personally examine the values and goals of our profession and be morally accountable for the choices we make.
How do we respond as people of integrity to tough dilemmas that we face, whether short staffing, coworkers who cheat the patient or the system, or a tough clinical issue? Knowing what we believe and having clearly defined core values help us live in a consistent manner. Utilizing tools such as ethical frameworks and professional codes of ethics helps clarify ethical dilemmas and resolve ethical issues. Books about ethics and integrity provide additional resources. Studying Scripture builds a strong foundation.
How does integrity or walking our talk become part of daily life? How can we communicate chosen values and standards? David, an early king of Israel, prayed, "I know, my God, that you search the heart, and take pleasure in uprightness; in the uprightness of my heart I have freely offered all these things. O LORD [horizontal ellipsis] keep forever such purposes and thoughts in the hearts of your people, and direct their hearts toward you" (1 Chron 29:17-18). This is my prayer as we strive to be people of God, people of integrity.
1. Consistently walk your talk.
2. Keep your promises.
3. Be honest with yourself and others.
4. Freely admit your mistakes.
5. Stand up for what you believe is right.
6. Be available and approachable.
7. Help others whenever possible.
See http://www.ncf-jcn.org/03fa_pep10.htm for a related Bible study and discussion questions.
1 David Jeremiah, Turning Toward Integrity (Colorado Springs, Colo.: Chariot Victor Publishing, 1993), 7. [Context Link]
2 The American Nurses Association Code of Ethics for Nurses is available at http://www.nursingworld.org/ethics/code/ethicscodel50.htm; information about the Canadian Nurses Association Code of Ethics for Registered Nurses can be found at http://www.cna-nurses.ca/pages/ethics/ethicsframe.htm. [Context Link]
3 Erwin Lutzer, Measuring Morality: A Comparison of Ethical Systems. (Probe Books, Word Publishing: Dallas, 1989). [Context Link]
4 Ibid. [Context Link]
5 Ibid. [Context Link]
6 Diann B. Uustal, Clinical Ethics and Values: Issues & Insights (Educational Resources in Healthcare, East Greenwich, RI: 1993), 200-01. [Context Link]
7 The American Nurse Association Code of Ethics for Nurses.[Context Link]
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