1. Freda, Margaret Comerford EdD, RN, CHES, FAAN

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The subject of integrity has been weighing heavily on my mind recently. What is integrity? Why should nurses be concerned about the concept? The dictionary says that integrity is "adherence to moral and ethical principles; soundness of moral character; honesty." To be a person of integrity is to stand for something, even if that stance comes at a cost.


When I was young I was required to read "The Lives of the Saints." It is filled with gory, bloody stories of religious martyrs who suffered untold agonies for their religious faith. It seems odd now, but when I was a child it was somehow an accepted practice to ask children to read about all this violence. I guess it was supposed to teach us about integrity and taking a position for a belief. Those stories (which I would never consider using as bedtime stories for my grandchildren today), all had the same message: do the right thing. Thank goodness I've never had to choose between having my fingernails pulled out vs. denying my beliefs, but in today's world there are other moral dilemmas we must face. How we deal with such predicaments says a lot about our integrity.


One of the current concepts in the nursing literature that deals with integrity and ethical -dilemmas is "moral distress." Nursing has grown to the stage in its professional existence when we discuss and dissect the moral dilemmas we face daily. Clinically, the notion of moral distress often deals with life, death, pain, and suffering. Neonatal nurses have led the way in this literature, probably because they so often have to face the life and death choices being made by parents and physicians about continuing the lives of extremely small babies. These babies require an incredible number of dangerous and painful procedures, and nurses know that these infants could be facing multiple physical and mental incapacities. Nurses are in moral distress when they have to come to terms with ethical dilemmas such as these. How do they carry out orders for treatments they wish they didn't have to administer? Nursing is long past its "follow all the orders" phase. Well educated, ethical nurses view their work in terms of their own integrity and moral courage. Increasing numbers of nurses are studying this topic, and I urge you to read some of this literature in your own quest to understand your moral compass.


It is not just life and death procedures that require you to examine your integrity. I've known nursing administrators who have been asked to make decisions that they consider immoral for nursing. I've known nurse educators who have been gently or not so gently encouraged to issue passing grades to nursing students whether or not the students successfully completed their assignments. I've known nurses who have stood up to physicians who act like bullies who think they work in a hierarchical system where they are the captains of the ship. I've known nurses who have left a job rather than compromise their integrity.


I'm sure that most of you have faced ethical dilemmas in your work, and that your integrity has been tested. I'm willing to bet that in most instances you've made the ethically correct -decision. In my opinion, integrity is our most important attribute. I believe that nothing is more crucial than being true to yourself and having integrity. Nursing is a principled patient-centered profession that routinely stands on high moral ground. We know who we are, and what we stand for. According to one (unidentified) source "Integrity is doing the right thing, even if -nobody is watching." Sir Francis Bacon said "It's not what we profess, but what we practice that gives us integrity." I'm proud to be a nurse, and to subscribe to those values.