NURS 619 Week 7 Reflection Paper 3 on Integrity and Safety Across the Curriculum Example

Reflection Paper 3: Honesty Is Also a Clinical Skill, Reflecting on How a Curriculum Forms Nurses Who Report Their Errors

The Incident

Late in my practicum this term, a second-semester student gave a scheduled dose of metoprolol without checking the patient's heart rate, which had been 52 at the previous assessment. The patient's rate dropped into the 40s, the patient became dizzy, and the staff nurse responded quickly; the patient recovered fully. What troubled me most was what happened next. The student did not report the omission. It came to light only when the staff nurse asked why the pre-administration heart rate was blank. When I met with the student afterward, the student said, "I thought if I told anyone, I'd be dismissed from the program."

My first reaction was disappointment in the student, and some anger on the patient's behalf. My second, after a few days, was a question about us: what had this student learned, in two years of our program, that made hiding an error seem safer than reporting it?

Why a Student Would Hide an Error

The student's fear was real, and research suggests it is shaped by more than one person's temperament. When 25 international undergraduates at a Turkish nursing school were interviewed about safety, students explained that the culture they grew up in shaped what a safety lapse meant to them morally, whom they held responsible for it and what they felt free to do about it, although all of them cared deeply about keeping patients safe (Aktaş & Güneş, 2026). The student I worked with had grown up in a setting where admitting fault to an authority figure carried serious consequences, and nothing in our program had explicitly replaced that expectation with another one.

The bedside stakes of this habit are high. Archer et al. (2026) synthesized 24 studies of how nurses perceive the nontechnical skills involved in recognizing and responding to deterioration and reported that nurses who were new or afraid of being criticized waited longer to act, whereas teams with open communication and a supportive culture made escalation easier. A nurse who learned in school that admitting a problem is dangerous may carry that fear into the moment a patient needs someone to speak up.

What the Curriculum Teaches Without Saying So

Thinking about the incident, I realized that our program teaches about errors in two contradictory ways. In the classroom, students learn about just culture and the importance of reporting. In clinical evaluation, students know that errors lower their grades and can lead to dismissal, and they hear stories, sometimes exaggerated, of classmates who were removed after a single mistake. The hidden lesson of the clinical evaluation tool may be louder than the stated lesson of the lecture.

Academic integrity sits close to this problem. When Danino et al. (2026) gathered the eight studies that have examined both kinds of dishonesty in nursing students, most reported some statistical or predictive connection between cheating in courses and cutting corners in clinical work, while a minority treated the two as separate behaviors, so the authors concluded that the link is real but varies with context. The evidence does not show that cheating on a quiz causes hiding an error at the bedside, but it suggests that a program's handling of honesty in the classroom and in clinical practice should be consistent, because students experience them as parts of one formation.

Faculty consistency matters as well. The nine prelicensure educators Tracy (2026) interviewed described learning to handle misconduct largely on their own, with uneven backing from administrators and real difficulty building a shared culture of honesty; the study's recommendations centered on clearer policies and deliberate preparation of faculty. If faculty handle integrity differently from one course to the next, students learn that honesty depends on who is watching.

Bringing the Reflection to My Curriculum Plan

These reflections changed how I see the Cedar Hill curriculum plan I completed last week. I had placed safety in a program outcome and dignity in the philosophy, but I had not treated honesty as a thread running through the curriculum. I would now make three revisions. First, the clinical evaluation tool in every course would include a criterion for timely disclosure of errors, and disclosing an error promptly would count in a student's favor rather than only the error counting against them. Second, simulations in each year would include a scenario in which an error occurs and students practice reporting it to an instructor and to the patient's team, followed by debriefing on how it felt. Third, the faculty orientation would include a shared approach to academic integrity and to clinical errors, so that students meet the same expectations in every course.

My Own Role as an Educator

I also had to reflect on my own part in the incident. Earlier in the term, I had corrected the same student sharply in front of a staff nurse for an incomplete assessment. I believe the correction was justified, but the manner may have taught the student that I was someone to fear. Educators model the culture they want students to adopt. If I want students to report errors, I need to show them how I respond when I make one, and how I respond when they do.

What Students Told Me

After the incident, my preceptor and I held an optional discussion with the clinical group about errors, without naming anyone. I asked each student to write anonymously on a card what would happen if they reported a medication error. Of the eight cards, five predicted a failing clinical grade or dismissal, two predicted a meeting with the course coordinator, and only one predicted that the instructor would help them learn from it. None of these students had actually seen a classmate dismissed for a single reported error, yet most believed it would happen. Their beliefs came from rumors, from the tone of clinical evaluations and from the severity with which errors were discussed in orientation.

That small exercise convinced me that students' beliefs about consequences, not the program's written policy, decide whether they report. The written policy at my practicum site actually distinguishes between errors that are reported and errors that are concealed, treating the second far more seriously. But students had never been told this clearly, and the people they heard from were classmates. A curriculum that wants honest reporting has to teach the policy explicitly, repeat it in every clinical course, and make sure students see it applied fairly. I would add a short session on the error policy to the first clinical course and revisit it in each later clinical orientation, with faculty describing in plain words what happens when a student reports an error and what happens when one is hidden.

Faith and Honesty

Proverbs 28:13 says, "Whoever conceals his transgressions will not prosper, but he who confesses and forsakes them will obtain mercy" (English Standard Version Bible, 2001/2016). The verse joins confession and mercy, and I think a Christian school of nursing should do the same. Students should learn that disclosing an error is required and that disclosure will be met with fairness and a path to learning, not with automatic dismissal. That pairing is what makes honesty possible.

Commitments

I will carry three commitments into my teaching. When a student reports an error, my first words will be thanks for reporting it, before any discussion of what went wrong. I will tell students about an error I made as a new nurse and what I learned from it, so they see that reporting is part of professional life. And I will advocate, in any program where I teach, for clinical evaluation tools that credit disclosure.

Conclusion

A student hid a medication error because two years of education had not convinced the student that honesty was safe. Research on culture and safety, on links between academic and clinical dishonesty, on faculty handling of integrity and on the role of fear in escalation helped me see the incident as a curricular problem, not only an individual failure. Curricula form nurses through what they reward, and I want the curricula I help build to reward the truth. That aim will shape how I write evaluation tools, how I talk with students after mistakes, and how I describe the program's policies on the first day of every clinical course, so that the next student who makes an error knows that telling the truth is both expected and safe.

References

Aktaş, Y. N. K., & Güneş, Ü. (2026). Cultural influences on patient safety error responses among nursing students: A qualitative study. Nurse Education Today, 166, Article 107291. https://doi.org/10.1016/j.nedt.2026.107291

Archer, D., Rashidi, A., Kaur, R., Roderick, A., & Gallagher, O. (2026). Nurses' perceptions of their non-technical skills in recognising and responding to clinical deterioration in hospital settings: A systematic review. Journal of Clinical Nursing. Advance online publication. https://doi.org/10.1111/jocn.70497

Danino, E., Maoz, E., & Bekman, N. (2026). Beyond a linear assumption: A systematic review of academic and clinical dishonesty in nursing education. Journal of Professional Nursing, 66, 59-66. https://doi.org/10.1016/j.profnurs.2026.05.017

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Tracy, A. (2026). Nursing faculty's experiences with managing academic integrity in prelicensure nursing education: A qualitative study. Journal of Professional Nursing, 66, 45-51. https://doi.org/10.1016/j.profnurs.2026.05.022