Honesty, a reflection of self-respect and respect for others, is essential to maintaining trust with clients and undermines the trust necessary for clients to be candid with health professionals. Dishonesty can take a variety of forms. Below are some examples of dishonesty, in professional and personal settings.
About a month ago supplies started going missing from the unit – masks, gloves, bandages. Recently, clients have been reporting that items are missing from their personal belongings. The employer launches an investigation.
During the investigation Jane, a nurse who has worked at the hospital for seven years, is observed on the hospital's security camera leaving with large bags after her shifts. When questioned about it, Jane admits to stealing. The employer firs Jane and submits a complaint to BCCNM. An investigation is initiated by the college.
Honesty is an important quality for nursing professionals. When a nurse exhibits dishonest behaviour such as theft, it negatively impacts the public's trust in the profession and may present a risk to public safety.
Using the HONEST framework (Gallagher & Jago, 2016) we can analyze Jane's case to demonstrate the aspects of dishonesty and the consequences of it.
Highlight the type of dishonesty - Jane’s dishonest behaviour is stealing. This behaviour directly relates to her nursing practice as she stole from the hospital and clients, resulting in harm to the clients she has a duty to care for.Organizational issues that may have impacted the offence - It is unclear whether there were any organizational factors contributing to Jane's theft. Could the employer implement policies and protocols for ensuring clients' belongings are stored securely? Negative individual factors that contributed to the offence - Jane told her employer and the BCCNM investigator that she was experiencing financial difficulties and was selling the stolen items for cash.Explanations offered by Jane - Jane explained that her extraordinary personal circumstances led her to steal. She said that she could not sleep knowing that she had been dishonest with her employer or clients. Does Jane's remorse for her actions mitigate the severity of the offence?
Sanction applied - Jane is fired by her employer. After their investigation, BCCNM’s Inquiry Committee requests that Jane agree to:
Training or professional education that may remedy - As outlined above, the Inquiry Committee requests that Jane participate in remedial education. Her remorse and accountability indicate that Jane may benefit from courses and consultations and that she likely recognizes the importance of honesty in her nursing practice.
Reflections for your practice What would the public think if they witnessed this type of behaviour by a nurse? What happens to your nursing registration if you engage in dishonest behaviour like theft?
Dishonesty can affect your clients, the nursing profession, and your nursing registration. By stealing from an employer and from clients, a nurse fails to meet many of the Standards of Practice. Review your
Professional Standards as they relate to ethical practice, honesty and integrity.
On Wednesday, Eric forgets to administer medications to four of his twenty clients. To cover his error, Eric documents that he administered the missed medications. Eric justifies his action to falsify documentation by telling himself that the medications he had missed wouldn’t result in harm if not taken. On Friday, Eric’s manager approaches him and says that four clients had complained of not receiving their usual medications on Wednesday. The manager asks Eric if he had administered the medications. Fearing for his job, Eric said he did.
Eric's manager investigates and finds enough evidence of dishonesty to file a complaint with BCCNM. The concerns submitted by the employer include that Eric:
The BCCNM Inquiry Committee investigates. The investigator interviews Eric and reviews all the relevant documentation. In the interview, Eric admits that he had not administered the medications, had falsified the documentation, and had lied to his manager. Eric also says he felt bad for being dishonest, and he doesn’t consider himself a dishonest person.
Ultimately, Eric is accountable for his actions. Eric expresses remorse for his dishonesty. The Inquiry Committee requests that Eric:
Discovering his error, Eric should have assessed the clients for any impacts from the event and reported the error as per employer policies. The
Documentation practice standard requires that nurses complete an incident report following events such as medication errors or falls. The incident report is not part of the health record; record event facts affecting the client in the client's health record.
Medication practice standard requires that nurses take action, including following organizational/employer policies and processes, when an error or near miss occurs at any point of a medication-related activity. The
Professional Standards require that nurses be accountable and responsible for their own nursing decisions, actions and professional conduct, demonstrating integrity at all times, including being honest when a mistake is made. Lying about the medication administration and falsifying the documentation compromises the continuity of care and puts clients at risk.
Dr. Smith discovers that a nurse, Pieter, forged Dr. Smith’s signature on a medical certificate. Pieter then submitted the medical certificate to his employer to get three months paid ‘sick’ time off work. Pieter was really on vacation in Mexico. Dr. Smith makes a complaint to BCCNM.
Pieter’s behaviour does not uphold BCCNM’s
Professional Standards. Pieter’s conduct outside of work needs to be in line with the Professional standards, demonstrating honesty and integrity at all times. While Pieter’s behaviour isn’t directly related to his care of clients, forgery is dishonest, unethical and damages the public’s trust in the profession.
Pieter is fired by his employer.
BCCNM’s Inquiry Committee investigates Pieter’s case and reviews all the evidence, including:
Because Pieter’s behaviour and dishonesty could negatively impact the public’s trust in the profession, BCCNM’s Inquiry Committee determines that Pieter demonstrated conduct unbecoming of the profession. After considering the impact on the public’s perception of the profession and the seriousness of the conduct, the Inquiry Committee requests that Pieter agree to:
As a nurse, you are responsible for recognizing the ethical implication of every activity you engage in – whether it is personal or professional. Take a moment to think about dishonest behaviours you may have seen. How do these behaviours reflect on you and the rest of the profession?
Professional standards to find out which behaviours nurses must demonstrate in their practice and how honest, ethical behaviour fits into your practice.
Leila, a recent graduate and BCCNM registrant, forgets to renew her registration during the renewal time. Unaware of the oversight, she continues to work as a nurse. In July, Leila realizes that she did not renew her registration and has been practicing without registration for the last five months! Leila immediately calls the college to let them know and ask for guidance. Leila is told to go online and complete a reinstatement application and to disclose the information in the application. Leila is informed that because she practiced for five months without registration, her application will go to the Inquiry Committee for investigation.
The BCCNM Inquiry Committee reviews Leila’s case and considers the following:
BCCNM’s Inquiry Committee issues Leila warnings for 1) practicing without registration and 2) using the title ‘nurse’ without authorization. The Inquiry Committee also requests that Leila participate in consultation with a Regulatory Practice Consultant to give her an opportunity to reflect on her conduct, on the Standards of Practice and to understand how to prevent a similar situation from happening again.
Did you know that practicing without registration is one of the most common forms of dishonesty that BCCNM sees? Practicing without registration, either through oversight or intentionally, puts your clients, your employer, and yourself at risk. You can only work/volunteer and call yourself a ‘nurse’ if you maintain practicing registration. Remember – you have liability insurance only when you have a current practicing registration.
Usha is a newly graduated nurse and is passionate about helping people; however, she struggled with the theoretical parts of her nursing program and was caught cheating on an exam. She was given another opportunity to write the exam, but the cheating incident stayed on her permanent record and was reported to BCCNM by the school. When Usha applies to BCCNM for registration, the cheating incident is included as part of her application.
All applications to BCCNM are assessed on several criteria, one of which is good character. When determining whether an applicant is of good character, BCCNM reviews:
Good character refers to a combination of personal qualities and traits, such as:
So how does Usha’s dishonesty in school affect her ability to meet BCCNM’s good character requirement? When assessing Usha’s application, the Registration Committee must determine if Usha meets the above criteria of good character by considering some of the following questions:
Is there a pattern of dishonesty or untrustworthiness in Usha’s past?
What explanations and reflections were offered by Usha?
Is there any training or professional education that may remediate Usha’s dishonest behaviour?
After reviewing the information and Usha’s statements, the Registration Committee decided to deny Usha’s application for registration until she completes a course in professional ethics.
It is important for student and applicants to be aware of the requirements for registration and that there is more to the assessment process than just successful completion of the nursing education program. Dishonest behaviour in a professional or personal setting can impact whether you meet the requirements of good character and whether you will be admitted into the nursing profession.
For more information on BCCNM’s registration requirements, visit the