Performance potential
Placing the I in integrity
By Richard A. Ridge, PhD, MBA, RN, CENP, NEA-BC
I
ntegrity is usually talked about as a requirement
for leaders, usually, and healthcare and
nursing leaders specifically. Since 2005, at
least 80% of Individuals responding within the
annual Gallup ballot on perceived honesty of professions and occupations have ranked nurses on the
prime of the listing for honesty and ethics.1
The nursing
occupation has taken nice delight on this constant
discovering, which is being bolstered this yr because the
American Nurses Affiliation (ANA) launches its
“12 months of Ethics” to coincide with the revision of
the Code of Ethics for Nurses.2
But, how we outline integrity? Typically, how our
definition of integrity and morality pertains to
our understanding of moral habits isn’t properly
recognized or clearly outlined. Integrity is considered as
a vital part nursing and
a core worth for nurses in any respect ranges and in all specialties. We offer a framework for outlining and
understanding integrity in nursing observe so that you
might be higher ready to evaluate your individual integrity
and the integrity inside your organizations.
How do you outline integrity?
Integrity is adherence to the interrelated units of
requirements, values, and rules derived from the
three domains that have an effect on our selections and habits: private, skilled, and organizational.
(See Determine 1.) The extent to which a pacesetter adheres
to the requirements or codes that emanate from every
of those domains defines the integrity of the person. Integrity isn’t a worth by itself, however fairly
the extent of match between a person’s selections
and behaviors and his or her relationship to the
values and morals of the communities through which he
or she lives and works.three
Our private values are grounded within the ethical
framework that we have been raised to consider and
combine into our resolution making and habits.
Many people have confronted and resolved challenges of
various levels of severity associated to our personal integrity. Typically, the problems on the decrease finish of the
severity scale are forgotten, whereas extra critical
points could result in important crises with excessive ranges of ethical misery and detrimental private, skilled, or organizational outcomes. Ethical misery
outcomes from worth conflicts; ethical braveness describes the power of a person to talk up and
alleviate or cut back ethical misery skilled by
others.four
The ANA Code of Ethics acknowledges that nurses face
threats to their integrity in any healthcare setting.2
Organizational pressures to carry out could inspire nurse leaders to violate their very own private ethical
code to perform particular objectives and goals. These
conditions could lead to important ethical misery for
the nurses and nurse leaders. The undesired result’s
when the person rationalizes his or her habits to
mitigate the ethical misery, violating the non-public, skilled, or organizational framework.
Healthcare organizations have an outlined mission, imaginative and prescient, and values assertion to offer extra steering to leaders and employees relating to the
general intention and objective of the group and
the values that should be thought-about when making
selections relating to moral habits. The values
assertion describes the group’s core rules that help the general imaginative and prescient and mission.
Ethically sound organizations have leaders and
staff who’re conscious of those values and combine them into their resolution making. When the
group’s precise practices battle with the
said values, employees morale is undermined, cynicism develops, and the chance of unethical habits
will increase.5
52 April 2015  Nursing Administration www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Well being, Inc. All rights reserved.
Performance potential
Integrating integrity
So what can we do to foster a observe setting that values integrity?
1. Mannequin acceptable habits.
“Do as I say, and never as I do” is a
traditional idiom used to characterize
hypocritical habits that contradicts a pacesetter’s mandates and expectations. As leaders, our habits
is intently scrutinized and modeled
by others on our groups; our
habits influences group member
habits. Verbalized expectations
aren’t as sturdy as behaviors that
are modeled. For instance, if a
senior chief is noticed misrepresenting a scenario both in particular person or on a report, others are given
the message that deception is
acceptable below the proper
circumstances.
When a pacesetter throughout The Joint
Fee or different regulatory
Assessment asks a direct report back to ship a set of accomplished data that
meet the necessities, is the chief
implying that it’s all proper and even
mandated that the person appropriate these earlier than handing them off
to the surveyor? The place does one
draw the road? For instance, when
annual efficiency Assessments
should be accomplished, is it anticipated
that the supervisor indicators and dates an
analysis that has been inadvertently unsigned by the worker? If
a pacesetter asks for this habits, most
would see this as unacceptable. If
the chief tells the supervisor that he
or she actually doesn’t wish to know
how the supervisor got here up with the
outcomes however she or he is happy with
the end result, is that this acceptable?
2. Guarantee complete ethics
schooling for nurses in any respect ranges.
Schooling on compliance, organizational values, and acceptable
behaviors must be accomplished on
an annual foundation for all employees and leaders. In nursing, important consideration
must be paid to an in-depth Assessment and understanding of the ANA
Code of Ethics. Use interactive
studying strategies that concentrate on the
utility of the Code of Ethics
inside the context of your particular
group. Disseminate clear expectations about acceptable habits
associated to falsifying paperwork.
A strong academic program
for nurses can be based mostly on three
basis paperwork revealed by
the ANA. Along with the Code of
Ethics, “Nursing: Scope and Requirements of Follow” and “Nursing’s
Social Coverage Assertion: The Essence
of the Career” must be included. Information of the requirements
drives skilled observe and
sound resolution making constant
with the values and expectations of
the nursing occupation. The codified
requirements of observe and moral habits are one of many main parts that outline us as a occupation.
By making certain that our employees members
are educated about these requirements, we’re strengthening the occupation for the current, in addition to for
the long run. The Social Coverage Assertion is vital as a result of this offers the inspiration for connecting
nursing’s worth and accountability
to society. By higher understanding
nursing’s social context and contract
with society, as manifested by state
nurse observe acts, nurses are higher
ready to observe in extremely unstable and quickly altering healthcare
environments.
three. Create efficient buildings and
processes to help transparency.
Working towards at a excessive moral degree is
embodied inside the ANA’s Requirements of Follow, usually, and
nursing administration specifically.6
The nurse chief has the extra accountability to make sure that
efficient buildings and processes
are in place to help an moral
observe setting. The Ethics
Useful resource Middle, in its 2014 Nationwide Enterprise Ethics Survey, identifies three components that staff
use to guage their leaders’ character.7 All three components relate particularly to transparency. Workers
draw conclusions about their leaders’ character based mostly on (1) their private interactions, (2) how the leaders deal with crises, and (three) the
insurance policies and procedures that the
leaders undertake to information their organizations.
To be able to be totally clear,
the efficient nurse chief interacts
constantly and usually in a fashion that exposes the chief’s values
and resolution making for the critique
of his or her group members. In crises, staff discover whether or not leaders maintain themselves accountable or
shift blame to others, thus damaging their integrity. Workers assess
the extent to which leaders acknowledge and reward moral habits or
whether or not bending or violating guidelines
is preferentially rewarded and/or
acknowledged. By being clear,
staff are capable of adequately
and successfully decide these three
components.
four. Promote systematic
moral resolution making.
The American School of Healthcare Executives’ Coverage on Moral
Determination Making for Healthcare
Executives gives steering on
management resolution making in an
more and more advanced healthcare
setting.eight
Leaders are anticipated to ascertain a sound
decision- making framework so
that extremely advanced selections
aren’t made by a single particular person.
Moral resolution making contains
perception and perspective from these
affected by the choice; a full
depth and breadth of knowledge
to help the choice; and a course of that ensures beliefs, beliefs,
and rules are according to
group member and organizational
values.
Provision 5 of the ANA Code
of Ethics particularly addresses
www.nursingmanagement.com Nursing Administration  April 2015 53
Copyright © 2015 Wolters Kluwer Well being, Inc. All rights reserved.
Performance potential
character and integrity of nursing
observe, however with regard to the
preservation of integrity, nurse leaders have extra duties.
Nurse leaders are obligated to answer the moral and ethical issues of nurses and be sure that
these issues are resolved in a
method that preserves the integrity
of the employees members.
5. Promote accountability.
Don’t categorical efficiency expectations in a fashion that emphasizes
the outcomes on the expense of methods to
attain these outcomes. Expectations expressed too forcefully suggest permission to do no matter is critical to
accomplish the objective. Phrases such
as “I don’t care the way you get it
completed,” “get the outcomes irrespective of
what,” and “don’t come again subsequent
month with out the outcomes we’d like”
could create incentives for workers
to “sport the system,” withhold or
misrepresent data, or “fudge
the numbers.”
Accountability can also be established
by figuring out and addressing deviations from acceptable observe. Perceptions that leaders look the opposite
manner present the slippery slope for
additional transgressions. Zero tolerance for unethical habits sends a
constant message to leaders and
employees that even the seemingly least
important transgression is unacceptable when establishing a tradition
of excessive integrity.
The worth of integrity
Nurse leaders’ integrity is of the utmost concern in right now’s extremely unstable, aggressive, and high-stakes
setting. Nurses, usually,
and nurse leaders specifically are
confronted with tough selections each
day and, as recognized by the Gallup
survey, are sometimes held in excessive
regard by the general public. By understanding the non-public, skilled, and
organizational requirements that type
the premise of our integrity, we might be
higher ready to advertise excessive
ranges of integrity inside our
organizations. NM
REFERENCES
1.Riffkin R. Individuals charge nurses highest
on honesty, moral requirements. http://
www.gallup.com/ballot/180260/americans-ratenurses-highest-honesty-ethical-standards.aspx.
2. American Nurses Affiliation. Code of
Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses
Affiliation; 2015.
three. Tyreman S. Integrity: is it nonetheless related
to trendy healthcare? Nurs Philos.
2011;12(2):107-118.
four. Edmonson C. Ethical braveness and the nurse
chief. http://www.nursingworld.org/
MainMenuCategories/EthicsStandards/
Braveness-and-Misery/Ethical-Braveness-forNurse-Leaders.html.
5. Nelson WA, Gardent PB. Organizational values statements. Healthcare executives want
to steer the group’s tradition in reviewing and implementing values statements.
Healthc Exec. 2011;26(2):56, 58-59.
6. American Nurses Affiliation. Nursing:
Scope and Requirements of Follow. Silver
Spring, MD: American Nurses Affiliation;
2010.
7. Ethics Useful resource Middle. Moral management: a analysis report from the Nationwide
Enterprise Ethics Survey. http://www.ethics.
org/nbes/wp-content/uploads/2014/12/
ExecSummaryLeadership.pdf.
eight. American School of Healthcare Executives.
Moral resolution making for healthcare
executives. http://www.ache.org/coverage/
resolution.cfm.
RESOURCES
American Affiliation of Essential-Care Nurses.
The four As to rise above ethical misery. http://
www.aacn.org/WD/Follow/Docs/4As_to_
Rise_Above_Moral_Distress.pdf.
American Nurses Affiliation. Moral points.
http://www.nursingworld.org/MainMenuCategories/
EthicsStandards/Assets.
Ethics Useful resource Middle. http://www.ethics.org/.
Nationwide Middle for Ethics in Healthcare.
Built-in ethics. http://www.ethics.va.gov/
integratedethics/.
Richard A. Ridge is the director of Nursing
Innovation and Outcomes at Texas Youngsters’s
Hospital in Houston, Tex.
The creator has disclosed that he has no
monetary relationships associated to this text.
DOI-10.1097/01.NUMA.0000462381.26593.91
54 April 2015  Nursing Administration www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Well being, Inc. All rights reserved.

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