Senior nurse leaders' perspectives on integrity,dishonesty and ethical boundaries

Abstract

Background

Integrity is a foundational value in nursing, essential for ethical practice, professional accountability, and maintaining patient trust. Growing evidence of dishonest behaviors in academic and clinical settings highlights the complexity of practice, where boundaries between honesty and dishonesty are not always clear-cut. Despite this, limited research has explored how senior nursing leaders conceptualize integrity and dishonesty across the academic-clinical continuum.

Aim

This study aimed to explore senior nursing leaders’ perceptions of integrity and dishonesty, the underlying factors contributing to unethical behaviors, and potential strategies for addressing these challenges in educational and clinical contexts.

Design

A qualitative study was conducted. Data was collected through semi-structured, in-depth interviews and analyzed using thematic analysis to identify patterns and themes.

Participants

The study included ten senior nursing leaders from academia, hospitals, and the Ministry of Health. All participants held managerial roles and had experience in nursing education or training, allowing for perspectives across the educational-clinical continuum.

Ethical considerations

Ethical approval was obtained from the institutional review board. Informed consent was secured from all participants, and principles of confidentiality, anonymity, and voluntary participation were strictly maintained.

Findings

Three themes emerged: (1) integrity and dishonesty were perceived as existing along a continuum rather than as dichotomous constructs, with patient safety serving as a key moral boundary; (2) dishonest behaviors were shaped by a combination of individual, cultural, and systemic factors, including organizational pressures and inconsistent enforcement; and (3) leadership practices, particularly education, role modeling, and case-by-case management, were viewed as central to promoting integrity.

Conclusions

Integrity in nursing is not solely an individual attribute but is co-constructed within organizational and educational systems. Promoting ethical practice therefore requires integrated approaches that combine education, supportive organizational cultures, and clear policies, while acknowledging the complexity and ambiguity inherent in real-world clinical practice.