There is a French saying “qui vole un oeuf, vole un boeuf,” which translates, “if one can steal an egg, one can steal a cow.” This phrase came to mind as I read recent news coverage about 11 nursing school students caught cheating during their comprehensive nursing school exam at the Prairie View A&M University School of Nursing in Texas. Ethics is one of the cornerstones of our profession, and a cheating scandal like this should concern all nurses, healthcare professionals, patients, and their families.

An article in the Houston Chronicle reported how a group of final year nursing students sat for a comprehensive nursing exam, their last step towards graduation. The students were permitted breaks throughout the four to five-hour exam. During the test taking, several nursing students reported to the monitors that they observed others texting on their cell phones during the exam.

11 students were identified as participants in this cheating scheme, which included texting others who had completed the exam. They were called before the student court for their punishment. They were prohibited from graduating but would be allowed to return the following school year. After completing an ethics course, they could re-take the comprehensive exam. So far, 10 of the 11 have announced their intentions to return to school.

Was it ‘Just Cheating on a Test’?

Does the punishment fit the crime? I think not. You may wonder why I take it so seriously—some say it was, after all, “just cheating on a test.” It’s not like they altered medical records, forged prescriptions, or failed to follow procedures that led to a negative outcome for a patient. So why don’t I think an ethics course should suffice?

Consider the following. In this class at A&M, there were approximately 56 nursing students, all in their final year of their Bachelor of Science in Nursing (BSN) studies. If 11 were caught cheating, that means approximately 20 percent of the class was involved.

Since BSN nursing programs typically take four to six years to complete, one can conclude that most, if not all, the students involved in this cheating scandal were not newbies. Indeed, these were seasoned students who, in addition to their academic studies, were involved in the clinical aspects of the program. If they felt that cheating on the final exam was acceptable, did they also treat their clinical and patient care in the same cavalier manner?

A blogger recently posted in response to the A&M scandal that cheating was so commonplace now that she was not surprised to learn about the nursing students. However, a majority of other bloggers, many of them RNs, were not so forgiving. Many expressed concern at what appeared to be a rather light punishment for what many, myself included, viewed as a serious breach of integrity and ethics.

There have been calls for sanctions against the A&M School of Nursing. In addition, many called for the Texas Board of Nurse Examiners (BNE) to prohibit these students from sitting for the NCLEX-RN altogether, or to place some type of prohibition on their license for an indeterminate number of years, or to issue a list of the offenders to all the other 49 State Boards of Nursing.

Philippine Nursing Board Scandal

Some of you may remember a past column “A Breach of Integrity,” where I discussed a 2006 scandal involving the sale of test answers in the Philippines. In this incident, an unknown number of graduate nursing students accessed the answers to the Philippine Board of Nursing exam. Nearly a year passed before the Philippine government ordered a mandatory re-test of the suspect class. They did so only after the Chief Nursing Officer (CNO) organization and several others applied pressure for a re-test.

The final straw seemed to be when the CNO organization issued a written recommendation that no person who sat for the suspect exam should be hired. After this edict, the Philippine government accepted the earlier concerns of various parties and held a re-test. (This article is archived on WorkingNurse.com.)

Why I Believe a Stronger Punishment is Needed

Unfortunately, it will take a lot of pressure before A&M steps up and does the right thing. Here are some reasons why I believe stronger punishment is needed.

• It was a well-coordinated cheating effort. This wasn’t the spontaneous act of a student sneaking a peak at the test of the student in the next seat. It involved the active participation of students cheating on the exam and those who already completed it and agreed to share the answers. I hardly think one course of ethics would help correct the lapse that occurred.

• Deterrent effect. We must also consider the impact on those who may contemplate cheating in the future. Will this punishment serve as enough of a deterrent? 11 A&M students cheated and an unknown number of Filipino nursing school graduates bought answers to their RN licensure exam. These examples illustrate that we must be vigilant.

• The effect on other nurses and patients. Can you imagine being an RN, wondering if the A&M graduate you are working alongside was one of the 11 caught cheating? Or worse still, one who had cheated but wasn’t caught? I recently saw another blog post suggesting that before booking a procedure, patients should be allowed to ask whether any of the RNs had attended Prairie View A&M School of Nursing as a way to choose their medical facility.

Excusing Poor Behavior

Nursing has displayed somewhat contradictory behavior, usually in the name of the nursing shortage. It isn’t uncommon to make excuses when nurses exhibit poor, unacceptable or even dangerous behavior. Often, such behaviors are brushed off due to the nurse being overworked or the hospitals understaffed.

Though these are often the realities of nursing, many RNs resist the urge to cut corners and most display the highest of work ethics. For this reason, a cavalier attitude toward the A&M cheating scheme should not be allowed to take root and flourish in either our nursing schools or workforce. Since RNs are entrusted with the health and lives of others, we should be held to the highest level of ethical standards.

As the story of the A&M 11 travels the country by word of mouth, printed word, and the internet, in all likelihood, it will take on a life of its own. This makes it imperative that both Prairie View A&M School of Nursing and the Texas BNE take decisive action. In my opinion, A&M’s actions seem to fall far short; especially in light of an additional Houston Chronicle article that reports that one of the students alleged that the nursing school faculty encouraged the cheating.

At this time, there are no additional reports as to whether or not the BNE or another accreditation body will take action against either the school or the 11 students. My mother’s favorite saying “qui vole un oeuf, vole un boeuf” seems to have played out in the case of Prairie View A&M School of Nursing cheating scandal, as it would appear that the cow was indeed stolen.

Geneviève M. Clavreul RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.

18 COMMENTS

• RJH

  Dr. Clavreul writes that "stronger punishment is needed"! The prisons are over burdened with people who were fully aware of the "stronger punishment", yet committed the crime anyway. Instead of making puerile statements such as "stronger punishment needed", the likes of which has been demonstrated time and time again, as being ineffectual, can we perhaps do a better job in screening our prospective students for such aberrant behaviors?

  Jul 21, 2008

• Shannon Perry

  A number of years ago, a study was published that showed a distinct correlation between cheating on tests in nursing school and "cheating" in work; that is, nursing students who cheated in school also cheated at work by recording vital signs they hadn't taken or recording medications given when they weren't, treatments recorded as given when not done, etc. (I don't remember all the examples of "cheating" in the work environment. given in the article.) It is of concern that these students will be allowed to become licensed to practice as nurses when the likelihood of their cheating at work exists. Scary! And half of all nurses (and physicians) graduated in the bottom half of their class!

  Jul 11, 2008

• Gina ED RN

  I agree with Donna. To "Seasoned": before a nurse can collaborate with integrity and intelligence, they need to be able to stand on their own two feet as a nurse. You need to be knowledgeable and trustworthy. Cheating is not collaborating, just as conspiring to commit an illegal act is not idle chit-chat. Having been a hospital based educator, I can also advise all nurses that BEHAVIOR cannot be taught, as though it was a missing course. These students are not short of information; they are limited in their understanding and application of right and wrong. In short, they are many years past the (childhood) developmental stage at which there was the opportunity to LEARN this behavior. I have witnessed lying and misleading behavior by nurses at work. They don't keep their jobs. I wonder whether they learn from their loss of employment, or if they just twist the truth in their own minds and move on. Unfortunately, our current shortage allows them to disappear into the ranks and create potential disasters elsewhere. In summary, the range of competence and integrity among nurses reflects upon the range of nursing and hospital compliance and patient outcomes. If we, as a profession and as a nation, accept only the highest levels of both integrity and competence, then we will achieve the highest levels of healthcare outcomes. Hold yourself and your peers to these high levels.

  Jun 30, 2008

• Donna Carlson

  The latest polls show that nurses are considered one of the "most trusted professions" by the public. Nurses are expected to be trustworthy and honest. While these students (in the article) were caught cheating, sadly there are many others who get through nursing school with the same dishonest tactics and enter the workforce. If you'll cheat in nursing school, you'll cheat in your profession. Sadly, both the patients and the nurses themselves pay the price. If this trend continues, we'll lose the trust of the public...a real detriment to our profession.

  Jun 30, 2008

• SeasonedNurse

  Having worked as a nurse for many years and feel this is my career, I find it interesting that an article on Nursing Ethics has reached these pages. I wonder what Ms Clavreul would call the use of printed answers from the sites that hospitals and other healthcare organizations have that provide refresher education information with test , that are used to complete the requirements to maintain proper accreditation. Every organization that I have worked in expects nurses to collaborate, to complete these test. "It build teamwork", everyone need to complete these every year, to demonstrate competency. Yet no question is raised regarding is it ethical for one or two nurses to share their completed test with the rest of the staff so that these competency test can be completed. I question this and wonder if we are providing an environment in which the young nurses think it is alright to cheat, after all isn't sharing test answers cheating, wheather the questions are in the same order or not.. Many students entering the nursing field are individuals that have spent time in healthcare systems as non nurses and are very aware of how nurse in those healthcare organizations maintain there pay scales, by sharing testing information. Schools and work envirnments have taught students that working together and collaboration is the best way to get ahead in this world, have the lines been blurred so badly that there is no clear understanding of what is Ethical and what is not, after all it is a matter of perspectives, so I have been told. I am glad Ms. Clavreul has written this article, but the questions isn't just with nursing school and school exams. We should be asking it everyday of ourselves when completeing compentency and using others answers because we don't want to spend the time reading and reviewing the information.

  Jun 29, 2008

• Susie Q Baby Boomer UM Nurse

  Perhaps since the cheaters can not return and graduate with their class, and must take the ethics class, they will actually learn from their ordeal and end up becoming better nurses after they graduate. All cases of alleged cheating must be thoroughly investigated and punished according to the rules of the college or university. But to say every cheater should be expelled from school and never allowed to sit for the nursing board exam is like saying every convicted killer should get the death penalty.

  Jun 28, 2008

• NurseMom

  Cheating should never be tolerated. Nursing is a profession -- we need to be able to rely on each other, and cheaters cannot be counted on. It goes directly to moral fiber -- if you would cheat to get a better grade, what will you do to cut corners on patient care and whom will you blame when you're caught? We shouldn't have to work with colleagues that we cannot trust, and I doubt that those who cheat in school will suddenly change their colors when they graduate. They'll only change what they're cheating about and who it will affect.

  Jun 24, 2008

• Jane Doe2

  Thank you very much for your comments Jane Doe and I completely agree! I too am a Prairie View College of Nursing student and am very proud of the school that I attend. Now, I do not claim to know every ascpect of the case or individual cases of those involved, I just want to offer a slightly different perspective than that given by the media. My personal understanding of the situation(s) was that the "evidence" presented was largely fellow student testimony and little of "hard evidence". Meaning that any student (including those who were suspected of cheating) could basically mention another student and say that he or she cheated. A sort of Salem Witch Trial, if you will, on a nursing school level. If this indeed was the case (it being largely one student's word against another) then I agree with the action/punishment dealt. Now, my feeling is that if the decisions as to who was cheating was based on concrete evidence (such as the text sent to an unsuspecting student who did not reply back) then yes, they should all be expelled and forever carry a scarlett letter "C". Either way, the punishment has to be the same across the board. If it can not be proven beyond a reasonable doubt, as in any other court, then you do the next best thing. Keep them from graduating, make them go through the humiliation of repeating an entire semester while being labeled part of "the cheating eleven", make them take an ethics class, and make them retake the exit exam. When it is all said and done, there is NCLEX. And if they managed to get through the whole nursing program by cheating, I doubt that they will be able to make it past that!!! As for the rest of us, we hold on to our integrity. We hold our heads high knowing that maybe even though, like TrumpetRN, we might have made it with the lowest score out of the bunch, we did it without the use of that dreadful "C" word...

  Jun 24, 2008

• Jane Doe

  TrumpetRN, I am glad that you put your story of what happened out there. PVAMU is not the first nursing school to have a cheating scandal/cheaters, nor will it be the last. The name of my school is Prairie View A&M College of Nursing...not Texas A&M...we maybe in the A&M system, but we are NOT Texas A&M. I am very proud of my school. Now while there are some parts of the article I agree with (such as the punishment), there are others I don't agree with. You cannot convince me that NO ONE ELSE cheats, or has not cheated on an exit exam. I am in no way condoning the cheating, but let's face it: many people cheat their way through school. For somebody to be able to turn down care from a provider just because they graduated from a school where a certain event took place is preposterous! How do you know the next nurse who comes along isn't a cheater who just didn't get caught? How do you know that nurse even has a license? Yes I know you all know that people go to extremes and will do anything and we all know that there are nurses out there who managed to get into practice without a license. The school did not cheat, STUDENTS did. They made the choice and got caught. Now while this is an unfortunate situation, let's not act like no other school cheats. The same way any other RN can look down her nose at a PV grad, a PV grad can do the same thing- just because her school wasn't in the newspaper, doesn't mean cheating did not take place. I know that I have worked hard to make it to my final semster, and i will be darned if anybody will look at me as a cheater just because of what happened at my school. And as far as faculty encouraging cheating? Yeah I highly doubt that...these are the same instructors who REFUSE to give students ONE POINT to pass. Personally I don't feel the punishment fit the crime, but I do not believe that the reputation of PVAMU CON should be tarnished because of the choices STUDENTS made...out of all the schools that have had scandals, have people stopped going there? Are jobs not accepting applicants from certain schools that were in the news? Possibly...and then again maybe not. Why? Because at the end of the day, it comes down to what the individual can do, not what school they came from. And if anybody gets a job as a nurse and they are a cheater, it will come out. There are nurses who lost their license and probably did not cheat at all! So what excuse do you come up with then? This is the world...people do crazy things. Learn from it, and move on!

  Jun 23, 2008

• Kristin Gillard

  I am very surprised that the student council at A and M allowed the nursing students to return to the college the following year. If a student is cheating on a test, the question must be raised as to whether the individual is intellectually lazy or does not understand the information they are being tested on. Either example is not acceptable when caring for patients. I would be very concerned to have a nurse caring for me or working along side me who lacks ethics. This person could falsify documentation, cut corners with medication administration, or contaminate a sterile field, etc. I am sure a medical school would not tolerate this behavior and neither should we.

  Jun 23, 2008

• El Toro RN

  Ethical questions aside, there are also questions about the knowledge base these students possess. If they don't have the knowledge to pass the test on their own, they don't have the knowledge to become nurses.

  Jun 23, 2008

• Laura Arnold

  If an employee were caught doing something illegal or cheating at my place of employment, they would be terminated immediately. I am glad, because I would feel uncomfortable working along side someone who could be so unethical. Why should nursing school be different? I would rather train a new employee who received a "C" on a final but really is trying hard to learn, and is willing to work hard, and is personable, and is able to work with doctors and patients, than someone who cheated to get there and probably will cheat on the job when things are going bad. "Cheat," as in not giving a med because it is late in the shift, or forgoing the second dressing change...or not calling for help and trying to cover up a mistake, instead of facing up to it.

  Jun 22, 2008

• greema

  I was disappointed but not surprised by the occurrence of this incident. I do not think that the punishment fits the seriousness of the crime. One has to question if a individual lacks the integrity to be honest during their comprehensive exams from school would they be honest in practice when a mistake is made. And lets face it we all make an error at some time or other. There was a similar incident during my final project from an MSN program. The student had used a previous students project without changing much if anything. The faculty members who read the paper recognized it as someone elses work, checked out their suspicions, and the student did not pass nor was she allowed to finish her degree from our school. I admire the faculty of my university for standing up for intergrity in our profession.

  Jun 22, 2008

• samantha ball

  the sad truth in the past 20 years is the increase of nurses that look at nursing as a way to earn an adequate living and not a "calling" or without true empathy with their fellow man. many will do anything--lie-cheat-falsify records-without batting an eye. the nurses at A&M should not be allowed to become nurses. Harsh yes, but when you consider these people will literally be making decisions that effect peoples very lives not harsh enough. mistakes made and not reported can cost life. don"t want these people caring for my family or myself.

  Jun 22, 2008

• Beatrice Folgarelli

  Cheating is usually not an isolated incident, nor a spur of the moment thought. It is a planned action. This would probably not be the first time these people cheated on an exam or in life. Usually a pattern is established early on and carried throughout a life time. I certainly would not want to see these people practicing, as lives are dependent on the appropriate care provided by an RN.

  Jun 21, 2008

• Lizzie

  If the faculty members are found complicit, they should be fired. The students should be banned from graduating from the school forever. If, after a year or two, or five, the BNE wishes to allow tthe students to sit for the exam, maybe. The punishment needs to speak loudly and clearly that cheating can't be tolerated in a profession such as nursing. But there should also be room, as in all human endeavors, for mercy. These are young people and if they are contrite, in time, justice demands they be given a second chance. Maybe not a full chance, such as being allowed to graduate, but still being allowed to become nurses at some point.

  Jun 19, 2008

• Tom Qualey, MSN,RN

  Dr. Clavreul's focus on upholding the integrity of nursing is something we all face every day. These 11 students have engaged in mass fraud through their organized cheating efforts and have significantly damaged every nurse's reputation and credibility. There is no reasonable way to determine what other dishonest deed these 11 are capable of or what harm patients would suffer at their hands. I see no basis for the Texas BNE to determine that these dishonest individuals would be safe to provide nursing care. Ifr Texas A&M wishes to graduate these people and tarnish their own school's reputation, I guess that is there business - but, I do not think the Texas BNE should allow them to take the licensure exam since they acted as a group to cheat their way through the program. On another note, I reade "TrumpetRN"'s note and felt a genuine sadness for what took place. People who cheat make us all feel uneasy. From my reading of the post, I got the impression that TrumpetRN was still beating him/herself up for this event. Please - use it as a learning experience, and release yourself form this guilt. The event is over and I am confident you would act differently if a similar situation presented itself. That is what they call 'experience' - and opportunity to do better based on not doing so well the first time out. Best wishes, Tom

  Jun 19, 2008

• TrumpetRN

  When I graduated from nursing school I lived through a similar incident, except that no one got caught in my class. The day of our final exam our senior year we tested in an auditorium stile classroom. Everyone was spread out nicely. During the test I noticed some of my classmates cheating on the exam. I felt nervous and ashame at the same time. I felt as if I was cheating too. I could not believe that they will risk getting caught. I also thought, what if they get caught and the whole class fails? Eventually I was able to calm down and finish my test. I turned it in and left. Everyone "passed" and we all graduated. However, on the day of graduation when I was being congratulated by the Assistant Director of the program she gently spoke in my ear and she said to me, "I was surprised that you got the lowest score on the final" I was faced with a huge moral and ethical dilemma at that moment. I though of telling her "well at least I didn't cheat." But instead I asked her if I had passed the final. She said "yes" To this day I wandered what would had happened if I had said anything to her that night, but at the time, although selfish, my actions where in the best interest of my self and my family. The only thing I cared about was to get ready for the NCLEX. Now I can only tell you the story, and live with the guilt of not speaking up when I had the opportunity.

  Jun 19, 2008