Coffee Before Clinicals

Trust, Technology, and Truth: Navigating Academic Integrity in Nursing Education

• Jennifer Rossetti • Season 1 • Episode 3

Share episode

🎙️ Got questions or a topic you're dying to hear? Text us and let’s make it happen—we’re all ears and ready to roll!

Nursing has been the most trusted profession for 23 years running, but academic dishonesty threatens both education integrity and patient safety. Dr. Suzanne McWilliams, Director of Nursing at Northern Arizona University, unpacks why integrity matters in nursing and how AI is changing the landscape.

• Academic integrity directly connects to patient safety and professional conduct
• The real consequences of taking shortcuts include medication errors and missed treatments
• AI tools have dramatically changed how students cheat, potentially contributing to falling NCLEX rates
• Faculty must balance enforcing academic honesty with showing compassion and understanding
• AI can be valuable when used ethically - for brainstorming, not replacing original thought
• Building trust requires leadership modeling integrity and transparent communication
• Nursing education must be rigorous but compassionate, recognizing students are human
• Simulation provides safe spaces for students to make mistakes without academic consequences

Remember that trust is earned one decision at a time, and the habits you build now are laying the foundation for the kind of nurse you'll become.


Music by Smallrose Productions

Dr. Suzanne McWilliams, DNP, RN:

I hope that you know, when our students leave, that they have a voice too, so that if things need to change, that they feel empowered to be able to do that.

Jennifer Rossetti, MSN, RN:

Welcome to Coffee Before Clinicals, the podcast where we serve up real talk, strong support and just enough caffeine to get you through nursing school. I'm your host, jennifer, and today we're diving into topics that have been on a lot of people's minds lately Academic integrity. Let's be real. Nursing school is tough. Between exams, clinicals and trying to have a life, the pressure can feel like a full-body compression wrap and with tools like AI popping up everywhere, the line between resourceful and risky can get blurry fast. And this episode isn't about shaming or calling out anyone. It's about unpacking what integrity really means in nursing education and why it matters so much once you're out there making critical decisions for real patients. To help us explore this, we're joined by Dr Suzanne McWilliams, the Director of Nursing at Northern Arizona University.

Jennifer Rossetti, MSN, RN:

Dr Suzanne McWilliams, the Director of Nursing at Northern Arizona University. She brings a thoughtful, real-world perspective from both the classroom and the clinical floor. Whether we're just starting your program or deep into your final semester, this conversation is here to support you, not scare you. All right. Today I am joined with Dr Suzanne McWilliams, the Director of Nursing at Northern Arizona University. She has spent years not just educating nurses but helping shape who they are as clinicians and people, and what we want to talk about today is integrity in the nursing program. So hi, dr McWilliams, hello. So we are very excited to have you here and I just kind of want to ask some questions on your take of what's going on in nursing, and I know there's been an increase with AI abilities and things like that. So we want to talk about why it's so important to have integrity in nursing. So how would you define nursing integrity in your own words?

Dr. Suzanne McWilliams, DNP, RN:

So I think about the fact that for the last 23 years, nursing has been listed as the most trusted profession, which means that nurses come to the profession with a sense of honesty, doing the next right thing, even in moments where maybe they feel pressured or stressed not to do it, take shortcuts. Being able to advocate for patients takes a lot of integrity because you have to speak up, so it's an extremely important part of being a nurse. Yeah it really is.

Jennifer Rossetti, MSN, RN:

In your experience. What are some real-world consequences if we don't have integrity as nurses?

Dr. Suzanne McWilliams, DNP, RN:

Well, I think a lot about patient safety. One of the things that we know is that sometimes we take shortcuts because we're feeling very rushed and as a result you have six patients yes.

Dr. Suzanne McWilliams, DNP, RN:

And so maybe you skip a step in administering a medication or a treatment or following through with a physician's order, because you just feel overwhelmed, and that's when mistakes happen and that's when serious consequences can happen as well. Two things with that. One is being able to say no, I'm not going to take those shortcuts and stand up for yourself and your team to say hey, we can't be doing this because we're putting patients at risk. Or if you do take a shortcut and there's a problem being able to say hey, I did this and the results were this and that's scary.

Jennifer Rossetti, MSN, RN:

That can be very scary and that can be hard. If you're a new grad nurse and you have to talk about somebody who's like a seasoned nurse or something like that, that can be very intimidating and I think you just feel like you need to be able to do everything perfectly right all the time.

Dr. Suzanne McWilliams, DNP, RN:

So there's a lot of pressure there.

Jennifer Rossetti, MSN, RN:

Yeah, we see that a lot with our nursing students that they feel they have to be perfect and they don't. They don't have to be perfect, but we have to have that integrity piece. So, because we're in College of Nursing, how do you talk to a new nursing student about integrity? How would you approach the subject to them? Because they're just starting out and there's so much pressure that they have to have straight A's, they have to get 100% on that test. They can't miss a single question. So how do we relate that down to our nursing students?

Dr. Suzanne McWilliams, DNP, RN:

So one of my roles here is to do new student orientation and I spend a considerable amount of time talking about academic integrity and integrity as a nurse in the profession talking about academic integrity and integrity as a nurse in the profession and what they need to recognize as they're in the program. I think the great thing is is that we have the option for students to do simulation while they're here and also practice their skills so that they have a place that's safe, where they can make a mistake and be able to step back with their you know fellow students and faculty and say, hey, why didn't this work? What happened here? There's no grading in simulation, so the students really can have an opportunity to work through that process. So I think that's really important and then I think also just integrating the concept of integrity throughout the curriculum and reminding them that you know we're all human. Things can happen. I always tell them that life is going to continue to happen while they're here and the best thing they can do is learn how to communicate.

Jennifer Rossetti, MSN, RN:

So with simulation, that's great because you know it's not for grade, it's all zero, it's like pass-fail. But now let's get into something a little more heavy-hitting. You know like this is the exams. So we have these pressures that you know benchmarks. You have to get a certain percentage and each university has their own percentages, but you guys have a certain percentage that you have to get exam average. So let's talk about some types of, let's talk about academic dishonesty, and that's like a big concept right now.

Dr. Suzanne McWilliams, DNP, RN:

Yeah, and we've seen an increase in it, especially with AI. You know, back in the day, I mean, cheating hasn't been around forever and you know students used to do things like you know, wear baseball caps with things written on the brim. Or you know students used to do things like you know, wear baseball caps with things written on the brim. Or you know students have even written things on their legs and then, you know, been able to hike up their shorts or their skirts to be able to read the answers.

Dr. Suzanne McWilliams, DNP, RN:

Oh, my goodness, your test. But now with AI tools, students can log into an AI program that will actually take the test for them. That's become quite concerning and we've seen a real increase in that. I also think it might be one of the reasons why nationally we've seen NCLEX rates fall for the first time and we're looking at it to try and figure out what are the causes of it. But I do think students who are using these AI tools to you know shortcut and get you know passing grades on their exams when they go sit for their NCLEX exam. They can't do that.

Jennifer Rossetti, MSN, RN:

Why do you feel that they I mean I know cheaters will cheat, but we do have an increase. Why do you feel the extra stress is happening? Why do you think this?

Dr. Suzanne McWilliams, DNP, RN:

Well, I think there's always a big pressure at least I see it in our students for them to get you know 4.0, to graduate with that perfect GPA. And it's funny because nobody really looks at their GPA. Once they graduate, you know, they look at the fact that they're licensed, they pass their NCLEX exam, so that's, you know. That's really what they need to be focusing in on is being able to gain that knowledge to pass that test. I think the other thing too is that you know we have a group of students that are coming out of an era of COVID. We know the pandemic has had a significant impact on our education system. We had a lot of students that were at home trying to learn on a computer. I think that really did a disservice to them, but at that time we didn't know and we did what we could do to keep people safe, so we kept everybody home and I think we have students that really struggle with being in an academic setting like this, and nursing is rigorous.

Jennifer Rossetti, MSN, RN:

It's not easy. Do you think we foster that type of student because we are so competitive to get into? Everyone has to have a 4.0 to get into nursing school. So we're fostering that creative nature in a student.

Dr. Suzanne McWilliams, DNP, RN:

Yeah, I think it's challenging here. I know we have over 1,000 students that come in as freshmen and declare nursing as their major. There's no way we can admit all of those students, even with all of our campuses. So we know that there's a big, there's a lot of competition to get in and so I do think that does kind of push them a little bit to have that perfect score, that perfect GPA. But I think, more importantly, I think as faculty and then nurses in the clinical setting where the students are engaging, you know you need to make sure that they're letting students know you don't have to be perfect. You need to have the knowledge. You need to be able to assess your patients, make some decisions, seek help when you need it. I think those are all really important skills that our students need to learn and I think if we can build those throughout the program when they graduate, then I think they'll make great nurses.

Jennifer Rossetti, MSN, RN:

So I know you've had some instances of cheating. We're not going to talk, because obviously you can't talk about individual of cheating. We're not going to talk because obviously you can't talk about individual. But how do you guide those students, once they've been caught cheating, on how to recover from this that? You know we all are human. We make mistakes. We've all done things that just cause nature that we have as nurses. How do you instill in them that you know you're going to get through this, we're still going to have, you're still going to be a good nurse?

Dr. Suzanne McWilliams, DNP, RN:

Yeah, I think, having the conversation with them about why it happened you know where, what were they thinking in that moment that they decided to take this you know chance to cheat on an exam and then outlining with them what are those next steps that they can take so that they don't have to feel that they need to cheat. I think sometimes students have a really hard time talking with their faculty about what's going on in their life or how they're struggling in a class, because they don't want to see that they're not doing it, they're not excelling in the program. So I think, letting them know that the more they can communicate with us about what's happening, the better we can support them.

Jennifer Rossetti, MSN, RN:

So we need to balance that fairness, because they cheated, so we got to be fair to those that didn't cheat. But then we also, as nurses, we need to be grace, have grace and compassion like we would with our patients.

Dr. Suzanne McWilliams, DNP, RN:

And sometimes it's, you know, counseling them, to say maybe this isn't the right time for you to be in the nursing program and maybe you need to take some time off and then come back. You know we have students from all walks of life that come here, and you know, especially with our population, our Native American population, these are students that have a lot of commitments with their family and their tribes, and so they are pulled in many different directions. So being able to support them is key to making them successful.

Jennifer Rossetti, MSN, RN:

So we know that we've had cheating, we know that they're using different technologies, but AI has been huge. Like I love AI, so it's been a huge factor, even in the last, I think, two semesters that I've seen it's gotten better and better and easier and more integrated and we're using it in medicine where it's helping with identifying. You know, in radiology it's helping to identify breast cancer. It's helped. There's a lot of benefits to it. It's helping to identify breast cancer. There's a lot of benefits to it. Ai is everywhere. What's your first reaction when students mention using AI tools like ChatGPT?

Dr. Suzanne McWilliams, DNP, RN:

I tell them that it's fine but it's not the tool that they're going to use to write their paper. It's a great resource for them if they're really feeling stuck, Like I don't know how to start this. You know that's a great place to say give me some ideas of where I can start my paper. Or you know, and I know, you're one of those faculty who've embraced it and you utilize a lot of tools within your program and your teaching and I think, getting students to see that it can be a really useful tool to help them understand topics that they may be struggling with. So I think there is a huge place for it. I know as a university, we are really looking at trying to address AI in academics and how do we, as faculty, utilize it and then how do we help empower students to use it properly.

Jennifer Rossetti, MSN, RN:

I know AI has helped both as a student and as a faculty for myself, in that you look at that white page and you're like writer's block and you're like, oh my gosh, what am I going to write? What is it? And I can ask it a question and be like, okay, here's my topic, me five points, and it triggers me. And then I can go in and and start researching those topics and find I think one of the things that we can do for our students is to guide them and say, you know, this is great to analyze, it's great to consolidate, but the original thought needs to come from you and then you can use it to help build on. So what are there? Some examples of clear ethical lines, that one you can tell students but you can also help guide your faculty who have not maybe embraced this fully. You know, just in nursing in general, what are those clear ethical?

Dr. Suzanne McWilliams, DNP, RN:

guidelines.

Dr. Suzanne McWilliams, DNP, RN:

Well, I think it's important that you know we share with the students what the expectation is for them in using AI.

Dr. Suzanne McWilliams, DNP, RN:

You know we've developed some modules for them to be able to use to understand how AI can be used in their course.

Dr. Suzanne McWilliams, DNP, RN:

But I think it's really important that, as we are evaluating a paper they may have written and recognizing right away that this is a very AI-generated paper, and addressing that with the student right away. There's a couple ways you do it. Certainly, there's all kinds of tools you can run a paper through that will identify whether or not it's AI-generated or not. But then I think having the conversation with a student and asking them to kind of explain what their paper is about so you can learn to understand if they know what the concept is that they're trying to talk about, and then if they're honest and say you know what, I used ChatGPT and they wrote my paper, then they can do it again. I mean, I think there's always an option for a student to repeat an assignment and, you know, do it again, because I think that gives them the opportunity to learn from that situation and then I think it also reinforces the fact that having integrity is going to be a key component.

Jennifer Rossetti, MSN, RN:

So it's the integrity, not cheating, not using, not saying here, write 500 words on this paragraph and then submit that paragraph without tweaking it at all, without putting your own thought into it. I mean, it's fine to help you maybe write an email, right, so you know I've done that, but not to turn it in as your own work. But you said that there's tools that can use. I mean Yale, harvard, all of those higher Ivy League institutions. They've run researches that AI detectors do not work.

Dr. Suzanne McWilliams, DNP, RN:

No, they don't. Which is why I think the next step is is if you run it through the program and it says it's 90% AI, well, maybe they use Grammarly. Yes, you know, they use Grammarly. Yes, you know which is a great tool. I mean, I used it when I was getting my doctorate. It helped me, you know, be more concise and rethink sentences, and certainly my grammar was not always 100%, but you know.

Dr. Suzanne McWilliams, DNP, RN:

so that's going to come up as being AI generated and that's when you have the conversation with the students. So explain to me your topic. You know, tell me about what it is that your topic was about. You know. So I understand that. You understand what you're talking about, Because if they used chat, GPT to write their paper, they're not going to be able to tell me what the concepts are about.

Jennifer Rossetti, MSN, RN:

Right, right. How has your faculty and whole embraced AI? How do you feel? You think there's room to grow.

Dr. Suzanne McWilliams, DNP, RN:

Yes, I think we have faculty that are still very reluctant to use AI or to have students use AI, because I think they see it as just cheating. I don't think that they quite understand how robust it can be as a tool. I mean, ai is here to stay. It's not going anywhere, so we need to figure out how to embrace it and how to use it. You know, I think it's a great tool for us as we're developing curriculum. You know, because you can go out and find other universities that might be teaching us.

Dr. Suzanne McWilliams, DNP, RN:

You know a course and say you know, find me four. You know academics that are doing this and they'll give you a nice breakdown of you know how they're teaching the topic, which is amazing because we can certainly learn from each other. So I do think there's great use of that, and I think the other piece to I do think there's great use of that and I think the other piece to it is is all the different tools that are being developed now to help students understand and learn a topic, because sometimes concepts just don't come easily. I know a lot of our students really struggle when they take B2B. You know, it's just, it's just so out there and there's so much to learn in that area, so being able to give them tools that they can use to better understand the topic. So I think we have some great opportunities in also letting them know it's going to be a part of their life.

Jennifer Rossetti, MSN, RN:

So by doing all this, I mean to promote creating trust, promote that supportive growth, empowering our students, empowering our faculty. If we do all this, then we're going to maybe divert away from cheating because we have that relationship. How can nursing faculty, how can you recommend to design assessments that support both integrity, ai use, discouraged cheating? What could be some examples of assessments?

Dr. Suzanne McWilliams, DNP, RN:

Well, I think one of the things that we know, even just within the entire university, is that we need to better understand AI and how it's going to be impacting us as faculty. So I think starting there and helping faculty understand what the implications are as far as curriculum development you know how I mean. If you look at you know, I guess a Grammarly is a great tool. Pretty much everyone has that integrated into their email accounts now. So as you're typing away your email, it's going to correct you or give you suggestions. So I mean, I think there's an opportunity for us to be able to use AI tools to help us. You know, kind of craft, how we're going to teach in the future.

Dr. Suzanne McWilliams, DNP, RN:

And I think the more we can educate our faculty on how AI is, you know, evolving and how it fits into our program, I think is going to be the first step, and then from there, is being able to help us develop those tools that they can use to work with students, to help them identify when students are really struggling and just using AI to complete their work. I mean, I think the other thing that's unique about nursing is that it's a lot of skills, it's a lot of hands-on, so you can't use AI for those kinds of things. So you know, if they're, we haven't developed that robot yet, so I do think there are ways for us to be able to see if a student is really being successful.

Jennifer Rossetti, MSN, RN:

So, getting back to integrity and trust and how we are. The most trusted profession, I think COVID. I think EMTs were the only ones that beat us out one year in COVID, but then we were immediately right back on top. You had mentioned that you have a very diverse population of nursing students. Here we have the Native American population we have from all walks of life. How do we build a culture of trust in this program to meet some of the things that we've already talked about?

Dr. Suzanne McWilliams, DNP, RN:

Well, I think that, of course, one of the biggest things is always if leadership steps up. You know, of course, one of the biggest things is always if leadership, you know, steps up. You know, I think that's going to be key. We need to lead with integrity and I think a lot of that comes with, you know, and I said it before is communication is probably one of those important things that we need to be doing. You know, we're in the process of change.

Dr. Suzanne McWilliams, DNP, RN:

I think the College of Nursing here has experienced a lot of that in the last few years and, you know, I think being open and transparent is going to be extremely important for us as we move forward. And I think, like I said, as leadership, we need to lead that piece of it. And then the expectation is that as faculty, you know, we are also going to be the ones that you know, lead the way to show our students the importance of integrity by, you know, showing up, advocating for our students, you know, making sure that the curriculum that we're teaching is going to, you know, allow them to graduate and become a professional nurse.

Jennifer Rossetti, MSN, RN:

It's a balance of you don't want to make. I mean, we need it to be rigorous, they need to pass the NCLEX, but we need to have some of that compassion and the teaching and creating our courses so that they're not like so hard that nobody's going to pass. I remember taking a biochemistry class at seven in the morning and it was just, oh my gosh, we were never going to pass it. We can't have courses like that. That's not who.

Dr. Suzanne McWilliams, DNP, RN:

We are Right and I think you know it's been challenging because healthcare continues to change all the time. You know, I myself have not been at the bedside now for quite some time, since I started here at the College of Nursing and we were having a conversation about, you know, some of the things that are going on in the hospital systems and I had to step back and think, boy, if I went back to the bedside I'd have to go through a residency program right now.

Jennifer Rossetti, MSN, RN:

I think I would too. It's been, I think, two years three years for me, since I've been bedside, so a lot has changed.

Dr. Suzanne McWilliams, DNP, RN:

And I think that's also kind of key too, you know, being able to say you know what? That's not my area of expertise. I can't really talk to that concept because that's not what I know. And I think that's really important too, because, you know, sometimes and I would say for most of us in nursing faculty, we come from the bedside, we come from the clinic. We're not academics, we didn't go to school to be academics, so for us to come into this, that in itself is a learning curve. Now, how do I become an educator? And so I think that's another place too is to be able to step back and say to yourself you know well, you know there's areas where I need to learn more about how do I educate my students, and especially now, because the generation is much different than when you and I probably went to school- I think even building that, the foundation now in our students, because we are all educators.

Jennifer Rossetti, MSN, RN:

when we go to the bedside, we are educating patients, we're educating family, we're educating. So we need to make sure we're instilling all that and then someday they'll take our place and be our faculty. So what's something you wish every nursing student would remember when they feel like they're getting? Ah, that little, that little person on your shoulder is saying I want to cut, go ahead, it's just easy, just do it, just do it. What is something you want to instill in the students of tomorrow or today?

Dr. Suzanne McWilliams, DNP, RN:

Well, one of the things I tell them in orientation is that if you feel that you need to cheat on a test, what does that mean? When you're standing at the bedside with a patient, you know what would you consider not doing or doing because you feel compelled to get your work done. You know where are you going to take those shortcuts. I think that is important for them to understand that these people who they take care of are in their most vulnerable states, and so they're expecting us to do the right thing. And so if you're willing to cheat on an exam, what does that mean for you when you're at the bedside, right?

Jennifer Rossetti, MSN, RN:

It all comes down to patient safety. It all comes back to that, All right. Last thing what kind of nurse do you hope your students become, not just skill-wise but character-wise?

Dr. Suzanne McWilliams, DNP, RN:

You know I hope they all leave here feeling that they have the ability to be compassionate, you know, not just for their patients, but for themselves and for their team. I think that's extremely important. I always tell students that this is a team sport. There is no I in nursing, except for there is. But you know we can't do this on our own. We really need to be able to, you know, work as a team. You know I hope they take care of themselves. You know I hope that you know, when our students leave that they have a voice too, so that if things need to change, that they feel empowered to be able to do that. And then I always tell them that. You know nursing is such a huge profession.

Jennifer Rossetti, MSN, RN:

So if you find yourself feeling burnt out or questioning why you're doing this job there's many different ways you can be a nurse- I think the statistics of those that have just graduated to drop out of nursing within one or two years is significantly higher, and I think COVID has had a lot to play on that because of the ratios and just the grind of it. Now, you know, I like how you said that you know there's so much for them to do. I know for myself I've done several different occupations in nursing and I even did step away for a year after COVID to kind of recollect myself and make sure I'm okay first. So all right, well, I appreciate your time, dr McWilliams, and you know nurses are so important and we want to make sure that they feel empowered, so I appreciate your time.

Dr. Suzanne McWilliams, DNP, RN:

on meeting with me. Thank you for having me. I appreciate it.

Jennifer Rossetti, MSN, RN:

All right, here's one last step before you go. Integrity isn't just about avoiding shortcuts. It's about building a reputation you can stand on as a future nurse. Your word, your charting, your choices they all matter and the habits you're building now. They're laying the foundation for the kind of nurse you become. Trust is earned, one decision at a time. Thanks for tuning in to this episode of Coffee Before Clinicals. If today's conversation gave you something to think about, or if you just felt seen, do us a favor, share it with a classmate and don't forget to follow us on Spotify and Apple Podcasts so you never miss an episode. Until next time, take care of yourself and keep showing up with heart.

People on this episode

Head Shot

Jennifer Rossetti

Host
Contributor

Dr. Suzanne McWilliams, DNP, RN

Guest