Plagiarism in the Graduate Nursing Program: Occupation Stress or Lack of Knowledge?

Impetus for Academic Dishonesty

A majority of the research related to academic dishonesty is focused on the undergraduate population. Balik, Sharon, Kelishek, and Tabak (2010) found that students regarded behaviors that were deemed dishonest as normative. Moreover, students’ desire to succeed in the demanding nursing programs and secure a career as a professional registered nurse was an impetus to engage in dishonest behaviors (Balik et al., 2010; Woith, Jenkins, & Kerber, 2012). Time constraints related to achieving the desired grade and completing assignment also influenced students to commit academic dishonesty (Park, Park, & Jang, 2013; Theart & Smit, 2012). Interestingly, upper division undergraduate nursing students and second degree students engaged less in and were less tolerant of academic dishonesty than traditional students (directly from high school). There is a paucity of research focused on graduate nursing students’ involvement in academic dishonesty, specifically plagiarism.

Graduate Students

The lack of research focused on graduate nurses is concerning. Graduate nurses are often practicing nurses, in a profession that requires veracity, among many other ethical characteristics (American Nurses Association [ANA], 2015). Nurses are the most trusted profession according to the 2020 Gallup poll—a standing that the public has bestowed upon nurses every year except one (2001 was an exception, after the September 11 terrorist attacks, when firefighters earned the highest score) since it was added in 1999 (Saad, 2020). Plagiarism is a real moral and ethical concern in nursing education. But is it fair to say students who make unethical decisions will continue to make unethical decisions as professional nurses?

There is an established correlation between dishonesty in the classroom and future dishonesty as registered nurses (Balik et al., 2010, Bultas, Schmuke, Davis, & Palmer, 2017, Carter, Hussey, & Forehand, 2019). But graduate nursing students are already registered nurses, most of whom practice nursing while continuing their education. After graduation, many will serve as the primary care providers for their patients in the role of a nurse practitioner (NP) or doctor of nursing practice (DNP). Other roles such as the clinical nurse specialist, nurse executive, and other master’s-level nursing degrees demand that nurses practice with integrity and attention to the moral and ethical rigors of the profession.

To further complicate the matter, many graduate-level nursing programs are designed to accommodate working adults, with classes being held in an online format. While innovative teaching and learning strategies improve graduate nursing students’ access to education, the online student has more opportunities to engage in academic dishonesty (Boykins & Gilmore, 2012). The ease of access to digital data and information brings the concerns of academic integrity to a new level. Furthermore, for international students for whom English is a second language and whose primary education occurred outside of the United States, plagiarism can occur unintentionally at a higher rate than those educated in the United States (Knowlton & Collins, 2017).

Interestingly, Greenwood, Walkem, Smith, Shearer, & Stirling (2014) conducted a mixed-methods survey to 1,000 postgraduate students. The findings indicated that graduate students understood the need to reference others’ work but lacked the skills to do it and did not attempt to use referencing resources when needed. In our program, graduate students are required to complete a plagiarism module (either self-paced or faculty-led, depending on the degree program). Like the students in Greenwood et al. (2014), it is reasonable to think our students have the requisite knowledge about plagiarism to know that copying text without citing is an act of academic dishonesty. Our university also has several writing resources for students that are listed in the syllabus, course announcements, and the university website. Those resources include a Writing Center, a reference librarian solely for the College of Nursing, a required APA manual, and the course instructor.

I am left wondering if to balance the extreme emotional and ethical responsibility that nurses are required to make on a daily basis in the wake of COVID-19, graduate nursing students have found an essential release of ethical decision-making and accountability in the academic setting. In other words, are the unrelenting demands of caring for others during an enduring pandemic leading graduate nurses to make poor academic decisions such as plagiarism?

Stress and Decision-Making

As it turns out, there is also a paucity of literature relating to occupational stress and academic dishonesty or plagiarism. However, evidence does exist that may help nurse educators understand why graduate students may resort to academic dishonesty during an especially stressful time such as a pandemic.

Neurobehavioral research on decision-making largely focuses on the ability of the individual to analyze the associated risks and benefits of the contemplated options (Starcke & Brand, 2012). Data suggest that when faced with stressors, individuals may not appropriately attend to the full range of risks and benefits of their decision (Wemm & Wulfer, 2017). The risk and benefit assessment involved in decision-making is dependent on higher level or executive brain functioning (Starcke & Brand, 2012) such as that in which the prefrontal cortex is responsible (Euston, Gruber, & McNaughton, 2013). Savic, Perski, and Osika (2018) found changes in the prefrontal cortex of individuals who experienced high levels of occupational stress. Additionally, the prefrontal cortexes of women were significantly more affected than those of men (Savic et al., 2018). This is important because in 2020, 87.4% of registered nurses were women (U.S. Bureau of Labor Statistics, 2021), making nurses a high-risk group for impairment in the prefrontal cortex. Impairment in the prefrontal cortex can be related to occupational burnout, including a lack of motivation, unprofessional behavior, and poor communication (Arnsten & Shanafelt, 2021). Therefore, occupational stress puts not only nurses at risk but also patients.

Practicing nurses are experiencing more stress than ever related to their occupation and the COVID-19 pandemic (Blanco-Donoso et al., 2021; Hossain & Clatty, 2021; Sperling, 2021). Graduate nursing students who also function as a registered nurse must find ways to balance the competing priorities of their regular day-to-day responsibilities, the extraordinary demands of working during a pandemic, and the completion of their degree. It is reasonable that due to their excessive stress during unprecedented times, graduate nursing students may not fully evaluate the risks and consequences of plagiarism. Coupled with the idea that they may not be aware of the advanced technologies like TurnItIn^© available to instructors to detect plagiarism, it seems plausible they may perceive that simply copying and pasting a few sentences here and there from various internet sources is “meaningless.”

Promoting Academic Integrity

Unlike other semesters when plagiarism surfaced within a student’s paper, I now find myself at a loss on how to proceed. I read the moral and ethical dilemmas these nurses faced, I felt their pain, and I cried their tears. Was it just and righteous to award them a failing grade in a graduate ethics course for plagiarism when they served our family and friends so fearlessly in a time of crisis? Was it fair not to fail them?

As I began searching the literature about this topic, I gleaned an important insight. If we take steps to prevent plagiarism, we will not need to be the referee with questions like “Was your plagiarism intentional, or did your nursing education somehow fail you?” Despite the integrity demanded by the nursing profession, nurse educators and institutions lack consistency in how they manage and penalize students for plagiarism (Carter et al., 2019; Kenny, 2007). This is absolutely true in our nursing program. When a student is suspected or accused of plagiarism, there is a general tendency to take matters into one’s own hands rather than reporting the incident and permanently staining the students’ academic record. Reporting academic dishonesty is crucial to ensuring that future incidents are not passed off as learning experiences but instead a recognizable pattern.

It is a common thought that graduate students will enter their programs with a foundational knowledge of plagiarism. Unfortunately, students have a variety of backgrounds and baseline knowledge (Carter et al., 2019). Requiring a basic review course on plagiarism is a key element to ensuring equity in learning. Nevertheless, some students will still commit plagiarism and, when confronted, recite the same mantra: “I didn’t know.” Brainstorming with a colleague, we considered having students sign an acknowledgment form that not only would serve as evidence that they received plagiarism training but would also serve as recognition of the resources available to them in the event they were uncertain of their abilities to uphold the requisite behaviors. The benefit of that approach is that when confronted with a student who committed plagiarism, there is less ambiguity about how to interpret the situation. The signed document acknowledges that they understood the plagiarism training and are aware of resources to help them write responsibly. The difficulty lies where to store those documents and how faculty should access them.

Another colleague suggested having students add an antiplagiarism declarative sentence to each assignment/paper they submit. One suggested statement was “I have neither given nor received nor have I tolerated others’ use of unauthorized aid” (J. Rogers, personal communication, May 10, 2021). Other universities use a separate antiplagiarism declaration paragraph that must be signed and attached—not dissimilar to the declarations of conflicting interests and funding nursing journals now ask of all authors. Techniques such as these may serve as frequent reminders for stressed students.

Another important consideration is that due to the occupational stress of being a nurse during a pandemic and also being a graduate student, our students may not make good decisions. They may knowingly choose to plagiarize as their brain struggles to appropriately evaluate the potential negative consequences of their actions. Providing students an outlet for mental health services is important. Researchers estimate the initial impact of the COVID-19 pandemic is a serious concern for our healthcare workers. Approximately 10% of healthcare workers self-reported symptoms of PTSD (Geng et al., 2021), a number likely underreported. As faculty, it may seem we do not have many options to help students who appear to have difficulty coping. Offering office hours, providing resources related to self-care and meditation, and having university-sponsored mental health services are easy ways to help improve student coping. Other ways to help include offering students a sense of control through flexible due dates or extensions, choice of assignments or topics, and peer social (Arnsten & Shanafelt, 2021).

We owe it to our students and our patients to graduate nurses who demonstrate ethical practices and uphold the integrity of the profession within the classroom and in practice. To achieve this, we must strive to instill the knowledge, skills, and attitudes of integrity and the Code of Ethics (ANA, 2015) into our students. Consistent and transparent guidelines are essential to make students aware of the implication of academic dishonesty, including plagiarism.