This presentation will provide an overview of academic and professional integrity violations that may be seen in nurse anesthesiology students. It includes strategies that a school may employ to deter student misconduct, an overview of the disciplinary sanctions for integrity violations. It will conclude with a discussion of select case studies. At completion of the presentation, the learner will be able to define academic and professional integrity, especially as they relate to nurse anesthesiology students. Identify common violations of academic integrity. Discuss the student behaviors that constitute violations of professional integrity. Develop a plan for incorporating integrity expectations into the curriculum and the culture of the program. Report faculty efforts in preventing and addressing violations of academic and professional integrity, and evaluate applicable sanctions for student violation of integrity policies. Morals refer to an individual's ability to distinguish between right and wrong. It is believed that core morals are formed in the first five years of life. Initially, a young child does the right thing because of a desire to avoid punishment, and later by a desire for rewards. As the child matures, their morals are guided by a desire to fit in and please others, followed by a duty to obey rules, laws, and social codes, and finally acceptance of the ethical principle of justice, which recognizes the equality and dignity of others. While morals are guidelines for individual behavior, ethics are the moral principles that guide an individual's behavior as a member of a larger group. They provide a standard for choosing the right or wrong behavior when faced with conflicting choices. Personal ethics are an extension of an individual's moral behavior and are influenced by culture, religion, and personal experiences. It should be noted that not all individuals reach the final two stages of moral development and thus have a weak personal code of ethics. Professional ethics are ethical values and behaviors that are expected from professionals. Examples include the ANA code of ethics for nurses and the AANA code of ethics for CRNAs. The mission and values of nurse anesthesia programs align with both of these codes. The word integrity comes from the Latin integer meaning whole and complete. A common interpretation of integrity is honesty with a consistent adherence to strong moral and ethical principles. A person of integrity willingly and consistently acts in accordance with social standards and morals. They are self-aware, accountable, responsible, and truthful, and always do the right thing. More importantly, they always do the right thing even when no one is watching. Academic integrity is the fundamental basis for individual learning and achievement. Students must accept personal responsibility for their academic achievement and professional behaviors. Academic integrity includes honesty in one's research and scholarship, respect for the intellectual efforts of others, and appropriate utilization of program and university resources. Professional integrity based on the ANA and AANA ethical codes is expected in all interactions with patients, peers, faculty, and others. It includes honesty, respect, fairness, and good judgment in all interactions, a display of cultural sensitivity and nonjudgmental behavior towards others, and accepting responsibility for one's actions, no matter the consequences. Professional integrity is also expected of the school. Administrators, faculty, and staff must model the professional behaviors that are expected of the students. Faculty should be held accountable to the same integrity standards and must demonstrate compliance with published school policies. The school must ensure a fair, deliberative, impartial, equitable, and timely address or redress of student concerns or allegations. Cheating is the most obvious form of academic misconduct and involves unauthorized use of information, materials, devices, sources, or practices in completing academic assignments. Examples of cheating include a student having prior access to the exam materials, including old exams provided by another student, or obtaining exam questions from a student who took the exam early, using unauthorized material during an exam, including the use of approved devices with stored answers. Cheating from another student during the exam, or circumventing security protocols for online computer-based exams. Cheating also involves submitting another individual's work as one's own, or submitting the same paper in two courses without the prior approval of both instructors. Working collaboratively with another student when the assignment requires independent work is also a form of cheating. Plagiarism appears to be the most common form of academic misconduct, and many times is a result of poor understanding of the different types of plagiarism by the student. It includes submission of a paper prepared by somebody else, copying content from a reference source, both cited and unscited, with no or minimal changes in wording or syntax, and paraphrasing another's work without proper acknowledgement of the source. Even when the content is in the student's own words, ideas or information that are not common knowledge must be referenced. Academic misconduct goes beyond cheating and plagiarism. It also includes fabricating, distorting, omitting, or falsifying research data for a scholarly investigation, such as a DNP project. Research misconduct includes using data from another student's project without the consent of both the student and the instructor, representing the research conclusions of another as one's own, and sabotaging the research investigation of another individual. Alteration of academic transcripts, letters of permission, grade reports, attendance records, and other school documents is also considered academic misconduct, as is unauthorized use of school documents or email to misrepresent one's academic records, awards, or credentials. For student nurse anesthetists, academic misconduct extends to falsification of clinical experience records, patient charts, care plans, or clinical evaluations. Destruction or misuse of school's academic resources are also academic integrity violations. This includes the use of school equipment, such as computers, to destroy, damage, or steal the work of other students or scholars, and stealing, destroying, or deliberately damaging the resources to prevent others from using them. Student complicity in violations of academic integrity occurs more frequently than recognized by schools. A student is complicit when they fail to notify the instructor or the school of another student's academic dishonesty. When they provide exam or project information to another student, despite knowing that such aid constitutes cheating. Or they provide or sell original class materials to websites that sell academic materials. Posting exam questions on a class Facebook or website is also complicit academic misconduct. Students are expected to assume full responsibility for their personal, conduct, and professional behavior. Civility is the hallmark of professional integrity. It includes courtesy, politeness, respect, and consideration for others. Incivility or a lack of awareness or recognition of how one's actions affect others is a violation of professional integrity. It ranges from rude and disrespectful verbal and nonverbal behavior to physical threats to another's safety or well-being. Professional integrity violations are more common than academic integrity violations, but faculty find them more difficult to identify and to impose disciplinary sanctions. William Rehnquist, the former Chief Justice of the Supreme Court, said, I may not be able to define pornography, but I know it when I see it. Likewise, student violations of professional integrity are apparent when they display incivility to others. Examples of professional integrity violations that may be seen in student nurse anesthetists include the following. Unauthorized disclosure of confidential information regarding patients, peers, faculty, and others. HIPAA violations at clinical sites. Acts of commission or omission that are hazardous or potentially hazardous to patient safety. A lack of respect for the expertise and responsibility of clinical instructors, as demonstrated through a poor attitude towards clinical instruction and evaluation. Or insubordination, the failure or refusal to follow an instructor's directions or recommendations. Failure to comply with school policies and procedures. Failure to comply with the department policies and procedures of a clinical site. Use of class or clinical time for personal obligations. Use of profane or abusive language or a display of rude or discourteous behavior towards others. Verbal threats, acts of intimidation, display of physical violence towards others, and unauthorized absences from assigned clinical areas. Use of social media to disparage peers, faculty, school, or the clinical sites. Interruption of classroom learning, including frequent tardiness, talking, or use of cell phones during faculty lectures or student presentations. Or displaying an argumentative attitude towards learning activities or assignments. Also, nonverbal, disrespectful behavior such as eye rolling, groaning, and laughing is considered unprofessional misconduct. Nondisclosure of an intimate relationship with a clinical instructor or faculty member that provides a potential advantage for student assignment and assessment. Recording conversations without the express consent of the recorded individual. Demanding make-up or retake exams or extensions of assignment deadlines. According to Whitley and Keats-Spiegel, there are multiple factors that contribute to student academic misconduct. These include pressure by peers to divide assigned work even when the course syllabus prohibits it, or pressure to share or accept unauthorized exam content. Performance anxiety and fear of failure, especially in poorly performing students. Excuse making and self-justification, such as faculty expect too much on written assignments or they make the exams unnecessarily hard for students. This exam is only worth 5% of the course grade anyway. And I know other students are cheating, so I will too. Unaddressed academic violations in undergraduate education allow students to continue with academic misconduct they got away with before. Inability to manage the demands of graduate programs because of poor study habits or time management skills. Unfamiliarity with academic dishonesty, especially the many different forms of plagiarism. Poor understanding of the consequences of academic misconduct and the potential impact on their academic and professional careers. Overall, misconduct can be attributed to poor moral development and a lack of personal ethics, poor socialization, and a lack of professional integrity. As educators, we recognize that less than 10% of the students will take up more than 90% of our time. So it is important to note that the greater majority of students consistently display academic and professional integrity. Students avoid academic dishonesty because of their personal morals and ethics that cheating is wrong, a desire to earn their grades, a genuine interest in learning and scholarship, and respect for the course instructor. Good time management skills and study habits lessen the need to cheat. Fear of getting caught and the associated embarrassment as well as possible sanctions also serve to discourage cheating. Social or religious beliefs that cheating is wrong and brings shame to the individual and their family also serve as a deterrent to cheating. The core mission of an academic institution includes teaching, learning, and scholarship delivered in an environment that promotes academic and professional integrity. Schools of anesthesia are accountable to students, faculty, patients, supporting institutions, the nurse anesthesiology profession, and to society. They must promote academic and professional integrity throughout the entire academic community. The school must provide students and faculty with the necessary resources to prevent or address integrity violations and ensure equitable and fair treatment of students suspected of academic or professional misconduct. Student resources that discourage misconduct include policies that specifically address the expected student behavior and conduct as well as the ramifications for misconduct. The expected conduct and behavior should be communicated clearly during orientation to the program as well as throughout the program. Mandatory completion of an online integrity tutorial and quiz upon matriculation into the program. A separate plagiarism tutorial may also be required. Students may be asked to sign an integrity agreement or honor code pledging to keep themselves and their peers accountable for complying with the published integrity policies. This syllabi should include a written statement on the requirements of academic integrity and the students should be reminded at the beginning of each course of the expectations as well as the consequences of academic and professional misconduct in the classroom. Clinical practicum objectives as well as formative and summative evaluations need to include professional behavior and conduct. Students should be encouraged to include the ethical implications of clinical research in their seminar presentations. DNP projects should require ethics training for both the student and the DNP committee members as well as IRB approval or waiver. The student handbook should include policies on classroom and clinical etiquette. This syllabi should include a statement on faculty expectations regarding plagiarism, cheating, and unauthorized collaboration on assignments. Assigned student statement should be required on papers certifying that the paper is solely their work, that the content from other sources is referenced and cited, and that the paper or a component has not been submitted to meet the requirements of another course. If it has, the student should have the approval of both course instructors to submit the paper for a second time. Mandatory use of text-matching software, such as Turnitin, and the student handbook should also contain policies addressing the professional communication and confidentiality, especially as they relate to online courses, electronic communication, and social media. The school needs to provide resources for academic faculty that will support their ability to recognize and address integrity violations. Orientation to the school mission, policies and procedures, and culture is very important for new faculty and can be accomplished with a faculty handbook and inclusion of new faculty on established committees. Faculty workshops should be offered for faculty development, ideally offered annually. Students should focus on curriculum development and instructional methods for adult learners, methods of student assessment including secure proctoring of in-person or remote student assignments, and student confidentiality. Academic and professional integrity policies should be reviewed with an emphasis on empowering faculty to identify and address misconduct. Forms for mandatory reporting of student misconduct should be shared with faculty. Clinical instructors often feel isolated, both physically and professionally, from the academic community of the school, so the school needs to provide an orientation to its missions and policies and procedures for clinical instructors and coordinators. A clinical instructor handbook should include the policies and procedures that govern the clinical curriculum. Annual clinical instructor workshops should focus on practicum descriptions and learning outcomes, clinical instruction of adult learners, and summative and formative evaluation of adult learners. Guidelines for documentation of clinical deficiencies or areas needing improvement on evaluation forms should be provided, as well as recommendations for verbal discussion of performance with a student. Student confidentiality should also be addressed, as well as the need for mandatory reporting of student misconduct. Forms for reporting misconduct should be shared with the clinical instructors. As mentioned earlier, program integrity plays an important role in student compliance with integrity policies. Program administrators must model the academic and professional behaviors that are expected of the students and follow ethical guidelines, especially for unpopular but necessary actions. They need to communicate the expected academic and professional conduct, treat others with respect in a culturally sensitive manner and without prejudice, bias, or harassment, and maintain professional boundaries in all communications and actions with students and faculty. They should ensure regular student advisement, provide timely and honest communication of student performance, and maintain strict confidentiality of student records. For transparency, students should be represented on school committees and notified annually of program outcomes. Academic faculty have the following responsibilities to students. Provision of a course syllabus that includes a statement on academic integrity, their office hours and an expected time frame for a response to electronic communication from students. Free of assigned lectures and learning activities when scheduled. Faculty that are late for lectures are given unwritten approval for students to also be late. Fair and equitable student access to all educational resources, including texts and electronic sources. Display of a respectful, culturally sensitive, non-biased behavior towards others. Observation of professional boundaries in all interactions with students while encouraging the free exchange of knowledge and ideas. Non-biased student assessment that ensures equal treatment and expectation of students during exams, including no early exams or extended testing time, and grade penalties for sick calls on exam dates. The syllabus should include the grading rubric that will be used for paper assignments. And enforcement of academic and professional integrity policies. The following are expected of clinical faculty. Awareness of the knowledge, skill and attitude objectives for each clinical practicum so that student assessment is related to the specific practicum outcomes. Active involvement with student learning during clinical assignments, providing verbal feedback and recommendations, and encouraging free exchange of knowledge and ideas. Demonstration of professional integrity by treating students and other members of the surgical team with respect, acknowledging inability to answer some student questions and calling for assistance when patient care warrants it. Ensuring fair and equitable access to all clinical resources, especially limited specialty cases and unusual anesthesia techniques. Completion of formative and summative evaluations in a timely manner. Maintaining professional boundaries in all communications and interactions with students. And protecting the student's right to confidentiality. There are significant repercussions for failure to address integrity violations and apply appropriate sanctions for misconduct. Unaddressed academic integrity violations will result in an inaccurate evaluation of the student's mastery of the knowledge, skills and attitudes that are necessary for the practice of nurse anesthesiology. And the school may grant credentials to an undeserving student. Graduating a student with unaddressed academic deficiencies or unprofessional conduct may result in an inability of the graduate to pass the certification exam. It also has potential for incompetent practice that may result in patient injury and damage to the reputation of the school, faculty, graduates and the profession. Unaddressed academic cheating encourages others to cheat because of poor enforcement of policies or lack of sanctions. Studies have shown that students guilty of academic cheating will continue to cheat at work and in relationship with others, especially if they are not held accountable. Unaddressed academic cheating is unfair to others as it allows unfair comparison with them and damage to the school's reputation can negatively impact their professional reputation. Academic or professional integrity violations are detrimental to the mission of the school, the student's professional development, the academic community, the nurse anesthesiology profession and patients and society at large. Despite school policies and procedures intended to prevent integrity violations, academic cheating and unprofessional conduct still occur in anesthesia programs. Faculty have the authority and the responsibility for initial judgments regarding integrity violations in courses and clinical assignments. However, the actions taken by an instructor for integrity violations do not preclude the school from further action, including dismissal, especially for repeat violations. The disciplinary sanctions imposed by the school are dependent upon the seriousness of the violation and should be guided by the published integrity, probation and dismissal policies. The disciplinary sanctions for violation of integrity policies are dependent upon the type and the severity of the violation, and they include the following. A formal violation of academic or professional integrity is placed in the student's record. Grade reductions or a failing grade for a course assignment are indicated for cheating, plagiarism or other forms of academic misconduct. Disciplinary warnings can be applied for second violations of academic misconduct and they are frequently used for professional integrity violations. Removal or exclusion from school committees or leadership assignments and for consideration for future school or professional awards, including grants and scholarships. Probation is indicated for a serious or a repeat integrity violation. 30-day probations are common and may include a corrective action plan. Suspension is indicated for more serious integrity violations. It is more common for clinical misconduct. Allowable time off cannot be used for suspension and suspended time must be made up after the scheduled graduation date. Dismissal is the most severe sanction for integrity violations and is often preceded by a period of probation or suspension. The course faculty member is responsible for identifying student misconduct. Another student may alert the instructor to a violation of academic integrity or the faculty may physically observe the student cheating during an exam or recognize plagiarism in a submitted paper. Late arrivals to class, disruptive behavior during lectures and presentations, and demands for extension of assignment deadlines are considered professional integrity violations. The instructor should contact the school to determine whether the misconduct is a first violation. First violations can be resolved between the instructor and the student with the student receiving a reduced or grade of zero for the assignment or agreeing to change their classroom behavior. Written documentation of the misconduct and resolution must be submitted to the school and an academic or professional integrity violation is placed in the student file. If there are no additional integrity violations, the documentation can be destroyed upon the student's successful completion of the program. A second integrity violation cannot be resolved by faculty. Documentation and supporting evidence must be submitted to the school. An integrity violation including the school-imposed sanctions and signed by the program director and student is placed in the student's permanent file. Clinical misconduct can include academic integrity violations but more likely will involve professional integrity violations. After observing the misconduct, the clinical instructor should contact the clinical coordinator to determine whether the misconduct is a first violation. A first violation that did not result in patient injury is resolved between the instructor and the student and documented on the daily and summative clinical evaluations. A second violation is also documented on the daily evaluation record and the clinical coordinator submits written documentation of both violations to the school. A violation of professional integrity and applied sanctions signed by the program director and student is placed in the student's permanent record. Probation suspension and dismissal are indicated for serious, intentional or egregious integrity violations. These include behaviors that jeopardize patient safety or the patient-provider relationship or provide a threat to the health and safety of others. They can also be used for repeat integrity violations. Probation suspension and dismissal should be documented on the official academic transcript. If a student withdraws during a period of probation or suspension, a W grade and notation that the student withdrew with an unresolved academic or professional integrity violation is documented on the academic transcript. It must be noted that integrity violations are not disclosed to external entities without the written student consent or mandatory disclosure by law. Violations of integrity policies may be liable for criminal or civil prosecution, as in the case of patient injury or peer or faculty defamation. A standing school ethics or grievance committee will grant the student the right of appeal if sanctions are imposed against them. The policy and procedure for appealing a sanction should be clearly delineated in an appeal or grievance policy. When filing an appeal, the student can deny the violation or admit to the violation but appeal the sanctions. The school's sanctions are suspended during the appeal process and the committee can decide to uphold, overturn or modify the school's sanctions. The student can either appeal the committee decision to the next level as outlined in the grievance procedure, admit to the violation and accept the sanctions, or deny the violation and withdraw from the program. Again, the academic transcript should note that the student withdrew with an unresolved academic or professional integrity violation. When faced with student integrity violations, a school is presented with the following challenges. Students may unintentionally commit plagiarism out of ignorance, especially students who have limited experience with professional writing. Students fail to recognize the disciplinary and professional implications of integrity violations and they give coursory acknowledgment of integrity policies and honor codes. Students ignore integrity violations by peers out of friendship, sympathy for a struggling student, or a fear of retaliation. Faculty, especially clinical instructors, fail to enforce integrity standards because of additional paperwork, a desire not to be the bad guy, or a fear of being sued. Institutional grievance committees do not understand the clinical behaviors that are expected of a professional nurse and may overturn clinical sanctions. This is especially true of institutions that offer limited health care programs. Following case studies provide a sample of the integrity violations that I observed in my 29 years as a program director. I could have included dozens more, but hopefully these will suffice for providing a framework for addressing integrity violations in other programs. In Case Study 1, students were required to log their clinical cases daily on Typhon. In her junior year, a student had been counseled for recurring late case logging. In the first quarter of her senior year, she received a 30-day probationary warning with a corrective action plan for repeated late logs of cases. The advisor reviewed time management strategies with the student and randomly monitored her Typhon logs for the month. The student was compliant during the second quarter, but resumed late logging of cases again in the middle of the third quarter, at which time she received a 30-day probation, which required weekly meetings with her advisor. At the start of the fourth quarter, advisors verified that the upcoming graduates have or will meet all case requirements by graduation, and if necessary, will adjust their clinical site assignments. The advisor noted that the student had met all minimum case requirements, but had logged seven hearts and seven central lines for the third quarter at a clinical site that did not provide this experience. In a meeting with her advisor, the student insisted she must have accidentally logged the incorrect information for the cases. She admitted that she had done no cardiac cases. The student received a two-week suspension for an academic integrity violation, specifically falsification of clinical records on Typhon. A mandatory two-week make-up time would occur in September following scheduled graduation, and would include a cardiac rotation. To avoid any changes in logged cases, her access to Typhon was suspended. She was required to submit a list of all cases for her third quarter practicum by the end of the suspension period. And she was told that if additional falsification of cases was discovered, she would be dismissed from the program. The clinical coordinator contacted the school to confirm the need for the student to regain access to EPIC since she was no longer at that site. The school confirmed that case information was needed due to discrepancies in the student's Typhon records, but did not disclose the nature of the discrepancies or the suspension status of the student. The student appealed the suspension to the school grievance committee, and she was allowed to remain in clinical during the review of her appeal. The grievance committee upheld the school sanctions. She submitted the list of her cases for the third practicum, all seven heart cases were replaced with general surgery and orthopedic cases that did not require central lines. She completed the two-week suspension and was allowed to attend the graduation ceremony. She met her cardiac and central line requirements during her additional two-week clinical assignment. The probationary warning, probation, academic integrity violation and suspension were placed in her permanent record. The transcript noted clinical probation in the third quarter and clinical suspension in the fourth quarter. Case study number two. A clinical instructor called the program director after discovering that a student had posted negative comments about her on Facebook. A student from another program told the CRA about the derogatory comments. The Facebook page was private, but the other student opened his page, which allowed the CRA to view the posts and to take screenshots which she forwarded to the school. She informed the school that she would no longer work with the student. The screenshots included 12 negative and derogatory statements about the CRA and about patient care at the clinical site. The student had been at the site for four weeks and had only worked seven days with the CRNA. And her daily evaluations of the students were consistent with others' evaluations. The advisor and program director met with the student. The student was furious that someone had let the CRNA see her comments and demanded to know who had provided access to her page. She did not deny the posts, but insisted that they were private and that she had the right to express her personal opinions. The communication policy, which included guidelines for student use of social media, was reviewed with the student. She was notified of the CRNA's refusal to work with her in the future, which could have a negative impact on the department and daily operating room schedule. The student who gave access to the Facebook page was not identified. The student received a violation of professional integrity for using social media to disparage as clinical instructor and a clinical site, and for demonstrating a lack of respect for clinical instruction and evaluation. She was required to move all of the posts regarding the instructor and site from her Facebook page, and was told that a repeat violation would become part of her permanent record. She was also reminded that her defamation posts were subject to libel and slander charges by the CRNA. The student was also immediately removed from her position as one of two class representatives. An email was sent to the other class representative notifying him of the need for the class to elect a new representative. No details were provided regarding the reason for the election. Case study number three. As in many anesthesia programs, the core didactic courses were divided into sections and taught by several different CRNAs and anesthesiologists. Chronic pain management was taught by an anesthesiologist from the home clinical site. After the pain exam was completed, the program director received an anonymous email from another student that claimed that one of the students was dating the anesthesiologist and had spent the night before the exam at his condo. According to the email, everyone in the class knows about them and believe that she had seen the exam before today. The program questioned the need for an anonymous email and responded to the email assuring complete confidentiality if the student would speak directly with her. The student refused stating a fear of retaliation and recommended the director speak with the student in question. The program director graded the exams that evening and noted that the suspected student had received the highest grade, a grade that was higher than normal for her. The student was contacted by phone and asked if she was involved in a relationship with the attending. She was informed that it was not the relationship per se that was the concern, but the appearance of an undue advantage that it may offer the student. The student repeatedly denied any relationship during the call and was angry that a peer suspected her of cheating on the exam. The program director requested a meeting with her at 9 a.m. the following day. Following her arrival in the office next morning, the program director received a call from the anesthesiologist who was very angry and demanded to know who had made the accusation. He repeatedly denied a relationship, but also said it was nobody's business. The program director agreed that personal relationships are private, but in this case, an undisclosed relationship had raised concerns of an unfair advantage and cheating on an exam. Shortly after the call, the program director met with a student who admitted she was in an intimate relationship with the anesthesiologist and had spent the night before the exam at his place, but she denied having access to the exam. The program director decided to discard the exam because of security concerns and wrote a new exam based on the lecture handouts and required readings for the following week. All scores were similar to the scores on the original exam, except for the student in question whose score was now mid-range. No integrity violations was issued to the student because of a lack of direct evidence of cheating. Minutes from the meeting with the student were placed in her file until graduation. Now, even in a consensual relationship, the unequal distribution of power has potential for favoritism, coercion, exploitation, and retaliation against the student. The school developed a new policy that required the student to notify the school of a relationship with any institution. The school could take steps to ensure that the instructor was not involved in the instruction, supervision, evaluation, or advisement of the student. The anesthesiologist was removed from all future lecture assignments because of integrity concerns on his part. The program director received several emails from the class thanking her for addressing the issue so promptly. One student mentioned that an upper class student One student mentioned that an upper classmate had encouraged them to not say anything because the school probably knows and won't do anything. When requested, the student submitted a letter to the school acknowledging a personal relationship with the anesthesiologist. One other student submitted a letter three months later. Since several CRAs were also aware of their relationship but never spoke up, the topic was included in the next clinical instructor workshop. A junior student had been counseled by a course instructor for plagiarism, specifically a failure to cite the source of paraphrased content. After confirmation by the school that this was a first violation, it was resolved between the instructor and the student. The student submitted a revised paper for a mandatory grade reduction. The instructor forwarded the documentation to the school and a violation of academic integrity was placed in the student file until graduation. The following quarter in applied pathophysiology, students were assigned individual papers on cardiac disorders. The core syllabus was clear on the requirement for independent work and papers required a statement certifying that the paper was solely their work. At that time, turn it in was not required by the school. The student submitted a paper in which the writing style appeared to be different from his other papers. Since all course exams and papers were retained by the school until graduation, the instructor was able to review the papers from the prior year. Except for minor changes in the first and last paragraphs, the student had submitted the exact same paper as a student in the senior class. Since this was a second academic integrity violation, the two papers were forwarded to the school. In a meeting with the program director and his advisor, the student initially denied having access to the other paper, even when presented with both papers for a side-by-side comparison. He finally admitted to copying the paper but said he only did it because his peers had also used papers from the prior year. He received a grade of zero for the assignment which lowered his course grade to a B- and he was required to retake the online tutorial and quiz on academic integrity. He received a second violation of academic integrity. Both violations were placed in his permanent file. The instructor was asked to review all papers from the current and prior classes. There was no evidence of cheating noted in any other paper. In a meeting with the program director, the senior student denied sharing the paper. When presented with a side-by-side comparison, he insisted that the junior student must have got it from somebody else. He was counseled on the academic integrity policy that prohibits a student from providing exam or project information to another student. He was also required to retake the online tutorial and quiz on academic integrity. A violation of academic integrity for complicity in cheating was placed in his file and was not reviewed until graduation. And case study number five. During a pediatric rotation at an affiliate clinical site, a student posted several pictures of an unusual surgical procedure on Facebook. The post included the date, patient's age and gender, and the name of the clinical site. The site was not private and several CRNAs went through the post and notified the department chair and the school. The clinical site terminated the student's rotation and reported the HIPAA violation to their office for HIPAA compliance, which in turn notified the patient's family and the state licensing board of the HIPAA violation. Now the school professional integrity, communication and social media policies required full compliance with HIPAA as do the ANA and the AANA code of ethics. The student had received a prior violation of professional integrity for unauthorized disclosure of confidential information regarding a classmate that he was privy to as a member of the Problem Resolutions Committee. He received a second professional integrity violation and was dismissed from the program for the HIPAA violation. He filed an appeal with the Grievance Committee, which upheld his dismissal, which was documented on his academic transcript. The school had no follow-up regarding his status with the State Board of Nursing. Adult students admitted to anesthesia programs come with their own morals and personal ethical values. While not expected to teach ethics, schools are expected to establish and enforce academic and professional integrity standards and to apply disciplinary sanctions for integrity violations. In closing, I make the following recommendations for the prevention, identification and address of student integrity violations. Publication of a student handbook that includes policies addressing student admission, progression, retention and separation from the program, including academic and professional integrity policies that clearly outline the consequences for academic or professional misconduct. An honor or integrity code that is signed by students. Mandatory completion of an online integrity tutorial and quiz during the first week of enrollment. Mandatory student attendance at a writing workshop early in the program that covers the different forms of plagiarism. And encourages use of the university writing center for assistance with course papers. Instructors should require the mandatory use of text matching software such as Turnitin for all submitted papers. And students should have a signed statement on their paper certifying that the submission is 100% their own work. Live proctoring of in-person exams with restricted use of electronic devices and remote live or software proctoring for online exams. No early exams allowed to prevent sharing of exam content and scrambled questions and answers on late exams for students excused for vacation. A grade reduction is applied to students who call in sick on exam days. Exams and papers are stored in the school office and not returned to the student, although they are available for review by the individual students. Collaborative and collaborative exam preparation Collaborative institutional training initiative should be required for students and DNP committee chairs. An IRB approval or waiver should be required for all DNP projects. Online forms for faculty reports of misconduct will reduce the paperwork and allow timely reports of misconduct. Integrity expectations are reflected in all aspects of the program and faculty model the desired professional behaviors. Enforcement of integrity policies and applicable sanctions for violations is vital for maintaining an ethical academic community that is accountable to students, faculty, patients, the nurse anesthesiology profession and society in general. Thank you for your attention. Please contact me if you have any questions regarding this presentation. Thank you.

integrity violations

nurse anesthesiology

academic integrity

professional integrity

ethical principles

cheating

plagiarism

academic dishonesty