The New Face of Cheating: Protecting Academic Integrity in Nursing Education

In this episode of Nursing EDge Unscripted, host Dr. Kellie Bryant is joined by Dr. Kimberly Kelly-Cortez and Dr. Kelli Selvage of Chamberlain University to examine the changing landscape of cheating and academic integrity in nursing education. The conversation explores how artificial intelligence, social media, wearable technology, and the commercialization of cheating are creating new challenges for nurse educators while raising concerns about clinical judgment and patient safety. The guests discuss practical strategies for promoting academic integrity, including redesigning assessments, fostering authentic learning experiences, and helping students understand the ethical responsibilities of the nursing profession. They also emphasize the importance of creating a culture of integrity through clear expectations, faculty development, and institutional support rather than relying solely on punitive measures. Throughout the episode, the discussion highlights why protecting academic integrity is essential to preparing competent, trustworthy nurses who are ready to provide safe, high-quality patient care.

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, Bluesky, and YouTube. For more information, visit NLN.org.

Transcript

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[music] Welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host, Dr. Kellie Bryant, director of the Center for Innovation and Education Excellence at the National League for Nursing. Today we have a hot topic today. We're going to be discussing the changing face of cheating in nursing education and why protecting academic integrity is essential both for student development but also patient safety. So joining me today I have two wonderful guests. We have Dr. Kimberly Kelly-Cortez who is the vice president of the BSN online operations at Chamberlain University and Dr. Kelli Selvge, executive dean of the BSN online program at Chamberlain University. I want to welcome you both to our Nursing EDge Unscripted podcast. Thank you. Thank you for being here today. So we're going to dive right in because 20 minutes it doesn't do us justice on this topic. Like I said, this is something that comes up so often. And I think this will be like a part one of some webinars to come. So stay tuned. But first question, what trends are you seeing right now related to cheating and academic integrity in nursing education? Well, that's a big question. I think I'll jump off and then Kelli can always hand it off to you as well. But I think one of the trends that we're seeing is just an increase in academic authenticity issues. And I think the reason that we're seeing that and we're seeing kind of that trend grow is just the advancement of technology. Right? We have AI, we have social media, we have so many things that are really kind of moving students in a different direction and even almost like a normalization of cheating. And so we have some of these things that are kind of pushing that forward. And so I think students nowadays are just a little less familiar of what cheating really is or what academic authenticity is. And it's so readily available, we're just seeing it increase. And in the profession of nursing, I mean, that's just a little scary, right? because we're really not sure have they developed that clinical judgment that we need them to do and the critical thinking skills necessary to be a nurse or is it AI driven or is AI supporting that and really where is that deficit so I think that's really where we are right now is really just trying to jump into it and figure out the kind of the basic old who what where when how you know are we going to manage this yeah and I agree Kim I think technology is a huge thing you see students using proxy software wear using their watches, their cell phones, the Meta glasses. But you also see some monetization of cheating. You mentioned social media, but there are students and unfortunately even faculty that that are seeing helping students cheat as a way to generate income. You know, which is very sad, but it hurts our students. It hurts our profession. It hurts, you know, nurse educators across the country. Oh, and Kim, and then Kelli, you brought it up also. You named a few of them, but what are those factors that are contributing to the normalization of cheating among students? I think there's a lot of factors. One is how readily available it is, how easy it is. I think that's one of the factors, but even before that, I think it's even a student's understanding of what is cheating, what is academic authenticity, what is it to be developing these skills on your own and really moving through those assignments. You know, we've had cheating for a long time in in higher education. I mean, it's nothing new. Students would get together, they'd pass notes, students would write things on their arms. I mean, there were all sorts of things that have happened, but tech has made that a lot easier. So, now there's these there's different ways of doing it, right? I think that's kind of what's bringing it up. It's, hey, we're just going to study together, but then you get three questions and you get three questions and you get three questions and are we really creating a study guide or are we cheating? Oh, hey, I heard we're going to be taking XY exam. Did you know that's out there on the internet? Did you see it? Do you know where that's going? You can find that on, you know, any site, Tik Tok. You can find it on, you know, Instagram. They're really able to do this. And then there's also a ability right now for anonymity in cheating, which I think makes things a little different. Students, like Kelli said, can go out and there's actually companies monetizing this or groups or individuals that are saying, "I will take your test for you in proxy testing." And with this technology, they're able to mirror that. And it's funny, people think that's only happening online, which I also think is really interesting. There are also a lot of instances of this happening on the campus itself because students have access to these testing labs or these skill labs or universities or colleges are requiring students to use their own personal laptop with a proctor in the room but they don't realize this software is there can get around these locked down browsers. So I think it's just becoming it's becoming easy and we're not really informing students what is cheating, how much AI is cheating, what I mean obviously proxy testing you have to know is cheating, but again it's really just that it kind of gets to that point and are we asking so much of our students they feel they have no way out? Are the courses so big? Is the requirement so large? Is the plethora of information I mean are we are we not noticing the red flags early enough to support them and students aren't seeing the way out? So, those are a lot of different factors, but they're all kind of rolling in together to really see this new ecosystem of academic authenticity and those concerns we're seeing. Yeah, I definitely think the social media environment and just the ease of it has really normalized it, I think, for some of our students. you know, back in the day to write something on your hand or to try to bring in an index card under your leg, you know, in in a group setting, somebody was going to see you, right? And so you didn't do it out of fear. But now you go on social media and, you know, all of our students have group Facebook pages and different things and there's advertisements in there about, hey, do you need help with this assignment? Hey, do you need help on this test? Reach out to me. And it, you know, it makes people who probably never would have cheated before think, well, maybe this is easier than I think. Well, if all of these people aren't getting caught, I'm not going to get caught either. But also, to Kim's point, I think as nurse educators, we've tried to get ahead of the students in cheating, and I think that has escalated the bloat in the curriculum, but also in trying to change out test questions more frequently. we've had to go to very detailed information and I think you know with no mal intent we've almost caused students to feel like they have to cheat to be successful because they can't memorize an entire textbook. They can't memorize all 20 signs and symptoms of this medication or this disease process. But that's kind of what we're now expecting of them. That's a good point. You're talking about curriculum overload. Us, you know, as faculty, we also need to see what are we assigning these students to do. Is this really necessary? Is this really how we're going to assess the students because like you said, they could have good intent and just get overwhelmed and just, you know, high achievers. They want to get that A, but I don't have time to do all these assignments or so resorting. Not that that's excuse, but yeah. One other thing I want to touch upon that you brought up, you were talking about how sometimes students aren't even aware that what they're doing is considered, you know, cheating or violation of academic integrity. So, what can we do as faculty, as administrators in these nursing programs so that we can kind of lay down those guidelines in the beginning when they first come through the door? what are some um you know steps that we should take so that everybody knows these are the guidelines um and this this constitutes cheating versus you know you're just creating a study guide. Well, I think part of that answer there is really what you just said is on day one at the very beginning. I think it's really being very open and honest and having these discussions in the beginning. They're embedded in the course. They're not just in your handbook, you know, where it says you will not or these are the things we're doing. It's not embedded just in a policy. The policy is lived. You know, the way we're going to do this is a lived experience within your courses. So, your faculty are telling you from day one, you know, this is academic integrity. These are the things we're looking at. And it's not just because it is a policy. It's a part of the nursing profession. I always say nursing is what happens behind closed doors when no one's looking, right? You really have to have that autonomy but also that just intrinsic ethical nature that you're really looking at this from the best interest of your patients which then means also the best interest for you while you're going through nursing school to really learn this content and move it forward. So you want to try to draw that parallel very early and also say when you can use let's say AI. I think that's a really big one right now especially with generative AI. We know a lot on the testing. We see a lot on some of the testing, but even in your everyday assignments really that is there a reason we need all of the discussion boards? I'm not saying yes or no, but do we need them? Is there value in that? And are you actually asking the students to do something more than recall? Are you asking them to apply? So then where does AI fall into that? Where are you allowed to use it? And I know one of the things we've really been working on at Chamberlain is to give students that information up front as we're going through curriculum revisions and doing other things. We're really listing, okay, this is AI free, nothing. This right here, AI informed and explaining what that means. And so then as you're starting to see that as you move on, students know where you can use that particular piece of AI and then a lot of reflection on that. So I think it's something from the very beginning. There's other people too that are doing honor statements, attestations, but again, we do a lot of that. So it almost has become second nature and it's not just a box you check and move on and really talking about that in every assignment. what is it you're able to do from the beginning? Excellent. Thank you. And I would say not just educating students but also new faculty coming in. I think a lot of times new novice faculty coming in don't realize that creating that study guide in an attempt to help your student prepare for that exam has really just given them all the key points to the test questions. And then by using that you've you know you've hurt the student because they're only memorizing the answers to these key points and not really being able to apply the information or critically think through the concepts. And so I think there's a lot to do on the front end with new nurse educators to really help them understand how to prepare students for exams. Excellent. not just for the students, for the faculty also. So, we talked a lot about cheating, but for those of us, you know, I'm a little bit removed from academia. Can you let us know how are these students cheating? Like what are some of the methods that you're starting to see, whether it's online exams, proctor exams, or even if they're taking these exams in person? Just so we're aware. An interesting one that's that you're seeing, I think, or I'm seeing a greater influx in is proxy testing. I will say proxy testing is very large. And this is interesting. People think again it's only for the online environment, but in proxy testing, they're mirroring their screen or they're using another IP address. Basically, someone else is taking the test for you. So even when you're proctored, so right now we're sitting here together, you can see me, I can see you, but behind the scenes, someone is actually taking the test for them. It's very hard to find. And usually AI helps us find it along with a live proctor or someone else. But the only way to see it is maybe they're moving their mouse. their eyes aren't looking in the same direction as you would think for someone answering something on the screen. It's really a very detailed nuance and we're actually seeing this on the campus as well that students have set up either their computers that way and they're using that or they've gone in and changed the testing center computer. They've downloaded something and I think we've relied very heavily on lockdown browsers but now what we found is that the new tech can get around the lockdown browser. So that's one that you're seeing in those testing areas. You're also seeing when they're going in to do things, Meta glasses. People are wearing Meta glasses or they'll still have the tried and true earbuds and cell phones and just the tried and true everything that you'll see. But with the Meta glasses, they're coming in and watching those things. And some of the students will tell you with Meta glasses, well, I was just trying to get that information. It's my way of taking notes. So, I was here doing this simulation. It was my way of taking notes. And many times maybe it isn't an issue perhaps unless of course are you doing some sort of assessment with that. But now that information's out and what you're really seeing is a lot of proprietary information from vendors who are providing these simulations providing this other information or just out there. So it's bigger than just the student. You're seeing some of these other type of issues where it's escalating into fraud. I mean, there have been some cases where students have been held accountable to even by some of these other vendors releasing their information out into, as I call it, the ether. It's just out there. Yeah. And I think at the campus level, it really boils down to faculty who are usually the ones proctoring. You know, it used to be you could proctor from the front of the room and maybe even get some stuff done on your computer, but you really have to be walking around. If you're not behind the students, you're not going to catch that. The exam is moving, but the students not moving their mouse or clicking a button or [clears throat] doing anything because again to that that proxy software, somebody else is controlling that exam. But even to the technology, you know, we see students that embed cameras in their clothing to be able to take pictures, to sell them online. They have maybe an accommodation to take a break and they're going to the bathroom because they've hidden notes in the bathroom so that they can, you know, read up on their notes and come back to finish that exam. So, you know, it's almost a mix of old school and new school. [laughter] technologies based off of whether it's online a testing you know room if it if it's on a campus or you know a lot of programs don't have the space for the campus to have the computer so they're allowing students to test on their own computers but you know proctored by faculty and you don't know what's on that student's computer and so you really have to be very dig diligent in your proctoring if you're going to catch any of that type of software or glasses. Many times faculty are afraid to ask a student, you know, are those Meta glasses or, you know, we don't always know what the technology is or where it's hidden. It just seems like a lot for faculty to be watching during the exam and so much of what you're sharing I wasn't even aware of. So, what tips or advice do you have for faculty as they're moving forward with all what you just explained, all these new ways of cheating? What are some of the things we need to be aware of? What are some of the things that we need to be doing now either before the exam, during the exam? Can you provide any tips? You know, I think it's you've got to you've got to know what the students know, right? You've got to know how they're cheating now and just understand it's always going to evolve. But you do have to be vigilant. If you are proctoring on a campus in a room, you've got to have probably multiple proctors depending on how many students you have and you have to be up walking around and monitoring and being able to see the student screen and the student and do those movements match. You know, you have to Kim's point with policies, what's the dress code for testing? you know, if they can wear hats and big baggy clothes, it's going to be much, much harder to see that they have a cell phone or that they have some sort of a device. So, you know, really thinking about how you want your students dressed. Do they come in their scrubs like they do for clinical? So that you can really, you know, be able to monitor and see what they're doing. But I think you also have to be like we do with everything else, you have to educate the students on the front end. You've got to make them aware of what cheating is, what the expectations are, and what the consequences are. And then you have to be able to hold to those consequences, you know, and initially if a program's struggling with things like this and they're developing these policies, it can be hard to fail a student because it might be the student that you really thought was a great student and you're taken aback that they were doing this. But you've got to hold to those policies and those sanctions and follow through so students know that it really does matter and we do take this seriously and we're not going to tolerate it. I think too on that Kelli those are great points and I think on that as well is we I don't think it's realistic to expect a faculty member to become a cyber security specialist and that's almost what it takes at this point. I think there's a lot of collaboration that has to happen in this day and age with the leadership at you know at in the organization your IT counterparts and really trying to utilize where you can and where you have the finances to some of these vendor you know supported systems that are out there because it is a big challenge. One of the hardest things you have for faculty is really trying to figure out what role they do play in all of this. And your campus, your organization has to make that decision because it's very hard for students to go to a faculty member that's just said, "Hey, I think you were cheating on that exam. I think this is happening. We're going to investigate this." So, it becomes difficult for the faculty to maintain that relationship. So, there needs to be a lot of training for faculty. where do you end and where does maybe your organization's process for student code of conduct follow like where do you go are you the referral are you moving it through you may sit on the committee but where is that role and I think being very intentional about that typically we find it to be beneficial for faculty to be on the committee for a different course not their course just something so that you can have a little bit of distance between some of those things you still want to play that role But again, you need to maintain that relationship if you really want to help a student, especially a student that is struggling. So, I think that's a big part. And then your policies, I think it's clear from the very beginning. It seems a lot to put into a policy, but you really do need to put that in there. Is proxy testing an expulsion right from the get- go, or is it a dismissal? Or is it one or two sanctions? Before you get to that point, you and your organization and your legal organization need to get together and really decide where is that line? What is the evidence to support that? And then where do you go from there? Because it needs to be very objective in in that your policies cannot have a lot of subjectivity when it gets to this. Right. And like you said, it's so important that there's a team that puts this policy together, including legal. And having a strong policy. One of the questions that I get faced a lot when I'm doing some workshops, I do a lot of workshops on AI is that, you know, a lot of faculty are depending on these AI detection tools like the Turn It In and Grammarly to see if a student has plagiarized or has used AI to submit some of their assignments. What are your thoughts about using these AI detection tools? What are the are you aware of the legal ramifications? because a lot of them are stating that they're for screening, but I have heard of programs using the findings from these AI tools to u for disciplinary actions towards students, including expulsion. So, what are your thoughts? I think most organizations are having to use things like that to get into it. I think typically a rubric or something up front that really lets a student know. Typically, when you're using Turn It In or anything else, you're doing a paper, you're doing a project, you're doing something that we want, some sort of a performance assessment that's either, you know, just something else besides your typical objective assessment. And I do think a lot of us are relying on those. There typically is a a percentage to that. And you have to figure out from your legal that works with that. Many times, if you're giving students opportunities to go back and redo that, hey, you turned it in the first time, you've got a 30%, 40%, 60%, whatever your number is that your organization went with. If you're giving them another attempt, then you kind of are following into that process. Okay, go back and revision revise it. How many times has this occurred? Typically, what you see for a lot of things that that has worked well is patterns. You're looking for patterns. So, this student has demonstrated this pattern. But I think the interesting thing with many of these tools is the AI is getting to be smarter than us. Students will take it and they will I mean, I think the tools are great. I think you need something. You're going to need AI to help you with this. But I do think even in that students are sending it through multiple AI generators and within that they're asking them to humanize it each time they send it in and humanize it more. So it's getting harder to find it. And the AI detection tools are typically the only ones that are going to find something that AI has humanized three times or four times. Students are really smart with this. If they only spend this much time studying, but oh my goodness, I say that all the time. It would be amazing. So I do geniuses passing all their tests. It's fantastic. So, I think you need the [clears throat] assist, but I think you need a documentation like again goes back to objectivity for it to work is that you really need to then say what gets you to that level of expulsion. Is it, you know, and again, is it that first attempt or is it that pattern? Kelli, I don't know if you have different thoughts there, but. No, no different thoughts there. I agree. I think it's so challenging with papers and just there's so many AI platforms now. It really is a challenge. So as faculty, you know, I know when I was in school, you'd have like these short essay questions or, you know, even when you were going to apply for college, you wrote your college essay. Now I hear, you know, that now in this day and age of AI, you could forget it. Like people are going to use AI to create these essays and answer these questions. How has we as faculty have to change the way that we're assessing students in this new day and age with AI? Because it definitely seems like we might have to do things differently and we want to also encourage the use of AI as you mentioned before, Kim. So, how do we have to kind of adapt to this new AI world? I think it comes down to you know in that is figuring out the way to incorporate it and then having that works best for you and then the reflective piece. The reflective practice is so big in nursing, right? We really live on reflection. What is that? And I think that's really important to bring in. Call it out. Say,"Okay, I want you to do this with AI." And we see this a lot. This has been a very common tact now. Do this particular assignment with AI. And then reflect where would you see something different? Where does this not exactly line up? Where are you where are those differences? What would you do differently in this place? Now I can't say they're not going to use AI again, but the hope would be is that they feel it's a safe space because we told you to use AI to go in and do this. Another thing is where is you know you may even ask in nursing where does AI live right so where does AI live where is AI going right and then in nursing and then you say where is the human component of that what do you bring into that what would you look at how would this look at it differently so I think there's different ways you have to kind of look at that but inviting it in is the best way but then also telling students when it's not welcome it's not welcome on this assignment we need you know again not to say they're not going to use it but it's not welcome on this assignment let's see what your thoughts are on this and then even using it for reflection. So now after you wrote it, you turned it in. This was my feedback. What did AI give you? If that's the tact you want to take, but it's moving into that. Another big thing is, I don't know, I'm going to date myself. Choose your own adventure. That's always great on assignments as well is that even when some of those performance assignments have those differing techniques and really ask the students, pull from your historical perspective or pull from a time in your life when this happened. really hard for all of you to have the same time in your life. It happens, but it shouldn't be as common and then build it from there. Those are great tips. Well, and I also think you can, you know, if you have the individual and even, you know, you can use AI for this or maybe it is that, you know, to your life, but then you can put students in groups and have that discussion here of, well, this is what I would have done differently or I would have approached it this way and a I AI came from it from this perspective or if they have to talk about that personal, you know, kind of alignment or that personal experience, it's going to be much harder to elaborate on that in a in a group discussion if it wasn't really yours. So, I think, you know, faculty are so creative and, you know, I think there are a lot of good ways that even with papers and kind of those written assignments where to Kim's point, let them use AI, but then that reflection, you know, whether that's, you know, maybe not again in writing because they just use AI, but how do you bring that into a group type setting? [clears throat] And I think heard I was just gonna say too I think Kelli on that as well. One of the really great things that we always forget about even in online on ground we have postconference all these really great touch points that we forget about and then really having those conversations that deeper conversation it's already built there and that was isn't that the purpose of clinical anyway right you're building it you're bringing that bridge together but it will really tell you where your student is how your student is doing and what's going on but again it requires faculty to really be prepared to have that conversation yep need those. Yeah. What I was going to say that some of the faculty that I interact with that have in person classes, they said they've gone back to paper and pen. Take out paper pen. We're going to have some written assignments in person. People want scantron we've done that. Yeah. Bringing in the Scantron. I've heard that too. You went way back, Scantron back. Yeah. You were talking about essays. I was like, "Yeah, you just do those essays right there in the classroom." [laughter] No AI. no AI good old spot. And I think that's a great call out though because I do think on campus you have some more options to do. Not that I'm advocating the scantron and going back to that, but having that in that group. And so I think when you're doing other modalities, whether it's and there are a lot of programs out here that have hybrid online different aspects, it's really then how do you figure it out there? How do you create these on authentic interactions that don't just become another discussion board? Maybe that's it. You don't have those anymore. And they are authentic conversations that you're having again. So, you really have to be very deliberate, I think, in how those are created to get that. You're never going to stop at all. The point is try to make students aware and try to move the needle on this and not penalize all your excellent students for, you know, some of the areas that we have and we always say we have some bad actors, right? And we want to figure out a way to stop that, but also to encourage all of our really amazing students in their learning and as they're moving forward as well. because that's the fear that we hear from faculty that they're using AI so much that they're going to it's going to decrease their critical thinking and they're going to be dependent on AI. So those assignments are a great way of helping to promote that critical thinking. So I can't believe we are out of time and like I said we can go on and on and on about this topic. And so I want to end on one last question. What final message would you give nursing faculty who are concerned about cheating but unsure where to start and what to do? What would be your advice to them? Well, I think to Kim's last point is don't lose sight of all the good students that you have and that this is some bad actors, right? Every institution has them. And to educate yourself as a nurse educator. And then be creative. You know, we've had to adapt so many times in nursing education. I mean, just since co, right, we all flipped to online for a while. We've moved to, you know, testing online or, you know, off of paper and scantrons. You know, going from overhead projectors, I'll date myself to PowerPoints to, you know, flipped classrooms. We can figure this out. It's just we have we're going to have to find different and creative ways to assess our students. And yes, they're going to have to take an NCLEX. They need to be able to take exams, but we don't have to exam them to death. There are other ways to ensure that they are getting the information and probably better ways with reflection and group discussion to ensure they are really applying those concepts and are critically thinking. You know, using those postconferences and making those much more rich and robust in the conversations to really gauge where the students are in their in their nursing education. And I want to touch upon I would be remiss if I don't mention simulation. Don't forget this competency [laughter] is simulation. I have to put the plug in but thank you Kelli, Kim and I say building on that with Kelli besides simulation which is phenomenal and we definitely want to move into that you know utilizing that as well. I'd say it's moving it out of just a policy state. So not just thinking about academic integrity from a policy state but really as a professional state. really moving into your professional identity and your professional scope. Really moving it in that direction. I think students want that. Like students, they want to do the right thing. They do. They want to do the right thing. They want to get there. I mean, again, we want to make sure we're moving into that. So, I think it's just refocusing what we're doing. Being creative, yes, but making meaningful assessments. Is this meaningful? Are we not just doing it because we've always done it right? learning about the technology that's there so you can educate your students that this isn't the way we want to do this. How would you feel if your mother was being taken care of by a nurse that just making it real I think is where it's so important and just don't lose faith. I will say as this continues to go, I have a lot of students that have turned in other students for this because they are tired of this and they feel this is what they need to do and they feel that this is their their opportunity and part of their ethical pro, you know, process as a nurse to really say this is going on and this is happening. So, it's an interesting dynamic. It's I think it's shifting a little bit in that. So I think as we all become more aware just don't lose faith in that and know that we will solve this just like we've solved everything else. Absolutely. That was a great way to end things. And also just saying you know even though we're talking about this topic most students are honest. [laughter] They are great students that want to do the right thing. So you know we're talking about a small percentage of students. So I'm glad that you brought that topic up. So I want to thank you both. Thank you Dr. Kimberly Kelly-Cortez and Dr. and Kelli Salvage for sharing your expertise and practical insights on evolving changes when it comes to academic authenticity. I love that term that you use and integrity. This perspective reminds us that protecting academic integrity is not only essential to the student learning, but it's a professional accountability for patient safety. So, thank you all for listening to this podcast. I'm sure there's going to be more conversations, so stay tuned on this topic. And we are glad you're joining us from any of your favorite streaming platforms and we hope to see you in our next episode of the Nursing EDge Unscripted. Thank you. Thank you.[music]