In October 2019, the California State Board of Pharmacy invalidated about 1,400 initial applications for licensure as the direct result of integrity violations of the California Practice Standards and Jurisprudence Examination (CPJE) for Pharmacists. This examination is used to establish minimum competency of pharmacy school graduates to safely practice (California State Board of Pharmacy, 2019). The integrity violations were the result of intentional online posting of examination questions. The Board's decision was swift and detrimental to newly licensed pharmacists who suddenly had no license to practice (Karlamangla, 2019; Nessel, 2019). The financial impact alone has been devastating (Karlamangla, 2019). The actions threaten loss of income, disruption of postgraduate residency training, and the requirement to complete a makeup licensing examination. Some pharmacy graduates are now working at clothing retailers and other department stores and facing a mountain of student debt while they await the rescheduling of the examination.

State licensing agencies, such as boards of pharmacy, nursing, medicine, and others, are enacted to protect the public (Hudspeth & Klein, 2019). The CPJE examination is one measure that the California Board uses in fulfilling its mission. Inherent in this role is the protection of examination question pools (California State Board of Pharmacy, 2019). Yet, the theft of proprietary property and cheating on the licensure examination now is a malady for many health professions.

According to Gallup poll data, the public entrusts nurses and pharmacists as the highest ranked professionals in terms of honesty and ethics (Brenan, 2018). Such entrustment was earned by the professions' members adherence to the self-governing Codes of Ethics. Professional conduct standards should have prevented a tragedy such as the violations connected with the recent California pharmacy examination. The standards should have caused the individual(s) involved to reject thoughts of cheating. Intentional disregard of individual self-regulation of professional standards, such as this conduct, creates uncertainty about the ability to self-regulate in the future. There are far reaching implications for lack of honesty and ethical comportment in caring for patients. Although this egregious act cannot be undone, nor the consequences completely reversed, there is a much more ominous impact: such actions also weaken the public's trust in the profession.

Academic dishonesty in the form of test cheating is not new. Kaufman (2008) identified that the trend of academic dishonesty has steadily increased. Some of the root causes for academic dishonesty, as described by Kaufman, include situational factors, personal factors, and technology factors. Situational factors included size of classroom, the amount of space between students during examinations, and the teaching style of the professor. Personal factors included gender, work ethic, and self-esteem as influencing academic dishonesty. Also called out were the factors of not having a grounded definition of cheating and lack of clear moral judgment and will. Technology was cited as well, specifically in the areas of gaming and online learning. The competitive nature of winning in gaming can be enhanced through widely available online cheat guides. Kaufman correctly stated that in the gaming, at least the game could be turned off; however, entering a profession is a continuous experience. On-line learning presents different opportunities for academic dishonesty. Faculty should anticipate and develop practices that minimize such. The collective understanding of these three factors has implications for health professional education.

Advanced practice nurses (APNs) can take action to minimize the risk of a similar experience with our national certification examinations. We must be the primary stewards of the profession. Stewardship of the profession must be reinforced throughout all stages of formal education. During the Nurse Practitioner (NP) program, faculty and preceptors set the tone for professional engagement. Nursing faculty are known for emphasizing professional integrity as a component of the coursework. This component should continue in each NP course because the responsibility for trustworthiness is even more impactful when graduates take the lead as the primary provider for their patients. Academic programs, like licensing boards, bear responsibilities for protecting the integrity of all examination material. During the educational period, future APNs must learn to embrace ethical decision making and have plentiful opportunities to incubate, mature, and demonstrate such competencies. Swift consequences must be in place for individuals seeking to take short cuts.

Advanced practice nurses have the professional responsibility to advance the profession through scholarship. At one end of the spectrum, APNs must be consumers of the professional literature. Teaching future APNs to critically evaluate literature builds trust in science. At the other end of the spectrum are the opportunities to contribute to the literature. Today's APN students are tomorrow's authors. History tells us that not all contributions to publishing adhere to ethical standards (Hicks & Harris, 2016). Students, faculty, and clinicians must recognize that one's reputation for upholding ethical standards permeates all areas of professional life. If students are identified as implicated in the CPJE examination, who will accept the future scientific manuscripts of these graduates for publication? Who will believe that their research was conducted with ethical principles in mind? These acts have potentially grave consequences that can affect an entire career.

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