INTEGRITY

We frequently hear the statistic that nursing is the "most trusted profession." According to the Gallup1 poll, nursing in 2023 was rated for the 21st consecutive year as the most trusted profession, a remarkable achievement considering that the other professions that they surpassed included teachers, physicians, pharmacists, and military officers. Of note is that telemarketers, car salespeople, and members of congress were the least trusted of all professions!

As nurses, we are humbled to be held in such high esteem by the public. It is also of note that in the 2023 poll, most all professionals were rated lower than in recent years, a finding attributed to general distrust by the public of health professions sparked by the pandemic. Yet despite the profound impact of COVID on public health, nurses remain highly regarded, trusted, and seen as professionals with integrity. As one of the nation's more than 4 million registered nurses, I will admit that with the release of each year's Gallup poll, I always check to see how nursing was rated, and I feel a sense of pride each year when I see nursing at the top of the list.

I also am admittedly biased in believing that hospice and palliative care nurses surely influenced those ratings because we are the "best of the best." While I have high regard for our colleagues in all nursing areas, I do carry a secret conviction that hospice and palliative nursing is a cut above. I also wonder what it is about the nursing profession and our field of hospice and palliative nursing care that every year results in those public rankings. I have concluded that the secret lies in the foundation of our nursing practice, especially in serious illness care, and it is integrity.

Integrity is defined as "the state of being whole, entirely undiminished."2 I think of nurses in our field who have stood whole, entirely committed and undiminished in their determination to change a cultural history of avoiding death, denying pain and suffering, and valuing only the extension of life while sacrificing quality of life. I think of my nursing colleagues who are leaders within the Hospice and Palliative Nurses Association who have pioneered new ways to care for seriously ill or dying infants, comforted families in the intensive care unit, and formed deep bonds with cancer patients or heart failure patients whom they have supported for months to years of chronic debilitating disease. It takes integrity.

The American public represented in the gallop poll is right-nurses can be trusted. Nurses are committed to doing the right thing. As the philanthropist W. Clement Stone3 described this concept of integrity, "Have the courage to say no. Have the courage to face the truth. Do the right thing because it is right." Every day in practice, nurses in our field do the right thing because it is right.

Many nurses have reported that it is increasingly difficult to maintain the ethical foundation of our practice. Overwhelmed health systems, struggling economics, and rising rates of homeless and underserved communities are "testing the steel" of our integrity. Moral distress is a part of our daily work. Many nurses feel abandoned by their own organizations and struggle to provide the quality of care they felt called to do when entering the profession. The definition of integrity cited above as being whole and undiminished crumbles by the end of a shift for many nurses who go home feeling quite the opposite, quite diminished and not at all whole. I would venture to say that those are also the days when integrity is on the line.

Parker Palmer4 wrote: "It takes courage to 'join soul and role' in organizations that make it unsafe to show up with integrity and act in alignment with it. But when we find that courage, our lives become more whole, our work reaches deeper, the people we serve are better served and in ways, large and small the world becomes a better place."

There are many voices of concern about our field of hospice and palliative care given the changing health care landscape and enormous influencing factors. Are we living into the vision of Dame Cicely Saunders and Florence Wald as they imagined what hospice care would look like? Does our daily practice come close to our national guidelines for palliative care? And the real "acid test"-are we providing the kind of care that we would seek if someone we loved were dying?

Nurses who conduct quality improvement projects, return to school, and complete a thesis or doctoral research study and all of those who collect data on outcomes of care are acting with integrity. They have the courage to ask difficult questions and publish their findings in journals such as the Journal of Hospice & Palliative Nursing to make the truth known. Integrity also lives at the bedside each time a clinical nurse questions current practice or speaks the truth about patient care. The voice of the nurse remains our best chance to serve the public and live into the rating of the most trusted profession.

Betty Ferrell

JHPN Editor in Chief

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