Abstract: Even after more than two decades in higher education, my identity remains rooted in clinical nursing. Both my employer and regulatory body view my current teaching and research activities through the lens of professional nursing practice. Given this framework, an important ethical question arises: If I continue to act as a nurse, are my students comparable to patients? This article critically explores the ethical dimensions of the student–teacher relationship in nursing education by drawing analogies with the nurse–patient dynamic. Through a philosophical reflection grounded in professional ethics, the paper examines similarities and differences between these roles. Special attention is paid to practices of institutional control and student monitoring, which, while intended to support academic success, appear to diverge from the ethical standards expected in clinical nursing. The conclusion urges nursing educators—and particularly those in leadership—to realign educational practices with the foundational ethics of the nursing profession.
Keywords: Nursing ethics, Nurse education, Professional identity, Student–teacher relationship, Analogy in bioethics, Surveillance in education, Character formation, Autonomy and coercion.
Introduction
Despite spending over twenty years working full-time in a university setting, I continue to identify as a nurse first and foremost. During lectures, students occasionally ask whether I still consider myself a practicing nurse, whether I engage in any direct care, or if I miss clinical work. In response, I often demonstrate my active registration status via the Nursing and Midwifery Council’s website. Though I might feel apprehensive about returning to ward duties after a long academic absence, I remain professionally competent and legally eligible to do so. These interactions lead naturally to classroom discussions about professional responsibility, competence, and the necessity of self-assessment and continuous learning.
In the UK, being a registered nurse is mandatory for supervising and assessing students in clinical settings. However, teaching theoretical content does not legally require active registration—only appropriate qualifications and experience. Nevertheless, my teaching and research responsibilities fall under the remit of professional nursing as defined by the NMC, and my annual reflections align with the standards outlined in the Code. My professional conduct—both in and out of the classroom—is subject to regulatory expectations, including online behaviour and emergency responsiveness, reinforcing the fact that I am perceived not only as a lecturer but as a nurse acting within the bounds of professional ethics.
This raises an intriguing question: if I am governed by the ethical principles of nursing, should my interactions with students reflect the same moral considerations as those guiding nurse–patient relationships? Is it appropriate—or even necessary—for academic engagement to be informed by clinical ethics? This paper addresses these questions by examining the analogical relationship between educational and clinical care, and by evaluating whether the mechanisms we use in teaching uphold or undermine the values at the heart of nursing.
Nursing Ethics and Analogical Reasoning
In a recent encyclopedic contribution on the field of nursing ethics, I positioned the discipline within the broader frameworks of professional and healthcare ethics. The professional ethics perspective highlights that ethical decisions in nursing are inevitably shaped by formal codes—most notably the NMC Code. Meanwhile, as a domain within healthcare ethics, nursing has evolved beyond the traditional dominance of medical ethics, asserting its own moral identity through values such as compassion and care. Unlike many other health professions, nursing emphasizes person-centered engagement, with ethical theories rooted in relationships rather than detached rationality. This has made nursing ethics particularly amenable to frameworks such as virtue ethics, feminist ethics, and care ethics, all of which highlight the role of the moral agent within complex relational contexts.
Though I do not exclusively subscribe to virtue ethics, I recognize the shortcomings of both deontological and consequentialist moral theories when applied to nursing. These theories tend to privilege rational detachment over emotional intelligence and relational awareness—traits that are essential in nursing practice. Consequently, I have come to endorse a pluralistic approach, one that incorporates elements of character-based reasoning alongside traditional moral calculations. This is particularly relevant in educational settings, where developing students' moral agency and professional character is as critical as conveying clinical knowledge.
A central method for exploring ethical questions in applied contexts, including nursing, is reasoning by analogy. Widely used in bioethics, analogical reasoning enables practitioners to identify relevant similarities and differences between two cases or relationships in order to draw ethical insights. For example, if one case (S) shares certain features with another (T), and S includes a normative quality (Q), it can be reasoned that T may also possess or require Q, or a closely related ethical quality (Q*).
In the context of this discussion:
• S represents the nurse–patient relationship.
• T denotes the relationship between a nurse educator and their students.
• Q refers to the ethical values inherent in nursing, particularly those codified by professional standards.
Rather than aiming for a rigid logical proof, my objective is to use analogy to draw ethically illuminating comparisons. The goal is not to claim that students are patients in a literal or legal sense, but to consider whether the ethical principles governing nurse–patient relationships can—and should—inform the ways in which nurse educators relate to their students.
Of course, not all educators in nursing are themselves nurses, which introduces complexity into the comparison. The analysis here focuses on those who, like myself, are practicing under the formal identity of a nurse. This allows us to critically assess how ethical obligations extend beyond clinical settings and influence our professional conduct within academic institutions. The next section identifies specific areas of ethical overlap and divergence between the clinical and educational domains.
Ethical Parallels Between Clinical and Educational Relationships
To explore the analogy between nurse–patient and educator–student relationships, it is helpful to identify where these interactions converge and diverge, particularly in terms of ethical expectations. The following comparisons examine various aspects of each role, offering insights into how nursing ethics might inform academic practice.
Professional Registration and Scope of Practice
Both practicing nurses and nurse educators who maintain clinical registration are accountable to the NMC. This accountability is not symbolic; it actively shapes professional expectations. Unlike university lecturers in other disciplines—who are not governed by a centralized code—nurse academics operate under a regulatory framework that defines their ethical conduct in both clinical and educational contexts. While universities may have institutional policies for all staff, these lack the legal and ethical weight of the NMC Code, which binds nurse educators in unique ways.
Confidentiality and Disclosure
A key tenet of the nurse–patient relationship is the duty of confidentiality. However, the boundaries of confidentiality become ambiguous in educational settings, especially when students disclose sensitive information. For example, if a student reports unsafe clinical practice that might endanger patients, disclosure may be ethically required. On the other hand, if a student reveals a personal issue unrelated to clinical care, the threshold for disclosure varies depending on whether the listener is a registered nurse. University policies often permit broader disclosure in the name of student safety, whereas nursing ethics demands stricter confidentiality—raising questions about consistency in ethical obligations.
Relational Boundaries
The nurse–patient relationship is characterized by clear professional boundaries, as stipulated in the Code. These are designed to prevent exploitation and ensure objectivity. In contrast, university guidance on staff–student relationships tends to focus on potential conflicts of interest or power imbalances, often through institutional policies that discourage or prohibit intimate relationships. While both domains emphasize protection and professionalism, university policies sometimes lack the nuanced perspective found in broader healthcare ethics, which recognizes that relationships—particularly post-care—may evolve naturally and ethically, provided transparency and accountability are maintained.
Power Dynamics and Authority
Although modern academic environments strive for collegiality and informality, power asymmetries remain entrenched in educational structures. Students may address faculty by their first names, but behind this familiarity lies a rigid hierarchy: lecturers control grades, assess progression, and hold sway over disciplinary procedures. These dynamics are intensified in professional programs like nursing, where progression depends on institutional endorsement of a student’s health and character. In clinical care, by contrast, the nurse’s authority is tempered by a duty to recognize and minimize power differences in order to promote patient autonomy. This obligation is largely absent in academia, where power is often exercised without critical reflection.
Centering the Other: Patients and Students
The philosophy of patient-centered care is foundational in nursing and emphasizes dignity, autonomy, and the individual's needs. A comparable concept—student-centered learning—has gained traction in higher education, particularly in the context of learner empowerment and individualized instruction. Despite superficial similarities, these approaches are not always treated as morally equivalent. Patient-centeredness is seen as a moral imperative, whereas student-centeredness is often instrumentalized to achieve measurable outcomes like engagement or academic performance. This difference may reflect a deeper ethical misalignment in how each profession values the person being served.
The Illusion of Autonomy
Both patients and students are presumed to act autonomously, but this autonomy is often constrained. Students are encouraged to view themselves as adult learners responsible for their own progress, yet are simultaneously subjected to rigid attendance policies, compulsory activities, and surveillance of their study habits. Similarly, patients are expected to make informed choices about their care, though their autonomy can be undermined through subtle coercion or paternalistic practices. In both contexts, there exists a tension between stated ideals of autonomy and the reality of institutional control.
Moral Expectations of the Individual
While the obligations of healthcare professionals are well-defined, less attention is paid to the expectations placed upon patients or students. In both settings, individuals may be subtly—or explicitly—encouraged to behave in ways that support system goals: healthier lifestyles, higher academic performance, etc. These expectations may be framed as hypothetical imperatives (e.g., “If you want to succeed, you must try harder”) but can also lead to judgment or blame when individuals fail to meet them. The ethical implications of attributing responsibility, particularly in the face of structural inequalities or personal hardship, warrant closer scrutiny.
A Foundation of Care
Care is central to nursing identity and ethics, and though less frequently emphasized in higher education, a parallel ethic of care is emerging in the literature on pedagogy. In particular, the relationships fostered between students and personal academic tutors are often described as caring, attentive, and trust-based. These relationships are asymmetrical yet deeply meaningful. Research suggests that such bonds are sustained through qualities like diligence, empathy, and reflexivity—qualities that resonate strongly with nursing ethics. However, institutional cultures often undervalue this form of care, prioritizing metrics and outputs over relational integrity.
Together, these points suggest that the relationship between nurse educators and their students shares key ethical dimensions with clinical care. However, academic practices often diverge sharply from the values that underpin nursing. In the next sections, we will explore how institutional mechanisms—such as surveillance and coercion—may undermine the development of professional character and ethical identity among students.
Coercion and Surveillance in Educational Practice
While much of nursing ethics emphasizes autonomy, relational integrity, and respect, the realities of higher education frequently involve coercive mechanisms that stand in tension with these values. Among the most prominent of these are attendance enforcement and digital surveillance, both of which are justified in the name of student success but may, in effect, compromise the cultivation of professional character and ethical agency.
Attendance Monitoring and Conditional Engagement
In clinical education, time spent in practical placement is strictly regulated; students must complete 2,300 hours of clinical training, which is meticulously recorded. However, theoretical instruction lacks such rigid standards. Despite this, many nursing programs impose stringent expectations around attendance in lectures and seminars, treating presence as a proxy for engagement. When students are penalized or pressured for missing sessions, this reflects an institutional assumption: that learning can only happen under tightly controlled circumstances, as defined by faculty.
Such approaches confuse the process of teaching with the process of learning. By equating attendance with achievement, institutions implicitly question the autonomy of learners and undermine the principle of self-directed education. While students are technically free to determine how best to meet learning outcomes, policies suggest otherwise. The ethos of adult learning is replaced with a framework of compliance, one that mirrors control mechanisms rather than trust in student responsibility. These structures contradict the ideals of student-centered learning and diverge sharply from the respect for autonomy foundational to patient-centered care.
For instance, university policies that require students to engage with every scheduled learning activity—whether synchronous or asynchronous—reflect a broader institutional desire to ensure measurable participation. Yet these demands can become performative: students may comply without genuinely engaging, much like patients following treatment plans out of fear of judgment rather than informed consent. In this light, compulsory attendance functions as a form of soft paternalism, cloaked in language of care but essentially focused on institutional order and risk aversion.
The Expansion of Surveillance through Learning Analytics
Beyond physical presence, universities increasingly monitor students’ digital footprints. The emergence of learning analytics has allowed institutions to collect extensive data on student behavior, from online module access and assignment submissions to library usage and physical entry into buildings. These practices, promoted as tools for “early intervention” or “student support,” in fact represent a growing culture of surveillance capitalism within higher education.
Students are rarely given the opportunity to opt out of these data collection systems. Consent is assumed, and transparency about how data is used remains minimal. While some studies suggest students are generally comfortable with these analytics, they often underestimate the extent to which they are monitored or misunderstand the implications of their data being repurposed.
Academic justifications for such monitoring typically invoke student welfare, suggesting that data can help identify those at risk of failure or withdrawal. However, this framing obscures deeper concerns. When universities define "at-risk" students based on predicted grade classifications or perceived underperformance, they conflate academic success with institutional prestige. Metrics such as the percentage of students earning top honors are not neutral indicators—they are often tied to league tables, funding, and public image. As such, learning analytics may primarily serve institutional interests, even as they are justified in the language of student benefit.
These developments present a serious ethical challenge. If the goal of nursing education is to cultivate professionals capable of ethical reasoning, relational care, and autonomous decision-making, then embedding them in a culture of surveillance sends the wrong message. Rather than modeling the values we expect nurses to uphold—trust, autonomy, respect—we subject students to conditions that contradict those very ideals.
Paternalism or Authoritarianism?
At its most generous interpretation, these systems can be seen as paternalistic: well-intentioned efforts to guide students toward success. Yet even paternalism, when unchecked, erodes trust and disempowers individuals. A more critical reading suggests that educational institutions, under financial and reputational pressures, engage in authoritarian strategies that treat students as subjects of control rather than partners in learning.
In the context of a tuition-based system, this dynamic is particularly troubling. Students, as fee-paying participants, are paradoxically expected to accept institutional intrusion into their learning behaviors. Universities deploy policies that closely resemble the logic of behavioral compliance—students are tracked, flagged, and nudged in ways that rarely align with the ethical norms of healthcare or the principles of professional development.
Even when surveillance identifies students in need of support, the ethical validity of the interventions remains unexamined. Reports may highlight improved progression rates or decreased attrition, but seldom do they address whether such results reflect genuine learning or merely strategic compliance. Furthermore, little research evaluates the long-term ethical impact of these practices on the development of future healthcare professionals.
Attrition and the Erosion of Character Formation
High dropout rates in nursing education are widely acknowledged as a multifaceted challenge. In the United Kingdom and beyond, student attrition is shaped by financial hardship, the emotional demands of clinical training, and mismatches between expectations and reality. While addressing attrition is an institutional priority, the strategies employed to mitigate it often raise ethical concerns—particularly when they rely on mechanisms of control and monitoring rather than meaningful engagement and support.
From one perspective, any measure that improves retention can be seen as a success. Yet when students remain enrolled primarily because they are subject to coercion—through persistent attendance enforcement, automated alerts, or risk classifications—the nature of their participation must be questioned. Do they persist because they are internally motivated to develop into competent, ethical practitioners, or because they fear academic penalties and institutional disapproval?
This distinction is not trivial. Within virtue ethics, which significantly informs nursing’s moral framework, character is cultivated not merely by outward behavior but through internalized values and intentional moral development. As Aristotle noted, virtues are acquired through habituated action—but those actions must be motivated by the right reasons. If a student attends lectures or completes assignments solely to avoid punitive consequences, their behavior reflects compliance, not moral commitment. Such an approach fails to foster the kind of self-aware, ethically grounded decision-making required of professional nurses.
This phenomenon aligns with what Kristjánsson and Thorarinsdottir describe as “constrained participation” — a form of engagement that appears voluntary but is in fact shaped by external pressures. Participation becomes performative rather than transformative. Students may do what is expected of them, yet remain disconnected from the professional values and ethical reasoning essential to nursing practice.
The result is a superficial version of success. Retention rates may improve, and more students may graduate on schedule, but the deeper objective of character formation is left unfulfilled. Ethical nursing practice requires more than technical competence or regulatory knowledge; it demands a deep alignment between personal values and professional obligations. An education system that rewards compliance over integrity risks producing graduates who conform without truly understanding why.
Moreover, such environments may discourage the very qualities we seek to cultivate: critical thinking, self-reflection, and moral resilience. If students are conditioned to follow rules without questioning them—or to meet institutional expectations without internal motivation—they are less likely to speak up when confronted with unethical practice in the clinical setting. This dynamic directly contradicts the aims of nursing ethics, which emphasize both individual responsibility and moral courage.
In vocational education broadly, but particularly in nursing, the purpose of professional preparation should be the development of both intellectual and moral virtues. This includes not only practical knowledge and critical thinking but also empathy, integrity, and the capacity for ethical judgment. Yet the current educational climate, driven by performance metrics and shaped by managerial priorities, often neglects this deeper mission.
A learning environment saturated with coercive tactics and constant oversight does not nurture professional identity—it distorts it. When success is defined narrowly by degree classification, employability statistics, or satisfaction surveys, educational institutions may celebrate metrics while overlooking the erosion of moral formation. Ultimately, the price of such success is paid not only by students but by the profession itself.
Conclusion
This paper has aimed not to offer a comprehensive ethical theory of academic practice but to provoke reflection among nurse educators and institutional leaders. Through an analogical comparison between the nurse–patient and educator–student relationships, it has been argued that significant ethical tensions exist in the ways nurse academics and universities currently engage with students. While the relationships are not identical, the ethical principles that govern clinical practice—respect, autonomy, relational integrity, and care—have strong relevance for educational contexts, especially in nursing.
Unfortunately, many contemporary academic practices—particularly those involving coercion, surveillance, and an overemphasis on outcomes—stand in stark contrast to the values enshrined in nursing ethics. These practices may improve metrics related to retention, performance, and institutional reputation, but they do little to cultivate professional character. Worse, they may actually inhibit the formation of ethical agency by conditioning students to prioritize compliance over critical moral engagement.
This is particularly troubling given the current context in the UK, where nursing shortages and financial strain place immense pressure on both healthcare systems and universities. Yet urgency must not override integrity. Ethical shortcuts—however effective in the short term—ultimately risk compromising the very standards we expect students to uphold as future professionals.
Nurse educators are not merely transmitters of content; they are active participants in shaping the next generation of practitioners. As such, their pedagogical decisions should be subject to the same ethical scrutiny that governs clinical care. This includes critically assessing the policies and practices imposed by universities, many of which may conflict with the professional values nurse academics are obligated to uphold.
The path forward is not to abandon accountability or educational rigor, but to reimagine how we pursue these aims within an ethical framework that is consistent with the foundational principles of nursing. This means resisting institutional pressures that prioritize data over development, control over care, and conformity over character. Instead, we must reaffirm our commitment to teaching as a moral practice—one grounded in respect, empathy, and professional integrity.
Authors:
PhDr. Bc. Mgr. Marcel Tóth, PhD. MPH,
Mgr. Adriana Vasiková
Bc. Iveta Kalúsová
Natália Wengová, Dipl. s
Ružena Píšová, Dis.
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