What Students Learn When No One Is Teaching: Professional Value Formation Across a BSN Program, the Hidden Curriculum on the Units and a Plan to Measure Values at Entry, Midpoint and Graduation
Student Name
American College of Education
NUR6043: Fostering Clinical Judgment Through Curriculum and Evaluation
Module 4 Assignment
Instructor Name
September 30, 2030
What the Reflections Showed
Every semester, students in our program write a short reflection on a professional issue they encountered in clinical practice. Last spring, reading 40 reflections from the third semester to prepare for this paper, I found that 23 described behavior by nurses that students saw as unprofessional: speaking about patients disrespectfully at the station, documenting care before it was given, ignoring a call light because the patient was "difficult" and, in two cases, a nurse telling a student not to report a medication error. Several students wrote that they had been taught one thing in class and seen another on the unit, and three wrote that they were beginning to think the classroom version was unrealistic. The pattern matches research in a concept-based curriculum, where analysis of students' written reflections identified two core concepts: appreciation for professional values and disillusionment with unprofessional behaviors (Elliott, 2017). Our students are forming professional values, and much of the forming is happening where no faculty member is present.
Values, Identity and the Hidden Curriculum
Professional values are the standards that guide a nurse's conduct, such as advocacy, honesty, respect for persons and accountability, codified for nursing in the American Nurses Association's code of ethics. They are one part of a larger concept. A concept analysis of professional identity drawing on 60 studies from health and related professions identified its attributes as skills and functions; knowledge, values and ethics; personal identity; group identity; and the influence of the context of care (Fitzgerald, 2020). The last attribute explains what the reflections show: values are formed in context, and the clinical unit is a powerful context.
Hafferty and Franks (1994), writing about medical education, distinguished the formal curriculum, what is stated and taught, from the hidden curriculum, the lessons conveyed through the structure and culture of the institution, and argued that ethics teaching in the formal curriculum is undermined when the hidden curriculum teaches something else. Their analysis transfers directly to nursing. When a nurse tells a student not to report an error, the student learns more about the profession in thirty seconds than in a semester of lectures on accountability. A values thread that addresses only the formal curriculum will lose to the hidden one.
A Values Thread Across Four Semesters
The thread works on the formal and hidden curricula together. Semester one: naming the values. In the fundamentals course, students study the code of ethics through short cases and write a personal statement of the values they bring to nursing. They also learn a simple way to respond when they see something that conflicts with those values: note it, discuss it with the clinical instructor the same day and decide together what, if anything, to do. Semester two: seeing the gap. Clinical post-conferences include a weekly segment, ten minutes long, in which students describe, without names, a moment on the unit that tested a value, and the group discusses what a nurse committed to that value would have done. The purpose is to make the hidden curriculum visible and discussable rather than absorbed silently. Semester three: acting on values. Students practice speaking up in simulation, including a scenario in which a staff nurse asks the student to document a task not yet done, using a structured script. The semester's reflection asks students to describe a time they acted, or chose not to act, on a value and why. Semester four: owning the values. In the capstone, students revise their semester-one values statement in light of what they have seen, and discuss it with their preceptor, who is asked to share how they have kept or struggled to keep their own values in practice.
Working on the Hidden Curriculum Directly
The program cannot control the culture of partner units, but it is not powerless. Three steps are within reach. First, clinical instructor preparation: instructors will be trained to recognize and debrief values conflicts and to protect students who raise concerns, since a student who reports an error and is then treated as a problem learns that reporting is dangerous. Second, feedback to partners: with students' permission and without identifying individuals, the program will share themes from the reflections with partner nurse managers each year, framed as observations about what students are learning, not as complaints. Several managers have told me they would want to know. Third, choosing preceptors: in the capstone, the program will ask partners to assign preceptors who are recognized for professional conduct, and will give preceptors a brief orientation to the program's values thread, since the capstone preceptor is often the model a new graduate carries into practice.
Faculty Are Part of the Hidden Curriculum
It would be convenient to locate the hidden curriculum entirely on partner units, but faculty teach values by how they behave as well. Students notice when an instructor arrives late to clinical but penalizes lateness, speaks about a struggling student in front of others, changes a grading rule after an examination or dismisses a question about a unit practice because it is awkward to answer. Each is a small lesson in what the profession tolerates. The thread therefore asks three things of faculty. First, consistency between what faculty require of students and what they model: punctuality, respectful language about patients and colleagues, and honesty about their own mistakes. An instructor who says in post-conference that they once made a medication error and reported it teaches accountability more powerfully than a lecture. Second, a willingness to discuss uncomfortable observations honestly. When a student describes a nurse documenting ahead, the instructor should neither defend the practice nor condemn the nurse, but help the student think through the value at stake and the options available. Third, protection. Faculty must make it safe for students to raise concerns about faculty behavior as well as staff behavior, through a route that does not depend on the faculty member in question. The program's end-of-course evaluation will add one question on whether the instructor modeled the professional values taught in the course.
Measuring Values Formation
Values are hard to measure, but a validated instrument exists. The Nurses Professional Values Scale-Revised is a 26-item instrument derived from the code of ethics; in a psychometric study with 782 students and nurses, it showed a five-factor structure, internal consistency reliability for the factors between 0.70 and 0.85 and a total scale alpha of 0.92 (Weis & Schank, 2009). Students will complete it at entry, at the end of the second semester and at graduation. A rise in scores, particularly between the second semester and graduation, when exposure to the hidden curriculum is greatest, would suggest that the thread is working; a fall would be a warning. Because a self-report scale can reflect what students think they should say, the scale will be read alongside the reflections, which will be analyzed each year for the balance of appreciation and disillusionment, and alongside clinical instructors' reports of students raising concerns.
References
Elliott, A. M. (2017). Professional values competency evaluation for students enrolled in a concept-based curriculum. Journal of Nursing Education, 56(1), 12-21. https://doi.org/10.3928/01484834-20161219-04
Fitzgerald, A. (2020). Professional identity: A concept analysis. Nursing Forum, 55(3), 447-472. https://doi.org/10.1111/nuf.12450
Hafferty, F. W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), 861-871. https://doi.org/10.1097/00001888-199411000-00001
Weis, D., & Schank, M. J. (2009). Development and psychometric evaluation of the Nurses Professional Values Scale-Revised. Journal of Nursing Measurement, 17(3), 221-231. https://doi.org/10.1891/1061-3749.17.3.221
How this NUR 6043 Module 4 example is structured
NUR 6043 Module 4 in many sections addresses professional value formation across a program; your classroom's instructions decide the focus. This example starts from evidence of the problem in the program, defines the concepts from sources, addresses the informal influences on values, designs a thread with specific activities by level and uses a validated instrument to evaluate it.
NUR6043 Module 4 questions, answered
What does NUR6043 Module 4 usually ask for?
NUR6043 Module 4 in many sections asks you to address how professional values form across a nursing program and how the curriculum can support and assess that formation. Your classroom's instructions decide the focus.
What is the hidden curriculum?
The lessons students learn from the culture and structure of their educational and clinical settings, which may differ from what the formal curriculum teaches.
How can professional values be measured?
Validated instruments such as the Nurses Professional Values Scale-Revised, given at several points in the program, combined with qualitative evidence such as students' reflections.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.