Ethics: Academic Flourishing: Elevating a Nursing Education Mandate

Human flourishing has been a topic of discourse for millennia. Rooted in Aristotelian philosophy, flourishing (eudaimonia) entails living a life of purpose, integrity, and connection, to grow both as individuals and as members of communities (Aristotle, 2019). There is an understanding that the central aim of education is human flourishing. In healthcare, human flourishing is considered an index of well-being, above and beyond simply being satisfied with the care received or the absence of disease (VanderWeele et al., 2019). Broadly, flourishing is conceptualized as “the relative attainment of a state in which all aspects of a person’s life are good” (VanderWeele & Case, 2025, p. 4). Provision 5 of the 2025 Code of Ethics for Nurses (Code) describes “flourishing is an aspirational state, not an emotion. At its core, it is about a life well lived, both as an individual and in community with others. It is neither a stand-alone nor a simple ethical concept and is inextricably tied to virtue, goodness, community, and practice” (American Nurses Association [ANA], 2025, p. 21).

The growing attention to human flourishing reflects a confluence of social forces that have prompted global self-reflection. The COVID-19 pandemic, in particular, has led many to reconsider what constitutes a “good life.” While understandings of what is good are shaped by cultural and personal contexts, it is nevertheless possible to identify dimensions that are nearly universal such as happiness, health, meaning, relationships, character, and financial security (VanderWeele, 2017). For nurses, the pursuit of flourishing extends beyond professional competence to the cultivation of authenticity, integrity, and wholeness of character. As emphasized by the Code, nurses are called to embody these values in both their personal and professional lives, advancing not only their own flourishing but also that of the individuals and communities they serve (ANA, 2025).

Flourishing – An Enduring Nursing Concern

Human flourishing has long been implicit in nursing ethics, particularly in virtue-based approaches that assume moral formation shapes the “good” nurse-citizen (Fowler, 2020). Florence Nightingale’s advocacy for soldiers, through writing letters, establishing a lending library, and safeguarding their financial stability, can be seen as early practices that fostered human flourishing (Bostridge, 2008). Bunkers (2010) advances this idea by linking human vulnerability with flourishing, emphasizing the importance of presence and attentiveness to the “now” in nursing practice.

Human flourishing is understood as a lifelong process of self-actualization and fulfillment that extends until death (Perkins et al, 2012). It represents a fundamental aspect of the human condition, encompassing not only achievement but also the lived realities of hope, regret, illness, suffering, and loss (Perkins et al, 2012). Essentially, human flourishing should be an explicit outcome of all ethical nursing efforts, particularly in nursing education.

Codifying Human Flourishing

The 2025 Code positions human flourishing among its key mandates for the nursing profession, extending beyond patient care to encompass the well-being of nurses, professional communities, and society at large (ANA, 2025). Flourishing is addressed in 6 of the 10 Provisions of the Code. Provisions 5 of the Code extend this concept to the nurse as a moral agent, emphasizing duties to self as a person of inherent dignity. The expectation of safe practice environments, professional competence, and authenticity of self are identified as preconditions for individual flourishing (ANA, 2025).

At the professional level, Provisions 1.1, 6.1, and 6.2 of the Code emphasize the creation of ethical environments where both nurse–patient and nurse–nurse relationships can flourish (ANA, 2025). These provisions frame flourishing as relational and communal, cultivated through reciprocity and shared moral purpose. Networks of mentoring, education, and mutual support are recognized as sustaining professional solidarity and reinforcing the virtues necessary for ethical practice (ANA, 2025).

The Code further extends flourishing to civic and societal domains. Provisions 9.2, 9.3, and 9.5 delineate the obligation of nursing education and organizations to cultivate skills for civic engagement and to resist policies that erode equity and human dignity (ANA, 2025). Provision 10.5 expands this mandate, positioning nursing as a collective force that actively counters harmful social and political structures while advancing conditions that enable health, justice, and societal flourishing (ANA, 2025). Collectively, these provisions reframe nursing’s goals beyond fostering health toward repairing and healing the world with flourishing as a unifying principle (ANA, 2025).

Measuring Flourishing

As society continues to grapple with life-disruptive social change, academic and practice stakeholders are responding through research and education, to understand the drivers of a life well-lived and well-being. The leader in this exploration is the Human Flourishing Program at Harvard's Institute for Quantitative Social Science (https://hfh.fas.harvard.edu/). Founded in 2016, the program advances the study of human flourishing, examining happiness, virtue, meaning, purpose, and community. In 2024, the program introduced a validated 24-item Student Formation Assessment to evaluate students’ perception of their university life experience as it relates to academic flourishing. A survey of 2,010 university students conducted by the Human Flourishing Program at the Harvard University Flourishing Data Collaborative (2025) generated findings with relevance to nursing education. While the composition of the sample by academic discipline was not specified, the results offer insights that may inform considerations of nursing students’ academic and personal flourishing.

More Knowledgeable But Less Honest

"I have never let my schooling interfere with my education."

Mark Twain

To evaluate changes in student formation over the course of their four-year university education, the Harvard study asked students to rate the extent to which their university experience supported them in achieving 24 outcomes across four domains: cognitive and epistemic capacities, virtues associated with academic flourishing, citizenship and societal contribution, and meaning and personal growth. Ratings were provided on a 0–10 scale, where 0 indicated “has not helped” and 10 means “has helped a lot”. The change in average domain scores from year 1 to year 4 was calculated by subtracting year 1 means from year 4 means (The Human Flourishing Program at Harvard University Flourishing Data Collaborative, 2025).

Not surprisingly, the most consistent development was reported in areas related to intellectual and personal flourishing, including becoming more knowledgeable and strengthening the pursuit of personal goals. Moderate growth appeared in critical thinking, clear self-expression, problem-solving with others, and a sense of being prepared to contribute positively to the world. By contrast, formation in relational, moral, and civic dimensions showed limited progress. More concerning, decreases were seen in developing courage, contributing to one’s country, living a healthy life, and especially in becoming more honest (The Human Flourishing Program at Harvard University Flourishing Data Collaborative, 2025). Overall, the data suggest that while universities strongly support intellectual and personal development, they may be less effective in fostering moral formation, civic responsibility, and healthy living. The challenge for faculty is not only to make students do well in school, but to do good in the world.

Although nursing academia often affirms its commitment to inclusive education and equitable opportunities for student success, a paradox remains in the profession’s reverence for the grade point average (GPA). This emphasis on GPA is frequently reinforced by ableist assumptions and narrow interpretations of technical standards, which can unintentionally disadvantage minoritized applicants and those who are living—and flourishing—with disability (Evans & Marks, 2022).

Nursing Education Implications

For over two decades, Gallup polls have consistently ranked nursing highest in perceived honesty and ethics. While professional organizations frequently report these findings as evidence that nurses are the “most trusted” professional, the survey explicitly measures honesty rather than trust. This distinction is important: honesty is a moral attribute, whereas trust encompasses a broader relational dynamic shaped by competence, reliability, and context. In healthcare, trust has been described as the foundation of therapeutic relationships and nursing’s reciprocal covenant with society (ANA, 2025).

Nursing’s enduring recognition for honesty suggests that the profession has secured a moral authority in the public eye, which in turn reinforces its social contract. By comparison, professions such as medicine and law are often evaluated more heavily on technical competence or authority, whereas nursing’s credibility rests on the alignment of ethical integrity with caregiving practice. The persistence of these survey results (e.g., Gallup ratings) highlights how perceptions of honesty not only support the public’s trust in nurses but also contribute to the profession’s distinct identity within the broader healthcare environment.

Findings from the academic flourishing sample study indicate that “becoming more honest” received the lowest ratings among students at the end of their four-year education (The Human Flourishing Program at Harvard University Flourishing Data Collaborative, 2025). While the authors did not offer an explanation, I wonder if the rise in use of artificial intelligence among students may be somehow connected with their perceived practice of honesty. Schools who are interested in participating in Harvard’s Academic Flourishing Initiative can find more information on the program’s brochure, The Academic Flourishing Initiative. (https://hfh.fas.harvard.edu/post/academic-flourishing-initiative).

I also wonder how nursing students, if surveyed independently, might respond in comparison to peers in other academic programs. Should nursing students demonstrate similarly low ratings on this item, such a result would raise important questions and suggest the need for critical reflection within nursing academia. Specifically, it would call for examination of how curricula, pedagogical practices, and clinical education explicitly foster honesty (the close cousin of integrity) and ethical comportment alongside technical competence. In this light, the assessment provides not only a measure of student formation but also an opportunity for the nursing education to evaluate how effectively it nurtures the moral and professional qualities that define the discipline’s identity and sustain its social legitimacy.

When Faculty Flourish, Students Thrive

Faculty development should emphasize the transformative influence that schools and, in particular, caring educators, can have on students’ character formation, professional trajectories (VanderWeele & Case, 2025), and ultimately on the well-being of their future patients and society at large. Such aspirations are most attainable when both faculty and institutions themselves embody the principles of flourishing (VanderWeele & Case, 2025), modeling the very qualities they seek to instill in learners. When educators model flourishing in their teaching, mentorship, and practice, they create the relational conditions in which students are more likely to thrive. In this way, faculty flourishing becomes both a prerequisite and a catalyst for student academic flourishing, ensuring that the virtues of honesty, courage, justice, and integrity are not only taught but also embodied in the culture of nursing education.

As faculty design and map nursing curricula to demonstrate alignment with current competency standards, such as the American Association of Colleges of Nursing’s (AACN) Essentials (AACN, 2021), they might also consider how human and academic flourishing are intentionally fostered across didactic instruction, simulation, clinical practice, and extracurricular experiences. This broader lens invites educators not only to evaluate how students are being supported in their growth, but also to engage in self-reflection. Faculty may ask themselves a challenging yet vital question: Am I flourishing or languishing in my own career?

Formation versus Education

In discussions of academic flourishing, scholars often distinguish between education and formation. Education refers to the structured acquisition of knowledge and skills. In nursing, this includes lectures, simulations, and clinical practicums that ensure students master the program’s epistemic goals. Formation, by contrast, is holistic and identity-shaping. It encompasses intellectual, moral, relational, and emotional growth, aiming to shape not only what students know, but who they become (VanderWeele & Case, 2025).

Benner (2015) asserts that “Formation requires that students embody new habits of thought and action… ‘formation’, as opposed to socialization, adds an agent-centered role of the professional in forming the habits, skills and practices necessary for good practice” (p. 2). Whereas education answers the question of what nurses know and can do, formation addresses who nurses are becoming and how they embody care. In practice, education ensures proficiency such as interpreting cardiac rhythm or titrating medications, while formation deepens the student’s moral capacity to preserve dignity, cultivate empathy, and act with moral clarity in moments of vulnerability. Together, they address both competence and character, knowledge and wisdom. In other words, virtues are essential both for the pursuit of knowledge and to develop moral character (VanderWeele & Case, 2025).

Student Flourishing

Student flourishing is defined as “the developing of students’ knowledge, understanding, and the cognitive skills and epistemic virtues that facilitate knowledge and understanding along with the promotion of those aspects of student flourishing around which broad consensus can be attained, and which teachers and educational leaders are prepared to address” (Kristjánsson & VanderWeele, 2025, p. 642). For students in prelicensure nursing programs, this process often entails a profound sense of liminality—standing at the threshold of discovering how their developing nursing skills can shape the lives of others and contribute to the profession. While schools and universities play an essential role in cultivating flourishing through curricular, clinical, and co-curricular experiences, they cannot be held solely accountable for its full expression. Students are also formed by a constellation of influences beyond academia, including families, neighborhoods, faith communities, workplaces, and broader economic and social conditions (VanderWeele & Case, 2025). Recognizing this interplay highlights both the opportunities and the limits of nursing education in guiding students toward flourishing.

For faculty, embracing the nursing Code as a touchstone can likewise nurture their own flourishing. In the face of mounting pressures in academia, ranging from workload demands to rapidly changing regulatory policies. The Code serves as a reminder of the profession’s higher commitments. By orienting their teaching, scholarship, and service toward dignity, justice, and civic professionalism, educators can sustain a sense of meaning and purpose in their careers. In this way, the flourishing of faculty and students becomes mutually reinforcing.

Positioning academic flourishing as a core value in nursing education affirms a vision of preparing nurses who are not only clinically competent but also anchored in the virtues required for ethical practice (Newsome Wicks, 2025). In times of social upheaval, flourishing may seem elusive, yet the nursing Code offers a compass that orients the profession toward human flourishing and dignity. When embraced as both guide and inspiration, it enables educators and students not only to embody practical wisdom but also to imagine a future where nurses positively influence the flourishing of those who receive their care and society as a whole.

Author

Fidelindo Lim, DNP, CCRN, FAAN
Email: fl9@nyu.edu
ORCID ID: 0000-0002-0694-3291

Dr Lim is a Clinical Professor at New York University Meyers College of Nursing.