Surveillant #EdTech Harms Nursing Students, the Profession, and the Public

Rachel K. Walker, PhD RN FAAN
11 min readDec 21, 2020

Rachel K. Walker, PhD, RN, FAAN

Jessica Dillard-Wright, PhD, MA, RN, CNM

Em Rabelais, PhD, MBE, MS, MA, RN


Published on December 20, 2020

“Objecting to surveillance” by is licensed under CC BY 2.0

Increasingly popular surveillant education technologies like remote test proctoring services harm nursing students, the profession of nursing, and the public. As such, these technologies are incongruent with the values and ideas represented by the disciplinary guiding documents including the ANA Code of Ethics and the nursing values implicit therein. Adoption of these technologies has further escalated in the context of the abrupt shift to remote learning during a global pandemic.

Surveillant education tech is a diverse and growing category of education technology (also known as #EdTech) that includes technologies designed to detect and track student behaviors that potentially violate institutional academic integrity standards, such as cheating on exams, plagiarism, and academic truancy (non-attendance, or looking away from the screen during lectures). These surveillant technologies also track student engagement with course material, logging which pages students have viewed and how long learners spent on each activity. These technologies paradoxically multiply the possibilities for academic integrity violations, creating scenarios where policies and procedures to adjudicate behaviors must be created as new and unprecedented possibilities emerge (Morris & Stommel, 2020; Moro, 2020). Table 1 provides a brief description of academic surveillance tool categories, with examples.

Plagiarism detection software is designed to detect textual overlaps between student work and content on the internet and warehoused in proprietary databases maintained by private companies who scrape and store text of work submitted through their platforms. These programs are often coupled with other surveillant tools like online learning management systems (LMS) such as Blackboard. Education researchers argue that these academic surveillance tools create new markets for educational technology, mobilizing narratives about the dangers of student misbehavior they are designed to limit as a sales tactic: “Many of our colleagues are entrenched in an antagonistic stance toward students in the aggregate: students are lazy, illiterate, anti-intellectual cheaters who must prove their worth to the instructor. TurnItIn and its automated assessment of student writing is a tool for that proof…” (Howard, 2013). This creates a distrustful, adversarial stance between educators and learners.

With the sudden push towards online education, surveillance tech companies have increased their sales of newer and even more invasive forms of academic surveillance. “First, spyware monitors a student’s computer, identifying any other applications in use. Spyware can include a log of every keystroke and mouse click a student makes, as well as looking at a student’s existing software. Second, schools can use a proprietary ‘lockdown browser’ that provides heavily restricted internet access. Third, educators can use a student’s own webcam to conduct persistent video and audio surveillance. These recordings capture the most intimate confines of a student’s home, and are reviewed by computer vision software and live proctors for signs of cheating” (Cahn, Magee, Manis & Akyol, 2020). As of this writing, and according to records maintained by the U.S. Patent and Trademark Office database, companies have also filed for patent protection of myriad surveillant education technologies not yet on the market, such as computational eyeglasses designed to biometrically scan the iris of a potential test taker, and emotion-tracking software (Day, 2019; Walker, 2020).

Table 1. Academic Surveillance Tools

A copy of Table 1 with active hyperlinks can be accessed here.

Recent years have seen a steady rise in remote proctoring and other surveillant education tech services within higher education. This rush was only amplified by the sudden switch to online learning last spring due to the pandemic: “2020 was already an awful time to try to learn, let alone prove yourself on high-stakes exams. The unequal playing field that defined academic testing prior to the pandemic has become even more distorted by the Silicon Valley goldrush to sell as much surveillance equipment to schools as possible — all in the name of thwarting cheating” (Cahn & Deng, 2020). An April 2020 poll by the education technology organization Educause indicated 54% of higher education institutions had adopted “online proctoring” services, and nearly half of those who had not were considering it in the near future. The same poll also found that most of these institutions were unconcerned about potential risks to students associated with adoption of these surveillance technologies, such as additional out of pocket costs, and privacy violations (Grajek, 2020). As Audrey Watters, an education researcher and technology critic recently noted, “What we’re poised to see in response to the coronavirus — and not just in education, to be fair — is more disaster capitalism (Woo, 2020), and “disaster capitalists share this same inability to distinguish between creation and destruction, between hurting and healing” (Watters, 2020).

The shifting terrain of higher education during the pandemic has been an economic boon to the #EdTech industry, wherein “one representative company, Examity, reported a 35% increase in growth from one quarter to the next during the COVID-19 crisis. Other popular platforms include PSI Services, Mercer|Mettl, ProctorU, Proctorio, Examsoft, Examity, and Verificient” (Cahn, Magee, Manis & Akyol, 2020). The field of nursing education is no exception. While to our knowledge there have been no similarly comprehensive surveys about the use of surveillance technologies specifically within academic nursing, press releases and advertising from industry partners, discussions on nurse educator discussion boards such as the AACN Member Communitiesand on social media sites like Twitter indicate both widespread adoption, and on-going debates (Kaplan, 2018; ACEN Accreditation, 2019; WKU Nursing, 2020).

Academic surveillance tools harm students, and the evidence for this is well-established (Cahn, Magee, Manis & Akyol, 2020). Table 2 provides a breakdown of categories of harm commonly associated with the use of these technologies. Notably, within the realm of test proctoring and surveillance, research has shown that the harm is disproportionate for students of color; queer, transgender, non-binary and/or gender non-conforming students; disabled students; low-income students or students without reliable internet access; and students who breastfeed, chestfeed, or care for very young children and other dependents. Further, “students who menstruate reported having to choose whether to risk a failing grade or use sanitary products when their periods unexpectedly began mid-test” (Cahn & Deng, 2020; Gilliard, 2018).

In the April 2020 Educause poll, more than a quarter of respondents indicated the online proctoring products adopted by their institutions did not meet Federally-protected education accessibility standards, placing the onus for advocacy squarely on disabled students to challenge their programs’ practices. Privacy violations, including unauthorized access to video and audio recordings, identification documents such as drivers licenses, and other sensitive information have also been recently documented. For example:

“Videos of students taking tests may have been accessible to unauthorized employees at Proctortrack, along with facial recognition data, contact information, digital copies of ID cards, and more, according to Patrick Jackson, the chief technology officer for the cybersecurity firm Disconnect, who analyzed Proctortrack’s leaked source code on behalf of Consumer Reports. After the software leaked, the information could have been accessed by criminals, as well. The code ‘was a ticking time bomb…’” (Jackson, 2020)

Table 2. Harms to Students Associated with Surveillant Ed Tech

A copy of Table 2 with active hyperlinks can be accessed here.

Educators and administrators within nursing have offered numerous rationales for the adoption and implementation of academic surveillance tools, often in the vein of protecting the integrity of the discipline and the public. However, these arguments fall apart under scrutiny. Table 3 outlines some of the common rationales for adoption of surveillant edtech. Though the received wisdom suggests that educational praxis must prioritize exam security to safeguard the integrity of the discipline, “the need for and effectiveness of academic surveillance tools is not established, [and] the dangers of such tools are” (Cahn, Magee, Manis & Akyol, 2020). However, all too often, conversations about exam security in nursing education are subverted — summarily halted — in deference to the primacy of national certification exams, such as the NCLEX, whose passage rates are so often used for accreditation purposes and as proxies for assessment of nursing program quality. Discussions of the ethical implications of these technologies are stunted, the necessity of surveillance technology a foregone conclusion amidst a competitive, neoliberalized terrain in higher education that lives and dies by standardized, proprietary exams (Stommel, 2020).

Table 3. Rebuttals to Arguments for Surveillance Proctoring Software

A copy of Table 3 with active hyperlinks can be accessed here.

Some schools of nursing have adopted ZOOM as their preferred approach to academic surveillance of testing, citing either additional costs or privacy concerns raised by automated remote proctoring as their rationales. But ZOOM is not benign. In the classroom, the proctor watches dozens, if not hundreds, of students taking an exam. Via Zoom and other video conference software, the proctor is observing students on a large monitor. At times, several proctors are monitoring students. While this method may not necessarily use A.I.-driven facial recognition software at added cost to the student, the student is still compelled to remain in place and watched throughout the exam. Students may still need to be paying for larger internet data use than normal, because video data transfer uses more data than would completing the test on a website without video. The proctor receives a privileged view into the student’s private home space. As such, this method is — at the very least — a privacy violation, queermisic, transmisic, classist/elitist, ableist and disabling (requires that students face the screen and not stretch, look away from the screen for eye care, etc.). Depending on the context in which the student is testing, innumerable other oppressions may be added. In April 2020, ZOOM was forced to remove certain surveillance capabilities from its platform, after it was discovered the company was secretly using A.I.-driven data-mining and attention-tracking software to flag meeting hosts when users looked away from the screen for more than a certain number of seconds (Amatulli, 2020; Krolik & Singer, 2020).

Harms of academic surveillance technologies are not restricted solely to nursing students; they translate directly to both the discipline and the public that nurses serve. Punitive surveillant practices that place nurses and nursing students in adversarial positions vis-à-vis the communities they serve, whether those are patients or students, are a problem for the profession (Jeffers et al, 2020). This behavior is taught beginning in nursing school. This kind of disciplining distorts the work of nurses, redirecting the labor of nurses (and nurse educators) to the extractive aims of a capitalist healthcare “system” and higher educational structures (Dillard-Wright, 2019). As discussed in recently published papers about the nature of institutionalized oppression within the discipline of nursing, surveillant ed tech represents yet another manifestation of institutionalized white supremacy culture within nursing that demands absolute control and conformity to normative standards of whiteness (Bell 2020; Dillard-Wright, Hopkins Walsh, & Brown, 2020; Rabelais, 2020; Rabelais & Walker, 2020; Valderama-Wallace & Apeosa-Varano, 2019). Nursing students careers are held back, or ended, by this type of software. These kinds of consequences disproportionately impact students of color; trans, non-binary, and/or gender nonconforming students; students who are caregivers to infants and other dependents; and disabled students. These students represent the diversity that the profession needs to properly care for rather than continuing harm upon these communities.

Academic surveillance technologies are incompatible with provisions 3, 5, 6, 8 and 9 of the ANA Code of Ethics for Nurses and nursing values of caring, compassion, and social justice. Nursing bills itself as a profession that prioritizes and focuses upon the patient as a whole person. While this rhetoric is compatiblewith care, compassion, and social justice, the harm waged upon students of nursing through surveillance educational technology — and any other oppressive policy, procedure, mandate (such as dress codes [Walker 2020]) — deprives students of being a whole person in the eyes of faculty. Nursing’s idealized pedagogy, in which faculty instill caring, compassion, and social justice — and, in fact, train the nurse into “an instrument for social justice” — cannot ever be realized when nursing institutions use “Software like Proctorio — the online exam proctoring service — [which] has not been designed with any thought to student well-being or learning in mind” (Stommel 2020). It is incommensurable to think that the ways in which academic nursing engages the violences of EdTech upon our students are not also tied to harms that extend to the public and thus even to the profession of nursing itself. Table 4 lists these harms and their descriptions.

Table 4. Harms to the Public and the Profession of Nursing

A copy of Table 4 with active hyperlinks can be accessed here.

Lawsuits against surveillance tech companies and academic institutions that deploy their products are coming. But before they arrive, nursing education can also choose to do better by the communities they serve. “In December, the Electronic Privacy Information Center (EPIC) accused five online test proctoring services, including Proctorio, of unfair and deceptive trade practices in a complaint filed with the Office of the Attorney General of the District of Columbia. EPIC also informed the five companies that it is preparing to file a lawsuit unless they change their practices. Several US senators have also recently written to the companies producing these tools to request more information about privacy, bias, and accessibility concerns raised by their tools” (Morrison & Heilweil, 2020). Nursing institutions that choose to deploy academic surveillance tools like remote proctoring should be prepared for further disruptions due to litigation and growing Federal and local regulation in this space, and especially with regards to facial recognition software (Buolamwini et al., 2020).

If professional nursing organizations and institutions are truly committed to nursing values of compassion, social justice, and diversity, equity, and inclusion in the classroom, they will:

● Take an unequivocal stance against the harms of surveillance in the classroom.

● Commit to practices of critical digital pedagogy, which include critical analysis prior to the adoption of education technologies (Morris & Stommel, 2017).

● Be honest and reflexive about historical and current realities of institutionalized oppression in nursing (Thorne, 2020), including exploitive and extractive relationships with industries such as test prep companies that require digital proctoring as part of their terms of service.

● Commit resources towards accountability for restorative justice, including acknowledgement and reparation of harms already caused, and the adoption of more just practices moving forward.


To learn more about critical digital pedagogy and other emancipatory approaches to online education, see also: Stommel, Friend, & Morris. (Eds). (2020). Critical Digital Pedagogy: A Collection. Hybrid Pedagogy Publishing.

The authors would like to thank and acknowledge additional members of the Nursing Mutual Aid collective who provided review and commentary as accountability partners in this work.



Rachel K. Walker, PhD RN FAAN

Scholar, activist, first nurse inventor to serve as an AAAS Invention Ambassador. Their work has been featured in Forbes, Science, Scientific American & NPR.