Issues with grading the unsafe student Dr Helen Mulcahy 2019

Requirements: Competence “Safe and effective practice requires a sound underpinning of theoretical knowledge that informs practice and is in turn informed by that practice” Reflected in the 5 domains of competence professional/ethical practice holistic approaches to care and the integration of knowledge interpersonal relationships organisational and management of care personal and professional development

Standards specific to Clinical Learning Environment Aim – “safe, caring, competent decision-makers” Integrate theory and practice Direct client contact Fully acquainted with learning outcomes Named preceptor Teaching and assessing education Support from named nurse lecturers Sufficient practitioners Audit of quality of clinical practice sites – near future

Luhanga, Yonge, & Myrick (2008)

Evidence from the literature Many examples of reluctance to award a failing grade Reasons identified as to why students passed – Reticence on the part of preceptors to identify or resolve problems early enough - Lack of preparation for preceptors The threat of the university appeals system Lack of preceptor adherence to appropriate procedures when assigning a failing grade Failing a student perceived as uncaring

Luhanga et al. (2008) Grounded theory study Theoretical sample of 22 nurse preceptors with 0-16 years of precepting experience who had precepted 1-20 students in their careers. Search of ‘negative cases’ Data collection –semi structured interviews Data analysis – constant comparative analysis

Results Five major categories 1. Hallmarks of unsafe practice 2. Factors contributing to unsafe practice 3. Preceptors perceptions and feelings 4. Grading issues 5. Strategies for managing unsafe practice

Failure to fail

Reasons for passing students who shouldn’t Fear of jeopardising students future Members of a caring profession Lack of experience Student failure interpreted as own failure Fear of being labelled as a ‘bad’ person by student and colleagues. Not dealing with problems early enough Felt student was a ‘nice’ person Complacency or laziness Extra workload involved Inadequate concrete evidence or documentation Lack of time to observe Lack of affective domain in evaluation tool – i.e. how could ‘bad attitude’ be captured. Nursing shortages

Recommendations Realisation of the important role of preceptors as gatekeepers to the profession. Support for the evaluative role of the preceptor by HEI Adequate preparation to improve knowledge and confidence Clear professional boundaries with students Careful, collaborative action when problems identified

Burns et al (2006)

When to call for help? As soon as you suspect an irresolvable problem Academic deficiency Unprofessional behaviour Motivation Absence/ timeliness Maturity Communication style

References Nursing and Midwifery Board of Ireland (2015) Public Health Nurse Education Programmes. Requirements and Standards. NMBI, Dublin Burns C., Beauchesne, M., Ryan-Krause P. Sawin K. (2006) Mastering the Preceptor role: Challenges of Clinical Teaching. Journal of Pediatric Health Care 20 (3) 172-183. Luhanga F., Yonge O., & Myrick F. (2008) “Failure to assign Failing grades”: Issues with grading the unsafe student. International Journal of Nursing Education Scholarship 5 (1) 1-13