1. Issues with grading the unsafe student
Dr Helen Mulcahy
2019

2. 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

3. 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

4. Luhanga, Yonge, & Myrick (2008)

5. 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

6. 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

7. 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

8. Failure to fail

9. 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

10. 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

11. Burns et al (2006)

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

13. 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)
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