Clinical Failure In Nursing Education
What is Clinical Failure
Clinical failure occurs when evidence based assessment and
evaluation processes implemented by faculty identify unsafe student behavior
(Larocque & Luhanga, 2013; Luhanga, Yonge, & Myrick, 2008, Tanicala,
Scheffer, & Roberts, 2011)
Impact of Clinical Failure on Nursing Education
Determination of clinical failure arises through the use of evidence-based tools and evaluation processes created through the use of public, professional, and academic standards (Killam, Montgomery, Luhanga, Adamic, & Carter, 2010; Larocque & Luhanga, 2013). Tools and processes need to be appropriate at the program level and timing of the clinical experience (Tanicala et al., 2011). The use of checklists with clearly defined behaviors and practices that align with each objective ensures accurate assessment, clear documentation, objectivity, and transparency (Larocque & Luhanga, 2013; Luhanga et al., 2008).
Students are evaluated and advised of
their performance at each clinical experience, followed by identified
remediation needs with required completion in a designated time frame (Larocque
& Luhanga, 2013; Luhanga et al., 2008). Examples of behavior and practices
that indicate clinical failure include clear knowledge deficits, psychomotor
skills below expectations, lack of motivation, inappropriate interpersonal skills,
actions that place others at risk for harm, poor attitude, lack of preparation,
unethical or unprofessional conduct, failure to identify and seek help for
deficits, lack of calculation competency, violation of policies, inability to
apply theory to practice, and cheating or falsification of documentation
(Killam et al., 2010; Larocque & Lubanga, 2013, Luhanga et al., 2008;
Tanicala et al., 2011). SYNOPSIS
Clinical failure may be determined to be due to professional, academic, and personal reasons. The National League for Nursing (NLN, 2005) identified the core competencies for nurse educators related to assessment and evaluation strategies. Based on these core competencies, the challenge for clinical faculty is recognition of students who are unsafe. If students are unable to remediate to a level of competence by the end of the clinical experience, then failing the student is the only option.
However, clinical faculty are hesitant to fail a student based on lack of preparation, risk of an appeals process, required time to complete adequate documentation, concern about being thought of negatively by others, institutional expectations that all students will pass, concern that teaching ability will be considered the reason for a student's lack of success, financial implications forth student, and concern that a second failure means dismissal from the nursing program (Killam et al., 2010; Larocque & Luhanga 2013; Luhanga et al., 2008; Tanicala et al 2011).
Supporting clinical faculty with thorough orientation to the
clinical evaluation tools and organizational policies, promoting faculty
student assessments that are objective, reliable, and valid. Clinical faculty
when have administrative support understand the importance of being the
gatekeeper of the profession, demonstrating responsibility and accountability
to the profession a society, as well as ethical and legal obligations to
determine clinical failure where established criteria are not met,
Outcomes of Clinical Failure
The literature supports the fact that challenges when determining clinical failure originate from lack of clear and concise evaluation tools and sustained organizational policies (Larocque & Luhanga, 2013) Evidence-based evaluation tools and processes must be established that clearly and concisely define behaviors and practices each level of clinical practice within the prom gram of study. Furthermore, problems associated with observing each student over a sufficient period of time may interfere with identification of unsafe students.
When the unsafe student is not identified, then student who are marginal or borderline may pass the clinical experience because the faculty member gives the student the benefit of the doub (Killam et al, 2010; Larocque & Luhanga 2013; Tanicala et al, 2011). Organizational policies must be in place to support clinical faculty decision making based on policies and documentation that will make the case for failure during an aca demic appeals process.
In addition, selection of clinical faculty must not only ensure expert practitioners, evaluators, and supervisors, but also ensure that they are fully immersed in translation of theory into practice and skilled in assisting students to close the theory practice gap: Orientation and ongoing education should be implemented to address specific clinical faculty issues based on identified needs.
Clinical faculty must be effective in engaging students where open and transparent communication of performance is presented with each clinical experience (Tanicala et al, 2011). Establishment of policy, tools, and guidelines as well as further research into these areas, offer the evidence required to ensure that safe students pass the clinical experience, that unsafe students have the opportunity to remediate to safety, and- those that remain unsafe will be assigned a clinical failure.
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