Academics Grading of Students In Nursing Education

What Is Students Grading In Nursing Education

The teacher’s assessment of students provides the basis for assigning a grade for the course. The grade is a symbol reflecting the achievement of students in that course. In addition to grading the course as a whole, grades are given for individual assignments, quizzes, tests, and other learning activities completed by students throughout the course.

Purposes of Grades

Through formative evaluation the teacher provides feedback to the learner on a continuous basis. In contrast, summative evaluation is conducted periodically to indicate the student’s achievement at the end of the course or at a point within the course. Summative evaluation provides the basis for arriving at grades in the course. Grading, or marking, is defined as the use of symbols, for instance, the letters A through F, for reporting student achievement.

Grading is for summative purposes, indicating through the use of symbols how well the student performed in individual assignments, clinical practice, laboratories, and the course as a whole. To reflect valid judgments about student achievement, grades need to be based on careful evaluation practices, reliable test results, and multiple assessment methods.

No grade should be determined by one method or one assignment completed by the students; grades reflect instead a combination of various tests and other assessment methods. Along similar lines, students may complete assignments that are not included in their grade, particularly if the emphasis is on formative evaluation. Not all of the students’ activities in a course, however, need to be graded. Grades serve three broad purposes:

(a) instructional

(b) administrative

(c) guidance and counseling

Instructional Purposes

Grades for instructional purposes indicate the achievement of students in the course. They provide a measure of what students have learned and their competencies at the end of the course or at a certain point within it. A “pass” grade in the clinical practicum and a grade of “B” in the nursing course are examples of using grades for instructional purposes.

Administrative Purposes

The second purpose that grades serve is administrative. Grades are used for:

Admission of students to entry-level and higher degree nursing programs;

Progression of students in a nursing program;

Decisions about probation and whether students can continue in the program;

Decisions about re-entry into a nursing program;

Determining students’ eligibility for graduation;

Awarding scholarships and fellowships;

Awarding honors and determining acceptance into honor societies such as Sigma Theta Tau International;

Program evaluation studies; and

Reporting competency to employers.

Guidance and Counseling

The third use of grades is for guidance and counseling. Grades can be used to make decisions about courses to select, including more advanced courses to take or remedial courses that might be helpful. Grades also suggest academic resources that students might benefit from such as reading, study, and test-taking workshops and support. In some situations grades assist students in making career choices, including a change in the direction of their careers.

Criticisms Of Grades

Although grades serve varied purposes, there are many criticisms of them. Nitko and Brookhart (2007) identified and responded to a number of these criticisms, which are applicable to grading in nursing programs:

Degrees are meaningless because of the diversity across nursing education programs, course faculty, clinical teachers, and preceptors.

Response: A consistent grading system is needed across sections of nursing courses and for grading clinical practice. It is important that full- and part-time faculty members, preceptors, and others involved in the course be oriented as to how to assess and grade each of the assignments. Clinical teachers and preceptors should discuss the clinical evaluation process and methods, how to use the clinical evaluation instrument and determine a clinical grade, and grading practices in the course.

A single symbol, such as an A or a pass, does not adequately represent the complex details associated with achievement in nursing courses.

Response: Grades are not intended to fulfill this need. They do not reflect every detail of the student’s learning in a course or every achievement. Instead, grades are a summary of achievements over a period of time.

3rd degree are not important.

Response: Although a grade is only a symbol of achievement, Nitko and Brookhart (2007) emphasizes that grades are important. The many ways that grades are used to arrive at educational decisions demonstrate how important they are to students, nursing education programs, and others. In addition, grades and overall grade point average (GPA) may predict later achievement such as performance on licensure and certification examinations. Although some may argue that the most valuable outcomes of learning are intangible, grades, nevertheless, are important.

Self-evaluations are more important than grades.

Response: Developing the ability to evaluate one’s own learning outcomes and competencies is essential for continued professional development. Both grades and self-evaluations are needed, not one or the other ( Nitko & Brookhart , 2007).

5th degree are unnecessary.

Response: In most educational settings, grades cannot be eliminated because they serve the purposes identified. A certain level of performance is essential for progression in a nursing program and for later educational decisions; grades provide a way of determining whether students are sufficiently successful to progress through the program.

6th degrees are ineffective motivators.

Response: For some student grades are effective motivators although for others this may not be true.

Low grades discourage students.

Response: Although low grades may be discouraging and stressful for students, they are essential for determining progression in a nursing program. Nursing education programs are accountable to the profession and the public for preparing graduates with knowledge and competencies for safe practice. Not all entering students have the ability to acquire this knowledge and these skills. Low grades are important for counseling students and suggesting remedial instruction; Failing grades indicate that students have not met the criteria for continuing in the nursing program.

8th Grades are inflated and thus do not reflect true achievement.

Response: Both public and private colleges and universities have undergone considerable grade inflation over the last few decades, as discussed.

Grade inflation has become a national problem (Johnson, 2003). Students are paying more for their education, and they want a reward of high grades for their “purchase.” In one study the most common reason for grade inflation as reported by faculty members was pressure from students (McCabe & Powell, 2004). In developing a grading system, it is important for nursing faculties to be clear about the standards for each grade level in that system and to communicate these to students. Scanlan and Care (2004) emphasizes that faculty need to develop valid and reliable evaluation methods and learn how to respond to irate nursing students complaining about their grades. Faculty also should periodically review the grades in nursing courses to assess if they are inflated, keeping in mind that nursing students are carefully selected for admission into the program and need to achieve certain grades in courses to progress. For this reason, grades in nursing courses tend to be higher than general education courses in which students are more heterogeneous.

Types Of Grading Systems

There are different types of grading systems or methods of reporting grades. Most nursing education programs use a letter system for grading (A, B, C, D, E or A, B, C, D, F), which may be combined with “+” and “−.” The integers 5, 4, 3, 2, and 1 (or 9 through 1) also may be used. These two systems of grading are convenient to use, yield grades that are able to be averaged within a course and across courses, and present the grade concisely.

Grades also may be indicated by percentages (100, 99, 98 ,… ). Most programs use percentages as a basis for assigning letter grades—90 to 100% represents an A, 80 to 89% a B, and so forth. In some nursing programs, the percentages for each letter grade are higher, for example, 92 to 100% for an A, 83 to 91% a B, 75 to 82% a C, 66 to 74% a D, and 65% and below an E or F.

It is not uncommon in nursing education programs to specify that students need to achieve at least a C in each nursing course at the undergraduate level and a B or better at the graduate level. Requirements such as these are indicated in the school policies and course syllabi.

Another type of grading system is two-dimensional: pass–fail, satisfactory–unsatisfactory, or credit–no credit. For determining clinical grades, some programs add a third honors category, creating three levels: honors–pass–fail. One advantage of a two-dimensional grading system is that the grade is not calculated in the GPA.

This allows students to take new courses and explore different areas of learning without concern about the grades in these courses affecting their overall GPA. This also may be viewed as a disadvantage, however, in that clinical performance in a nursing course graded on a pass–fail basis is not calculated as part of the overall course grade. A pass indicates that students met the clinical objectives or demonstrated satisfactory performance of the clinical competencies.

Grade Point Average

Another dimension of a grading system involves converting the letter grade to a grade point system for calculating the grade point average or quality point average (QPA). Grades in a 4-point system are typically:

A = 4 points per credit (or unit)

B = 3 points per credit

C = 2 points per credit

D = 1 point per credit

F = 0 points per credit

If a student took two 3-credit courses and one 6-credit nursing course and received an A in one of the 3-credit courses, a C in the other, and a B in the 6-credit course, the grade point average would be:

A = 4 points/credit = 4 points x 3 credits = 12 points C = 2 points/credit = 2 points x 3 credits = 6 points

B = 3 points/credit = 3 points x 6 credits = 18 points 36 ÷ 12 (credits) = 3.0

The letter system for grading may also include plus and minus grades. This is shown in Table 1. Bressette (2002) reported on the trend away from grading systems with few categories such as A–F to systems with more categories gained by adding plus and minus to each grade.

Although grade inflation may not decrease when plus and minus are used, these added categories allow for more differentiation for grading and may motivate students who can raise their grade through extra effort ( Bressette ). In a small study by McClure and Spector (2005), students who chose a plus/minus grading system were not more motivated than students who chose the straight A–F grading system.

Assigning Letter Grades

Because most nursing education programs use the letter system for grading nursing courses, this framework will be used for discussing how to assign grades. These principles, however, are applicable to the other grading systems as well. There are two major considerations in assigning letter grades: deciding what to include in the grade and selecting a grading framework.

Deciding What to Include in the Grade

Grades in nursing courses should reflect the student’s achievement and not be biased by the teacher’s own values, beliefs, and attitudes. If the student did not attend class or appeared to be inattentive during lectures, this behavior should not be incorporated into the course grade unless criteria were established at the outset for class attendance and participation.

The student’s grade is based on the tests and assessment methods developed for the course. The weight given to each of these in the overall grade should reflect the emphasis of the objectives and the content measured by them. Tests and other assessment methods associated with important content, for which more time was probably spent in the instruction, should receive greater weight in the course grade.

For example, a midterm examination in a community health nursing course should be given more weight in the course grade than a paper that students completed about community resources for a family under their care. How much weight should be given in the course grade to each test and other type of assessment method used in the course?

The teacher begins by listing the tests, quizzes, papers, presentations, and other assessment methods in the course that should be included in the course grade. Then the teacher decides on the importance of each of these components in the overall grade for the course. Factors to consider when weighting the components of the course grade are as follows:

Components that assess more of the important learning outcomes and competencies should carry more weight in the course grade than those that measure only a few of the outcomes ( Nitko & Brookhart , 2007).
Components that assess content that was emphasized in the course and for which more time was spent in the instruction should receive the most weight in the course grade ( Nitko & Brookhart , 2007).
Components that measure the application of concepts and theories to practice and development of higher level skills should be weighted more heavily than those that focus on recall of content.
Components that are more difficult and time-consuming for students should receive more weight than those that are easy and require less time to complete.

Selecting a Grading Framework

To give meaning to the grades assigned, the teacher needs a grading framework or frame of reference. There are three grading frameworks used to assign meaning to grades:

Criterion-referenced, also referred to as grading with an absolute scale
Norm-referenced or grading with a relative scale,
Self-referenced or grading based on the growth of the student ( Nitko & Brookhart , 2007) Table 2 illustrates these grading frameworks. Criterion- and norm-referenced evaluation methods were described; these same concepts apply to grading frameworks.

Criterion-Referenced Grading

In criterion-referenced grading, grades are based on students’ achievement of the outcomes of the course, the extent of content learned in the course, or how well they performed in the clinical practicum. Students who achieve more of the objectives, acquire more knowledge, and can perform more competencies or with greater proficiency receive higher grades.

The meaning assigned to grades, then, is based on these absolute standards without regard to the achievement of other students. Using this frame of reference for grading means that it is possible for all students to achieve an A or a B in a course, if they meet the standards, or a D or F if they do not. This framework is appropriate for most nursing courses because they focus on outcomes and competencies to be achieved in the course.

Criterion-referenced grading indicates how students are progressing toward meeting those outcomes (formative evaluation) and whether they have achieved them at the end of the course (summative evaluation). Norm-referenced grading, in contrast, is not appropriate for use in nursing courses that are based on standards or learning outcomes because it focuses on comparing students with one another, not on how they are progressing or on their achievement.

For example, formative evaluation in a norm-referenced framework would indicate how each student ranks among the group rather than provide feedback on student progress in meeting the outcomes of the course and strategies for further learning.

Fixed-Percentage Method

There are several ways of assigning grades using a criterion-referenced system. One is called the fixed-percentage method. This method uses fixed ranges of percent-correct scores as the basis for assigning grades (Miller, Linn, & Gronlund , 2009). A common grading scale is 92 to 100% for an A, 83% to 91% a B, 75% to 82% a C, 66% to 74% a D, and below 65% an E or F.

Each component of the course grade—written tests, quizzes, papers, case presentations, and other assignments—is given a percentage-correct score or percentage of the total points possible. For example, the student might have a score of 21 out of 25 on a quiz, or 84%. The component grades are then weighted, and the percentages are averaged to get the final grade, which is converted to a letter grade at the end of the course ( Kubiszyn & Borich , 2003).

With all grading systems, the students need to be informed as to how the grade will be assigned. If the fixed-percentage method is used, the students should know the scale for converting percentages to letter grades; this should be in the course syllabus with a clear explanation of how the course grade will be determined.

Computing a Composite (Single) Score for a Course

In using the fixed-percentage method, the first step, which is an important one, is to assign weights to each of the components of the grade.

In determining the composite score for the course, the student’s percentage for each of the components of the grade is multiplied by the weight and summed; the sum is then divided by the sum of the weights. This procedure is shown in Table 3.

Generally, test scores should not be converted to grades for the purpose of later computing a final average grade. Instead, the teacher should record actual test scores and then combine them into a composite score that can be converted to a final grade.

Total-Points Method

The second method of assigning grades in a criterion-referenced system is the total-points method. In this method, each component of the grade is assigned a specific number of points; for example, a paper may be worth 100 points and midterm examination 200 points. The number of points assigned reflects the weights given to each component within the course, that is, what each one is “worth.”

For example: Paper on nursing interventions 100 points Papers critiquing issues in clinical practice 200 points Quizzes 100 points Midterm examination 200 points Portfolio 200 points Final examination 200 points 1,000 points.

The points for each component are not converted to a letter grade; instead the grades are assigned according to the number of total points accumulated at the end of the course. At that time letter grades are assigned based on the points needed for each grade. For example: Grade Points A 900–1,000 B 800–899 C 700–799 D 600–699 F 0–599 One problem with this method is that often the decision about the points to allot to each test and evaluation method in the course is made before the teacher has developed them (Nitko & Brookhart , 2007).

For example, to end with 1,000 points for the course, the teacher may need 20 points for each quiz. However, in preparing one of those quizzes, the teacher finds that 10 items adequately cover the content and reflect the emphasis given to the content in the instruction. If this were known during the course planning, the teacher could assign 10 fewer points to quizzes and add another assignment worth 10 points, or could alter the points for other components of the course grade.

However, when the course is already underway, changes such as these cannot be made in the grading scheme, and the teacher needs to develop a 20-point quiz even if fewer items would have adequately sampled the content. The next time the course is offered, the teacher can modify the points allocated for quizzes in the course grade.

Computing a Composite Score for a Course

In this method the composite score is the total number of points the student accumulates, and no further calculations are needed. Nitko and Brookhart (2007) cautioned teachers to be sure that the weights of the components were reflected in the points given them in the total composite. For example, if the teacher wanted the portfolio to count 20% of the course grade, and the maximum number of points for the course was 1,000, then the portfolio would be worth a maximum of 200 points ( = 20% of 1,000).

Norm-Referenced Grading

In a norm-referenced grading system, using relative standards, grades are assigned by comparing a student’s performance with that of others in the class. Students who perform better than their peers receive higher grades (Brookhart & Nitko , 2008). When using a norm-referenced system the teacher decides on the reference group against which to compare a student’s performance.

Should students be compared to others in the course? Should they be compared to students only in their section of the course? Or, to students who completed the course the previous semester or previous year? One issue with norm-referenced grading is that high performance in a particular group may not be indicative of mastery of the content or what students have learned; it reflects instead a student’s standing in that group

Grading on the Curve

Two methods of assigning grades using a norm-referenced system are:

(a) “grading on the curve”

(b) using standard deviations

Grading on the curve refers to the score distribution curve. In this method, students’ scores are rank-ordered from highest to lowest, and grades are assigned according to the rank order. For example, the teacher may decide on the following framework for grading a test: Top 20% of students A Next 20% B Next 40% C Next 15% D Lowest 5% F

With this method there would always be failing grades on a test. After the quotas are set, grades are assigned without considering actual achievement. For example, the top 20% of the students will receive an A even if their scores are close to the next group that gets a B. The students assigned lower grades may in fact have acquired sufficient knowledge in the course but unfortunately had lower scores than the other students.

In these two examples, the decisions on the percentages of As, Bs , Cs, and lower grades are made arbitrarily by the teacher. The teacher determines the proportion of grades at each level; this approach is not based on a normal curve. Another way of grading on the curve is to use the normal or bell curve for determining the percentages of each grade.

The assumption of this method is that the grades of the students in the course should reflect a normal distribution. For example: Top 10% of students A Next 20% B Next 40% C Next 20% D Lowest 10% F As discussed , for ”grading on the curve” to work correctly, student scores need to be distributed based on the normal curve (Svinicki , 2001).

However, the abilities of nursing students tend not to be heterogeneous, especially late in the nursing education program, and therefore their scores on tests and other evaluation products are not normally distributed.

They are carefully selected for admission into the program, and they need to achieve certain grades in courses and earn minimum GPAs to progress in the program. With grading on the curve, even if most students achieved high grades on a test and mastered the content, some would still be assigned lower grades.

Standard Deviation Method

The second method is based on standard deviations. With this method, the teacher determines the cut-off points for each grade. The grades are based on how far they are from the mean of raw scores for the class instead of on an arbitrary scale ( Strashny , 2003). To use the standard deviation method, the teacher first prepares a frequency distribution of the final scores and then calculates the mean score.

The grade bound arise are then determined based on the standard deviation (Brookhart & Nitko , 2008). The cut-off points for a “C” grade range from one half the standard deviation below the mean to one half above the mean.

To identify the “A–B” cut-off scores, the teacher adds one standard deviation to the upper cut-off number of the C range. Subtracting one standard deviation from the lower “C” cut-off provides the range for the “D–F” grades (University of North Carolina Center for Teaching and Learning , 2001).

Self-Referenced Grading

Self-referenced grading is based on standards of growth and change in the student. With this method, grades are assigned by comparing the student’s performance with the teacher’s perceptions of the student’s capabilities (Nitko & Brookhart , 2007). Did the student achieve at a higher level than deemed capable regardless of the knowledge and competencies acquired?

Did the student improve performance throughout the course? Table 2 compares self-referencing with criterion and norm referenced grading. One major problem with this method is the unreliability of the teacher’s perceptions of student capability and growth. A second issue occurs with students who enter the course or clinical practice with a high level of achievement and proficiency in many of the clinical competencies.

These students may have the least amount of growth and change but still exit the course with the highest achievement and clinical competency. Ultimately, judgments about the quality of a nursing student’s performance are more important than judgments about the degree of improvement.

It is difficult to make valid predictions about future performance on licensure or certification exams, or in clinical practice based on self-referenced grades. For these reasons, self-referenced grades are not widely used in nursing education programs.

Grading Clinical Practice

Arriving at grades for clinical practice is difficult because of the nature of clinical practice and the need for judgments about performance. Issues in evaluating clinical practice and rating performance were discussed. Many teachers constantly revise their rating forms for clinical evaluation and seek new ways of grading clinical practice. Although these changes may create a fairer grading system, they will not eliminate the problems inherent in judging clinical performance.

The different types of grading systems described earlier may be used for grading clinical practice. In general these include systems using letter grades, A through F; integers, 5 through 1; and percentages. Grading systems for clinical practice also may use pass–fail, satisfactory–unsatisfactory, and met–did not meet the clinical objectives. Some programs add a third category, honors, to recognize performance that exceeds the level required.

Pass–fail is used most frequently in nursing programs (Alfaro- LeFevre , 2004; Oermann , Yarbrough, Ard , Saewert , & Charasika , 2009). With any of the grading systems, it is not always easy to summarize the multiple types of evaluation data collected on the student’s performance in a symbol representing a grade.

This is true even in a pass–fail system; it may be difficult to arrive at a judgment as to pass or fail based on the evaluation data and the circumstances associated with the student’s clinical, simulated, and laboratory practice. Regardless of the grading system for clinical practice, there are two criteria to be met:

(a) the evaluation methods for collecting data about student performance should reflect the outcomes and clinical competencies for which a grade will be assigned

(b) students must understand how their clinical practice will be evaluated and graded

Decisions about assigning letter grades for clinical practice are the same as grading any course: identifying what to include in the clinical grade and selecting a grading framework. The first consideration relates to the evaluation methods used in the course to provide data for determining the clinical grade.

Some of these evaluation methods are for summative evaluation, thereby providing a source of information for inclusion in the clinical grade. Other strategies, though, are used in clinical practice for feedback only and are not incorporated into the grade. The second consideration is the grading framework. Will achievement in clinical practice be graded from A to F? 5 to 1? Pass–fail? Or variations of these? A related question is , how will the clinical grade be included in the course grade, if at all?

Pass–Fail

Categories for grading clinical practice such as pass–fail and satisfactory–unsatisfactory have some advantages over a system with multiple levels, although there are disadvantages as well. Pass–fail places greater emphasis on giving feedback to the learner because only two categories of performance need to be determined.

With a pass–fail grading system, teachers may be more inclined to provide continuous feedback to learners because ultimately they do not have to differentiate performance according to four or five levels of proficiency such as with a letter system. Performance that exceeds the requirements and expectations , however, is not reflected in the grade for clinical practice unless a third category is included: honors–pass–fail.

A pass–fail system requires only two types of judgment about clinical performance. Do the evaluation data indicate that the student has met the clinical objectives or has demonstrated satisfactory performance of the competencies to indicate a pass? Or do the data suggest that the performance of those competencies is not at a satisfactory level?

Arriving at a judgment as to pass or fail is often easier for the teacher than using the same evaluation information for deciding on multiple levels of performance. A letter system for grading clinical practice, however, acknowledges the different levels of clinical proficiency students may have demonstrated in their clinical practice. Alfaro – LeFevre (2004) questioned whether some clinical nursing courses should be assigned pass–fail grades, and others be graded using a letter system.

A disadvantage of pass–fail for grading clinical practice is the inability to include a clinical grade in the course grade. One strategy is to separate nursing courses into two components for grading, one for theory and another for clinical practice (designated as pass–fail), even though the course is considered as a whole. Typically, guidelines for the course indicate that the students must pass the clinical component to pass the course.

An alternative mechanism is to offer two separate courses with the clinical course graded on a pass–fail basis. Once the grading system is determined, there are various ways of using it to arrive at the clinical grade. In one method, the grade is assigned based on the outcomes or competencies achieved by the student . To use this method, the teacher should consider designating some of the outcomes or competencies as critical for achievement.

Table 2 provides guidelines for converting the clinical competencies into letter grades within a criterion-referenced system. For example, an A might be assigned if all of the competencies were achieved; a B might be assigned if all of the critical ones were achieved and at least half of the others were met.

For pass–fail grading, teachers can indicate that all of the outcomes or competencies must be met to pass the course, or they can designate critical behaviors required for passing the course. In both methods, the clinical evaluation methods provide the data for determining if the student’s performance reflects achievement of the competencies. These evaluation methods may or may not be graded separately as part of the course grade.

Another way of arriving at the clinical grade is to base it on the evaluation methods. In this system the clinical evaluation methods become the source of data for the grade. For example: Paper on analysis of clinical practice issue 10% Analysis of clinical cases 5% Conference presentation 10% Community resource paper 10% Portfolio 25% Rating scale (of performance) 40% In this illustration, the clinical grade is calculated according to the evaluation methods.

Observation of performance, and the rating on the clinical evaluation tool, comprise only a portion of the clinical grade. An advantage of this approach is that it incorporates into the grade the summative evaluation methods completed by the students.

If pass–fail is used for grading clinical practice, the grade might be calculated as follows: Paper on analysis of clinical practice issue 10% Analysis of clinical cases 5% Conference presentation 10% Community resource paper 10% Portfolio 25% Clinical examination, simulations 40% Rating scale (of performance) Pass required This discussion of grading clinical practice has suggested a variety of mechanisms that are appropriate.

The teacher must make it clear to the students and others how the evaluation and grading will be carried out in clinical practice, through simulations, and in other settings.

Failing Clinical Practice

Teachers will be faced with determining when students have not met the outcomes of the clinical practicum, that is, have not demonstrated sufficient competence to pass the clinical course. There are principles that should be followed in evaluating and grading clinical practice, which are critical if a student fails a clinical course or has the potential for failing it. These principles are discussed in the text that follows.

Communicate Evaluation and Grading Methods in Writing

The evaluation methods used in a clinical course, the manner in which each will be graded if at all, and how the clinical grade will be assigned should be put in writing and communicated to the students. The practices of the teacher in evaluating and grading clinical performance must reflect this written information.

In courses with preceptors, it is critical that preceptors and others involved in teaching and assessing student performance understand the outcomes of the course, the evaluation methods, how to observe and rate performance, and the preceptor’s responsibilities when students are not performing adequately. Luhanga , Yonge , and Myrick (2008) found in a grounded theory study that preceptors passed students in clinical courses who should not have been assigned passing grades.

There is a need for faculty development especially for new and part-time teachers. As part of this development teachers should explore their own beliefs and values about grading clinical performance, the meaning of grades, and their views of “satisfactory performance” (Scanlan & Care, 2008).

Identify Effect of Failing Clinical Practicum on Course Grade

If failing clinical practice, whether in a pass–fail or a letter system, means failing the nursing course, this should be stated clearly in the course syllabus and policies. By stating it in the syllabus that all students receive, they have it in writing before clinical learning activities begin. A sample policy statement for pass-fail clinical grading is: The clinical component of NUR XXX is evaluated with a Pass or Fail. A Fail in the clinical component results in failure of the course even if the theory grade is 75% or higher.

In a letter grade system, the policy should include the letter grade representing a failure in clinical practice, for example, less than a C grade. A sample policy statement for this system is: Students must pass the clinical component of NUR XXX with the grade of “C” or higher. A grade lower than a “C” in the clinical component of the course results in failure of the course even if the theory grade is 75% or higher.

Ask Students to Sign Anecdotal Notes, Rating Forms, and Evaluation Summaries

Students should sign any written clinical evaluation documents— anecdotal notes, rating forms (of clinical practicum, clinical examinations, and performance in simulations), narrative comments about the student’s performance, and summaries of conferences in which performance was discussed. Their signatures do not mean they agree with the ratings or comments, only that they have read them.

Students should have an opportunity to write in their own comments. These materials are important because they document the student’s performance and indicate that the teacher provided feedback and shared concerns about that performance. This is critical in situations in which students may be failing the clinical course because of performance problems.

Identify Performance Problems Early and Develop Learning Plans

Students need continuous feedback on their clinical performance. Observations made by the teacher, the preceptor, and others, as well as evaluation data from other sources should be shared with the student. They should discuss the data together. Students may have different perceptions of their performance and in some cases may provide new information that influences the teacher’s judgment about clinical competencies.

When the teacher or preceptor identifies performance problems and clinical deficiencies that may affect passing the course, conferences should be held with the student to discuss these areas of concern and develop a plan for remediation. In some cases students need more time and practice to be successful (Gillespie, 2005; McGregor, 2007).

It is critical that these conferences focus on problems in performance combined with specific learning activities for addressing them. The conferences should not consist of the teacher telling the student everything that is wrong with her or his clinical performance; the student needs an opportunity to respond to the teacher’s concerns and identify how to address them.

One of the goals of the conference is to develop a plan with learning activities for the student to correct deficiencies and develop competencies further. The plan should include a statement that one “good” or “poor” performance will not constitute a pass or fail clinical grade and that sustained improvement is needed (Graveley & Stanley, 1993).

The plan also should indicate that completing the remedial learning activities does not guarantee that the student will pass the course, and that the student must demonstrate satisfactory performance of the competencies by the end of the course. Any discussions with students at risk of failing clinical practice should focus on the student’s inability to meet the clinical objectives and perform the specified competencies, not on the teacher’s perceptions of the student’s intelligence and overall ability.

In addition, opinions about the student’s ability in general should not be discussed with others. Conferences should be held in private, and a summary of the discussion should be prepared. The summary should include the date and time of the conference, who participated, areas of concern about clinical performance, and the learning plan with a timeframe for completion ( Gaberson & Oermann , 2007).

The summary should be signed by the teacher, the student, and any other participants. Faculty members should review related policies of the nursing education program because they might specify other requirements.

Identify Support Services

Students at risk for failing clinical practice may have other problems that affect their performance. Teachers should refer students to counseling and other support services and not attempt to provide these resources themselves. Attempting to counsel the student and help the student cope with other problems may bias the teacher and influence judgment of the student’s clinical performance.

Document Performance

As the clinical course progresses, the teacher should give feedback to the student about performance and continue to guide learning. It is important to document the observations made, other types of evaluation data collected, and the learning activities completed by the student. The documentation should be shared routinely with students, discussions about performance should be summarized, and students should sign these summaries to confirm that they read them.

The teacher cannot observe and document the performance only of the student at risk for failing the course. There should be a minimum number of observations and documentation of other students in the clinical group, or the student failing the course might believe that he or she was treated differently than others in the group. One strategy is to plan the number of observations of performance to be made for each student in the clinical group to avoid focusing only on the student with performance problems.

However, teachers may observe students who are believed to be at risk for failure more closely, and document their observations and conferences with those students more thoroughly and frequently than is necessary for the majority of students. When observations result in feedback to students that can be used to improve performance, at-risk students usually do not object to this extra attention.

Follow Policy on Unsafe Clinical Performance

There should be a policy in the nursing program about actions to be taken if a student’s work in clinical practice is unsafe. If the practice is safe even though the student is not meeting the outcomes, the student is allowed to continue in the clinical practicum (Graveley & Stanley, 1993). This is because the outcomes and clinical competencies are identified for achievement at the end of the course, not during it.

If the student demonstrates performance that is potentially unsafe, however, the teacher can remove the student from the clinical setting, following the policy and procedures of the nursing education program. Specific learning activities outside of the clinical setting need to be offered to help students develop the knowledge and skills they lack; practice with simulators is valuable in these situations. A learning plan should be prepared and implemented as described earlier.

Follow Policy for Failure of a Clinical Course

In all instances the teacher must follow the guidelines of the nursing program. If the student fails the clinical course, the student must be notified of the failure and its consequences as indicated in these guidelines. In some nursing education programs, students are allowed to repeat only one clinical course, and there may be other requirements to be met.

If the student will be dismissed from the program because of the failure, the student must be informed of this in writing. Generally there is a specific time frame for each step in the process, which must be adhered to by the faculty, administrators, and students. The content of the specific set of policies and procedures is not as important as the teacher’s knowing what they are and following them with all students (Boley & Whitney, 2003).

Grading Software

A number of the procedures used to determine grades are time-consuming, particularly if the class of students is large. Although a calculator may be used, student grades can be calculated easily with a spreadsheet application such as Microsoft Excel or with an online course management system. With a spreadsheet application, teachers can enter individual scores, include the weights of each component of the grade, and calculate final grades.

Many statistical functions can be performed with a spreadsheet application. Online course management systems provide grade books for teachers to manage all aspects of student grades. The grades can be weighted and a final grade calculated, but usually more advanced statistical analysis cannot be done. One advantage to a course management system grade book is that students usually have online access to their own scores and grades as soon as the teacher has entered them.

There are also a number of grading software programs on the market that include a premade spreadsheet for grading purposes; These have different grading frameworks that may be used to calculate the grade and enable the teacher to carry out the tasks needed for grading. With this software the teacher can print out grading reports for the class as a whole as well as individual students. Some even calculate test statistics. Not all grading software programs are of high quality, however, and should be reviewed prior to purchase.

Conclusion

Grading is the use of symbols, such as the letters A through F, to report student achievement. Grading is used for summative purposes, indicating how well the student met the outcomes of the course and the clinical practicum. Grades need to be careful based on evaluation practices, valid and reliable test results, and multiple assessment methods.

No grade should be determined on the basis of one method or one assignment completed by the students; grades reflect instead a combination of various tests and other assessment methods. There are different types of grading systems or methods of reporting grades: the use of letters A–E or A–F, which may be combined with “+” and “–”; integers 5, 4, 3, 2, and 1 (or 9 through 1); percentages; and categories such as pass–fail and satisfactory–unsatisfactory.

Advantages and disadvantages of pass–fail for grading clinical practice were discussed. Two major considerations in assigning letter grades are deciding what to include in the grade and selecting a grading framework. The weight given to each test and the evaluation method in the grade is specified by the teacher according to the emphasis of the objectives and the content measured by them.

To give meaning to the grades assigned, the teacher needs a grading framework: criterion-referenced, also referred to as grading with absolute standards; norm-referenced, or grading with relative standards; or self-referenced, grading based on the growth of the student.

One final concept described in the topic was grading clinical practice and guidelines for working with students who are at risk for failing a clinical course. These guidelines give direction to teachers in establishing sound grading practices and following them when working with students in clinical practice.