Grading Practices In Clinical Nursing Education 

Grading Clinical
Practice In Nursing Practices

    Grading
clinical practice is a process in which a clinical nursing faculty assesses the
nursing student in a clinical setting and then assigns a grade that determines
whether or not that student has met clinical course objectives and is safe to
practice (Amicucci 2012).

Implementation of Nursing Graded Clinical Practices

    Evaluating
a student’s level of performance involves monitoring the student’s progression
toward learning goals and then making a decision on that student’s performance,
which is reflected in the student’s final grade (Oermann, Yarbrough, Saewert,
Ard, & Charasika, 2009). The current standard of grading clinical practice
is based on the evaluation of clinical competency. Safe practice is one aspect
of competency along with analyzing complex patient situations, problem solving,
and effective communication with other health care providers, as well as the
patient (Oermann et al, 2009). 

    Nurse educators have failed to clearly define
competency (Cermann et al., 2009, Watson, Stimpson, Topping, & Porock,
2002). According to Watson, Stimpson. Topping, and Porock (2002, p. 423),
“competence may be achieved by a general level of performance being
assessed or it may be achieved by having a number of component parts of
competence, so called competencies, being performed.” Competencies are
determined by and distributed through national organizations of nursing,
accrediting bodies in nursing, schools of nursing, and clinical nurse
faculties.

Impact of Grading Nursing Practice In Clinical Education

    Clear
guidelines for grading clinical practice in nursing education have not been
established. When grading clinical practice, multiple strategies should be
incorporated in making a decision on a student’s clinical performance (Oermann
et al, 2009). Strategies and tools reported in the literature include clinical
evaluation forms/checklists, student contribution to clinical conferences, case
presentations, skills laboratory, simulation, and rubrics (Ashcraft et al.
2013; Coralli, 2006 Himes & Ravert, 2012: Houghton, Casey, Shaw, &
Murphy, 2012; Oermann et al., 2009).

    Due
to the lack of a clear definition, it is not surprising that there is also a
lack of valid and reliable instruments to assess clinical competence. The tools
and strategies mentioned above may be used but “the likelihood that vital
concepts are excluded and irrelevant concepts are included in existing clinical
competence assessment instruments is very high…when developed, there remains
the issue of what level of performance indicates competence and at what
level a student can be deemed incompetent” (Watson et al. 2002, p. 423)

    Graded
versus pass/fail assessment is another topic of debate when assessing clinical
practice. Use of pass/fail when grading clinical practice represents either
“acceptable” or “non acceptable” standards of nursing
practice (Andre, 2000). Thus, application of a pass/fail grading system does
not represent the efforts of the high-achieving student and
“pass/fail” does not accurately describe these efforts to future
employers, scholarship, and postgraduate committees (Andre, 2000). The grading
process provides insight to both the teacher and student on the student’s
standing as well as what the student needs to do to improve that standing
(Biggs, 1992).

    In
contrast, proponents for pass/fail propose that pass/fail encourages
self-reflection and self-regulated learning. According to the proponents,
overall performance and motivation among students is no less when using
pass/fail as opposed to grading, pass/fail fosters a less competitive learning
environment; pass/fail results in better group cohesion as well as increased
collaboration among students; and use of pass/fail can lead to improved
well-being, better mood, and lower stress in students (Robins et al., 1995;
Rohe et al., 2006; Spring, Robillard, Gehlbach, & Simas, 2011; White &
Fantone, 2010).

    Irrespective
of the grading system chosen, grades in clinical practice are affected by
leniency and subsequent grade inflation (Donaldson & Gray, 2012 Seldomridge
& Walsh, 2006). Grade inflation occurs when clinical scores exceed actual
student performance and is made obvious by class evaluations demonstrating many
high grades and a few average grades in the clinical setting (Seldomridge &
Walsh, 2006). Reasons for grade inflation include student-instructor
relationships, inexperience of faculty, pressure from students for good grades,
avoiding conflict associated with failing a student, and tool design (Donaldson
& Gray, 2012).

Outcomes of Grading Nursing Practices

    The
literature is rich with discussion on the problems of clinical evaluation, but
sparse in terms of solutions. Clinical nursing faculty has a professional
responsibility to fairly and accurately determine if a student is competent and
safe to practice. There is a need for research in grading clinical practice,
specifically in the following areas: 

(a) defining clinical competence

(b)
developing valid and reliable instruments to determine competence

(c) choosing
between graded versus pass/fail assessment

(d) reducing grade inflation.
As the role and opportunities for nursing practice continue to expand,
optimizing accuracy in grading clinical practice will help to ensure that
nursing students are prepared for the challenges of clinical practice.