What is Clinical Failure In Nursing Education

Clinical Failure In Nursing Education What is Clinical Failure?

Clinical failure occurs when evidence-based assessment and evaluation processes used by nursing faculty identify unsafe student behaviors during clinical practice. These behaviors may include knowledge deficits, lack of skill proficiency, unprofessional conduct, and actions that pose risks to patient safety or violate ethical standards. Clinical failure is determined based on professional, academic, and personal reasons and is supported by structured evaluation tools and processes that align with public, professional, and academic standards (Larocque & Luhanga, 2013; Luhanga, Yonge, & Myrick, 2008; Tanicala, Scheffer, & Roberts, 2011).

Impact of Clinical Failure on Nursing Education

Clinical failure significantly affects nursing education by challenging the educational framework, evaluation methods, and policies within nursing programs. The determination of clinical failure is made using evidence-based tools and evaluation processes created through public, professional, and academic standards (Killam et al., 2010; Larocque & Luhanga, 2013). These tools must be program-appropriate and match the timing of the clinical experience (Tanicala et al., 2011).

To ensure accurate assessment, clear documentation, objectivity, and transparency, checklists with well-defined behaviors and practices that align with each clinical objective are used (Larocque & Luhanga, 2013; Luhanga et al., 2008). Students are evaluated on their performance in each clinical experience and provided with feedback on identified remediation needs, which must be completed within a designated timeframe (Larocque & Luhanga, 2013).

Clinical failures may arise due to various factors, such as:

• Knowledge Deficits: Inadequate understanding of theoretical concepts and clinical skills.
• Psychomotor Skills Below Expectations: Lack of ability to perform essential nursing procedures safely and competently.
• Lack of Motivation and Professionalism: Demonstrating an inappropriate attitude, unprofessional behavior, or a lack of commitment to learning.
• Unsafe Practices: Actions that place patients, peers, or themselves at risk of harm.
• Failure to Seek Help: Inability to recognize deficits and seek assistance when necessary.
• Calculation Incompetency: Errors in medication dosage calculations or other clinical math.
• Violation of Policies and Ethical Standards: Engaging in unethical conduct, such as falsification of documentation or breaching patient confidentiality (Killam et al., 2010; Larocque & Luhanga, 2013).

Challenges Faced by Clinical Faculty in Failing Students

Clinical faculty members face several challenges in determining clinical failure:

1. Subjectivity in Evaluation: Ensuring that assessments are objective, reliable, and valid can be challenging when evaluating diverse student behaviors and skills.
2. Concerns About Consequences: Faculty may fear negative repercussions, such as student appeals, additional time required for documentation, damage to their professional reputation, or concerns about institutional expectations for student pass rates (Killam et al., 2010; Larocque & Luhanga, 2013).
3. Emotional and Ethical Dilemmas: Faculty may feel conflicted about failing a student due to the potential financial and academic consequences for the student, or concern that the failure reflects poorly on their teaching abilities.

To support faculty, it is essential to provide:

• Clear Policies and Procedures: Establishing standardized evaluation tools and organizational policies to guide faculty in making decisions.
• Administrative Support: Offering administrative backing to faculty members ensures they understand their roles as gatekeepers of the profession and the ethical and legal obligations of their positions.
• Orientation and Training: Regular training for clinical faculty on using evaluation tools, documenting performance, and understanding organizational policies (Tanicala et al., 2011).

Outcomes of Clinical Failure

The outcomes of clinical failure have broad implications for nursing education programs, including:

1. Improvement of Evaluation Tools and Policies: The literature highlights the need for evidence-based evaluation tools and clear organizational policies to define behaviors and practices for each level of clinical practice. This clarity helps in making objective decisions regarding clinical failure (Larocque & Luhanga, 2013).
2. Identifying Unsafe Students: A critical outcome is the ability to identify unsafe students early in their training. This early identification allows for timely intervention and remediation, preventing unsafe students from progressing further in the program without meeting minimum competency standards (Killam et al., 2010; Tanicala et al., 2011).
3. Preventing Marginal Students from Passing: Without clear policies, tools, and sufficient observation time, borderline or marginal students may be allowed to pass due to the benefit of the doubt given by faculty. This leniency can jeopardize patient safety in real-world settings (Killam et al., 2010; Larocque & Luhanga, 2013).
4. Supporting Academic Decisions During Appeals: Organizational policies must support faculty in making defensible decisions based on documented evidence to withstand academic appeals processes. Clear documentation of student performance, feedback, and remediation efforts is crucial for upholding decisions of clinical failure.
5. Ensuring Faculty Competence and Fairness: Faculty must be competent in both clinical practice and evaluation methods. Ongoing education and training help ensure that clinical faculty are equipped to assess students accurately, provide constructive feedback, and facilitate remediation when needed (Tanicala et al., 2011).
6. Ensuring Student Success and Patient Safety: Effective evaluation and remediation processes ensure that only students who meet safety and competency standards progress in the program. Students who fail to meet these standards, even after remediation efforts, should receive a clinical failure to protect patient safety and uphold the integrity of the nursing profession.

Conclusion

Clinical failure in nursing education is a complex but essential process that protects patient safety and maintains the standards of the nursing profession. By implementing clear evaluation tools, objective assessment methods, and strong organizational support, nursing education programs can ensure that students who do not meet clinical competency standards are identified, remediated, or, when necessary, failed. This process upholds the integrity of nursing education and ensures that only competent, safe practitioners enter the nursing workforce.