Legal Issues Related to Dismissing Students for Clinical Deficiencies

The Struggle Is Real: Investigating the Challenge of Assigning a Failing Clinical Grade

AIM

The aim of the study was to explore the relationships between role strain, faculty stress, and perceived organizational support for nurse faculty who faced the decision to assign a failing clinical grade.

BACKGROUND

Although faculty are responsible for assigning a grade reflecting students' competence and ability to practice safely, faculty find it troublesome and stressful to assign a failing clinical grade.

METHOD

A national sample consisting of 390 nursing faculty completed an online four-part questionnaire with an open-ended question. Data were analyzed using parametric statistical testing and conventional content analysis.

RESULTS

Statistically significant relationships were found between role strain, faculty stress, and perceived organizational support. Ten issues related to system breakdown were identified. Most (82.6 percent) reported assigning the failing grade; many reported changes in teaching practices following the deliberation to assign a failing grade.

CONCLUSION

The decision to assign a failing clinical grade remains a significant issue for undergraduate and graduate clinical nurse faculty.

The Fundamentals of Resident Dismissal

Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.

Nursing Students' Perceptions of Anecdotal Notes as Formative Feedback

Anecdotal notes are a method of providing formative feedback to nursing students following clinical experiences. The extant literature on anecdotal notes is written only from the educator perspective, focusing on rationale for and methods of production, rather than on evaluation of effectiveness. A retrospective descriptive study was carried out with a cohort of 283 third year baccalaureate nursing students to explore their perceptions of anecdotal notes as effective formative feedback. The majority of students valued verbal as well as anecdotal note feedback. They preferred to receive feedback before the next learning experience. Students found the quality of feedback varied by instructor. The anecdotal note process was found to meet identified formative feedback requirements as well as the nursing program's requirement for transparency of evaluation and due process. It is necessary to provide professional development to clinical nurse educators to assist them develop high quality formative feedback using anecdotal notes.

A descriptive analysis of the impact of moral distress on the evaluation of unsatisfactory nursing students

BACKGROUND

Nurse educators assume a difficult role when evaluating unsatisfactory students, including those at risk for failure in clinical and classroom settings. While the decisional dilemma inherent in evaluating unsatisfactory students has been well documented in literature, little is known about how moral distress impacts the nurse educators' decisions regarding whether to pass or to fail unsatisfactory students.

PURPOSE

This article aims to provide a descriptive analysis of the moral dilemmas and the potential impact of moral distress experienced by nurse educators when evaluating the performance of unsatisfactory students in clinical and classroom courses.

METHODS

Nathaniel's theory of moral reckoning guided the descriptive analysis of six studies to understand how nurse educators work through moral dilemmas, make decisions, and provide justification for their decisions when evaluating the performance of unsatisfactory students.

FINDINGS

Nathaniel's theory has been shown to be helpful in discussing the dilemma of evaluating unsatisfactory students, and it is a suitable framework for nurse educators in working through their dilemmas as a form of structured reflection.

PRACTICE IMPLICATIONS

The outcomes of this descriptive analysis highlight the need for educational administrators to provide support to undergraduate nurse educators experiencing moral distress in this type of situation.

Exploring the issue of failure to fail in a nursing program

A study using a qualitative descriptive design was undertaken to explore the issue of "failure to fail" in a nursing program. Individual in-depth interviews were conducted with nursing university faculty members, preceptors, and faculty advisors (n=13). Content analysis was used to analyze the data. Results indicate that: (a) failing a student is a difficult process; (b) both academic and emotional support are required for students and preceptors and faculty advisors; (c) there are consequences for programs, faculty, and students when a student has failed a placement; (d) at times, personal, professional, and structural reasons exist for failing to fail a student; and (e) the reputation of the professional program can be diminished as a result of failing to fail a student. Recommendations for improving assessment, evaluation, and intervention with a failing student include documentation, communication, and support. These findings have implications for improving the quality of clinical experiences.

The preceptorship experience: an examination of ethical and accountability issues

In this article, the authors examine ethical and accountability issues that emerged from a recent retrospective grounded theory study exploring the challenges for preceptors when working with nursing students whose clinical practice is unsafe. A primary goal of nursing education is to prepare safe and competent practitioners who can be accountable for their own actions (M. Smith, Y. McKoy, & J. Richardson, 2003). Within the context of preceptorship, both preceptors and faculty have an academic, legal, ethical, and professional responsibility not only to teach but also to evaluate students' clinical performance to ensure that as graduates of their programs they are competent to provide the public with safe nursing practice (P. Boley & K. Whitney, 2003; M. Smith, Y. McKoy, & J. Richardson, 2003). The findings of this study have implications for nurse educators and administrators in preparing and supporting both preceptors and students, especially in difficult or challenging teaching-learning situations.

Iranian nursing students' comprehension and experiences regarding evaluation process: a thematic analysis study

In this study, a qualitative design based on a thematic analysis approach was employed to explore the comprehension and experiences of Iranian nursing students regarding evaluation process in both classroom and clinical setting. After utilising purposeful sampling to choose 13 bachelor's degree nursing students, semi-structured interviews were held for data gathering. During the data analysis, three main themes emerged: 'definition of evaluation process', 'unfair evaluation' and 'ideal evaluation'. The second theme consisted of two sub-themes: 'problematic process' and 'unexpected outcome'. Our study findings showed a gap between what Iranian nursing students depicted as a fair and equitable evaluation and what they experienced during their academic career. There is a need to bring a change to process of evaluation to increase the feeling of fairness and justice regarding evaluation among nursing students. The findings can be helpful for international nurse instructors to be exposed to the unheard perspectives of nursing students and reconsider the weaknesses of evaluation process conducted by them.

Use of anecdotal notes by clinical nursing faculty: a descriptive study

Although the use of anecdotal notes by faculty to document clinical performance is thought to be a common practice, no empirical study of this evaluation tool has been conducted. To investigate the frequency and pattern of use, a faculty questionnaire was developed using the Context, Input, Process, Product (CIPP) evaluation model as a framework. The model was adapted to focus on clinical nursing education. Sixty-four nursing faculty from six schools participated in the regional study. A descriptive design was used to collect quantitative data from clinical faculty. Findings indicated that 97% of clinical faculty use anecdotal notes during the student evaluation process, and the majority of faculty do so on a weekly basis. Based on faculty feedback and the CIPP evaluation model, a clinical nursing faculty tool was developed after study completion to support clinical faculty in note use.

Point System Versus Legal System

Faced with increasing attendance and tardiness problems in an undergraduate student nursing clinical setting, the authors implemented a "point system" policy to objectively evaluate student performance. The authors discuss the policy, based on area hospital attendance point systems, and its impact.

Participatory inquiry with a colleague: an innovative faculty development process

Clinical evaluation is central to the aims of nursing education; however, little has been written about the actual evaluative practices of nurse educators and the sources of influence on those practices. In this article, we describe our experience as co-investigators into the evaluation practices of one of us (J.A.J.) and overview some of the challenges and opportunities of participatory inquiry. We describe how J.A.J.'s involvement in this research project encouraged her to explore her evaluative practices in a meaningful way, which moved her to a place of deeper understanding about her work and transformed her as a nurse educator. As a result of this study, we are convinced of the necessity for a faculty development process whereby colleagues commit to a critical inquiry process focused on identifying each other's evaluative practices and sources of influence on those practices. In addition, schools of nursing can encourage faculty participation in peer development by adopting an expanded view of scholarship in which the disciplined examination of one's evaluative practices is accepted as evidence of the scholarship of teaching.