Australian assessors' experiences of grading nursing student performances in clinical courses when that performance is not a clear pass or fail

Abstract

Accurate assessment of nursing students’ clinical performance is a cornerstone of professional nursing education. Such assessment is vital to ensure the delivery of safe clinical practice and maintain high nursing proficiency. Ensuring nursing students meet fitness for practice standards commensurate with their level of experience is an essential component of an assessor’s role. However, evidence suggests that some students pass assessment items within clinical courses of undergraduate tertiary nursing programmes despite not reaching the required standards of practice. Whilst this phenomenon, known as failure to fail, has been alluded to in studies involving mentor assessors in the Northern Hemisphere, to date, no comprehensive evaluation of failure to fail has occurred in the Australian nursing context. The aim of this programme of work was twofold: first, to identify whether failure to fail is a real issue in the Australian education nursing context; and second, to progress understanding of the failure to fail phenomenon and explore assessors’ experiences of grading marginal student performances when student performance is not a clear pass or fail. This aim was achieved through an exploratory, sequential, mixed methods design where the data and results from one phase of the research provided the foundation and direction for the next phase of the research. Guided by Invitational Theory, this programme of work included one-on-one and focus group interviews, and the development, testing, and piloting of the Assess-Safe Instrument measuring assessors’ experiences of grading marginal student performances. Invitational Theory, a humanistic theory designed to empower people to reach their full potential, was the theoretical framework that guided the two data collection phases of this study. First, one-on-one and focus group interviews were conducted with academics (n=23) to explore their perceptions of failure to fail. Findings from this discrete analysis identified two main themes that impacted upon assessors’ experiences: human influences and organisational processes. These data were then used to develop a tool that measured assessors’ experiences of grading nursing student performances in clinical courses when that performance was not a clear pass or fail and its psychometric properties were assessed. This was piloted with industry and tertiary assessors (n=149) in an Australian population. The findings of this analysis identified that assessors take their role of gatekeeper to the profession very seriously; however, personal, professional, and systemic issues impacted upon their ability to fulfil this role. The results of these two phases were integrated to enable greater understanding of the enablers and barriers to assessors managing failure to fail. Three enablers and four barriers emerged from across the data. These data suggested that enablers include assessor support, programme flexibility, and organisational culture. The barriers include grade inflation, student responses, organisational processes, and workload. The enablers facilitated assessors’ abilities to fail a student who was underperforming in clinical courses. Several barriers were highlighted that impacted on assessors’ abilities to award a failing grade to a performance that did not meet standards of practice. This new understanding provides a clear identification of the ongoing gaps in knowledge and practice, as well as target areas for future programme and assessor development in Australian, and possibly international, tertiary nursing programmes. Consequently, strategies that enhance the enablers and reduce the barriers to failing students will empower and support assessors to fulfil their gatekeeping role. This newly developed understanding has the potential to benefit student competence, assessors’ experiences, patients, their families, and the nursing profession.