In my Assessment class we have a final up to forty five minute compentency which we must pass or we fail the course (even though I have a 90% average on my written exams). Now I can see not allowing me to progress without passing the compentency (which is a C or 78%). However, why hold an "F" over our heads? What would be the harm in giving the lower of a C- or your current actual grade in the class (even a D- would work). After all if I was scoring a 77% rather than a 90% I couldn't "pass" the course, but would still get a "C-" rather than an "F". In my case failing would probably mean losing my house, car and utilities in Jan because I wouldn't receive financial aid due to failing the course (and therefore not having full time status the previous semester as required. I would work overtime, but it would probably be too little and late to avoid foreclosure since we will be running 30 days late in December anyways).
There are a few things on the test which no matter how much I study I still might fail (it's not likely, but there is probably a solid 10% chance of not getting it under final conditions). For example I often have trouble locating my large partner's femoral pulse (the instructor verifies that we've actually found the required pulses by feeling where we place our hands). Furthermore, I have trouble distinguishing vesicular, from bronchovesicular sounds on the posterior chest. In addition, I have trouble "counting S1 and S2 out loud" especially at the Aortic (2nd ICS, right sternal border), and the Right Atrial areas (4th ICS, right sternal border) in my larger partner (he's a 235 pound, thickly built body builder, but not real lean yet). I also have difficulty palpating the systolic blood pressure, because I can barely feel his brachial pulse (although I generally do fine on the auscultation) Any one of these issues could cause me not to pass.
The other issue with this type of "exam" is that everyone has a different "difficulty level". Consider, that I weight 270 pounds and am an even more difficult patient for him, that he is for me. It doesn't seem fair that either of us could fail out for failing some clinical skill when the average student is maybe 19 and weights maybe 135 pounds. It would be like giving some students a written test that was much harder than others, which is almost never done. I realize of course that in the real world we will sometimes encounter difficult patients (who are frail, obese, or otherwise difficult), but it generally won't be a one shot pass/fail situation where we are not afforded any assitance. Furthermore, it generally won't be for not being able to palpate (which is almost never done clinically) blood pressure, or to distinguish vesicular/from bronchovesicular sounds, or for not being able to count S1/S2 out loud.
Also, let's say that I fail out, but still want to be a nurse ( if I fail it will be on something like failing to properly palpate the systolic BP, failing to find the femoral pulses, or improperly counting S1/S2 or mis identifiying vesicular verses bronchvesicular sounds). What would be my best path "back in". One option that I've considered is to try to find an LPN program or even a diploma program that would take me. Then after a couple of years reapply to one of the University RN/BSN programs. I am unusual in that I really struggle with the "physical skills" rather than the academics. Even in my job as a CNA/home health aid I find that things like dressing/undressing clients to be difficult. Furthermore, changing "diapers" with gloves on is a real challenge (seldom do I not rip out the tips).
