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In my school, not participating in clinicals = absence. If you can't do something, or won't, or if you are late, unprepared, not fully in uniform, etc. you get marked absent for that day. We can have 2 absences per semester. If you miss more than that, you automatically fail the course, regardless of your exam scores.
Outstanding performance in class will not make up for inadequate performance in clinical, or excessive absences from clinical, in any nursing program I've ever attended or taught in. A student in that situation would fail out of the program.