Pass-Fail Clinical Grades. Are educators lazy?

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A question has been raised on another thread about why clinical practica are usually pass-fail, though they often constitute a significant number of credit hours. That is to say, suppose a student really busts their hump to submit excellent written care plans that are well researched. This student also shows good to superior judgement dealing with clinical situations and interacts especially well with patients and other nurses. Why can't he/she get an A? As it stands in many programs, an strong student's overall GPA is not improved by clinical excellence since it only gets a "pass". The hard work of one student is worth no more than the plodding, do-the-minimum-to-get-by performance of another.

A student asked about this and I didn't have a ready answer. The main reason I see for making clinical a pass-fail situation is because excellence is subjective. Unsafe practice is not. So it lends itself to pass-fail. (And avoids a lot of food-fights and grade-appeals after the semester.)

Here's a question for educators. Are we being lazy by making clinical practica pass-fail? Isn't there some way we could award distinctions between unimaginative, barely motivated students and those that are truely outstanding clinically? By settling for pass-fail, are we promoting mediocrity?

Related issue: Should clinicals be worth as many credit hours as the associated classroom materials and tests?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

hello, 1tulip,

we offer awards for clinical excellence.

but, you are correct that a clinical grading system is almost impossible due to the simple fact it is entirely subjective. either one demonstrates ability to practice in the clinical setting or they do not. they may have varying degrees of this ability. minimally met, maximally met, etc. again, that would still be subjective. we provide clinical check-off lists that state if the student arived on time, dressed neatly, was professional, able to work with minimal supervision, etc. as for meeting the objectives for the clinical rotation, they did or did not. pass or fail.

i suppose someone could sit down and identify the hundreds upon thousands of combinations of what could consitute an a-b-c-d-f, but, i for one would not even want to tackle a job such as that.

i don't view that as laziness. imho.

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Specializes in Gerontological, cardiac, med-surg, peds.

Excellent question, 1Tulip. As for our cinical grading system, it is dictated by the Board of Nursing to be pass-fail. We used to award "points" (5-3-1) and for truly excellent work (a "5" average), the student was awarded 3 points directly to his or her raw theory average at the end of the semester. We have recently done away with this reward system and now we are entirely pass-fail. I find the paperwork (passing or non-passing) to be infinitely more complicated than the point scale system we were using. So, no, for me at least, it is much more laborious to document whether one is passing competencies or not passing (unsafe).

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Specializes in OB, lactation.

I'm a student. In our rotations most of our performance is pass/fail, but this last semester three of our numerous care plans were graded as part of the accompaning lecture class. We also each had a presentation (mine was on TPN, one was presented each week in post conference) that was graded.

Ours usually work that way each semester.

We have a big class (like 80 people) and I always thought it would be fun to have a friendly competition for something like "most outstanding clinical group" but as you guys wrote, I don't know how you'd measure it. You could get the staff to rate the groups but it wouldn't be fair if one group had a cranky staff and one had one that was free with praise. You'd probably have to combine several factors and it would be somewhat subjective but I'm kind of competitive so it would be a fun little motivating thing for me. Also sort of like team-building/ encouraging teamwork, it would encourage the stronger students to pull up the weaker ones (or maybe at least try).

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Specializes in Pediatrics.

i would love to give my students an actual grade, but it's not up to me. as siri mentioned, our evaluations are very subjective. i found it very difficult to just pass and fail some students. some need to know that they are doing very well, and some, imo need to know that they barely passed. i took a lot of time and effort on the 'comment' section, trying to evaluate their strengths/weaknesses. but a numerical system would be nice, imo. i think it would give the student a better idea of their performance/abilities.

fyi- at the end of this semester, when the final lecture grades were in, we (the faculty) noticed that many of the lecture grades were good indicators of their clinical abilities. i know this is not always the case (so no bashing, please, b/c there were a few exceptions), but generallyspeaking, they were on target.

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I teach Fundamentals of Nursing clinicals. We used to be P/F. Now we give a grade. I think giving the grade is a bit ( only a bit) more time consuming. However, graded or not, writing extensive comments on careplans, concept maps and other assignments is what really takes the time.

In my experience, beginning students perform at pretty much the same level. Some do better written work, but they are all somewhat nervous and unsure of what the instructor wants. There are, of course, some students who are irresponsible and unsafe; they will fail under either system.

The advantage of the P/F system is that the nervous students (and confident ones too) can concentrate on learning, rather than on grades. Personally, I favor that approach.

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As a new RN-student-to-be (only one more week!), for the first semester I would definitely prefer P/F for clinicals. We are all on a learning curve, and the most important thing we need to keep on track is PATIENT SAFETY (I believe).

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In our school, the first year program use P/F, the second year clinical grade count 10% of our final grade. But it is sometimes too subjective in my opinion. We have a crazy teacher doesn't follow her grading scale. if she like you, you will be getting good grade. if she doesn't you can fail with your clinical grade. That is awful.

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Specializes in Pediatrics.
We have a crazy teacher doesn't follow her grading scale. if she like you, you will be getting good grade. if she doesn't you can fail with your clinical grade. That is awful.

You know, I'm not looking to start a war, but i am soooo tired of hearing that. I could care less about if I like my students. I have never had the occasion to fail one (yet), but there are plenty I did not like. But that does not justify failure. And if i like you, it doesn't mean you'll automatically pass.

:nono:

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I wasn't talking about every teacher, but there is always exceptions in this world. When a instructor can slap a student's face, a faculty's, even a patient's, but still able to keep her position due to the protection from ADA. What kind of crazy things can't you expect her do? God knows how many students may end up go to see the therapist after her clinical or still have nightmares years after finish school.

You know, I'm not looking to start a war, but i am soooo tired of hearing that. I could care less about if I like my students. I have never had the occasion to fail one (yet), but there are plenty I did not like. But that does not justify failure. And if i like you, it doesn't mean you'll automatically pass.

:nono:

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Hello. I am new to all nurses and I am intrigued by this forum or discussion board. I am actually preparing to do research as a part of the thesis requirement for my masters and it centers around improving the inter-rater reliability of clinical evaluation tools through use of simulation. I don't know if a "tighter" tool will help eleviate some of the subjectivity or not. I hope to shed some light on the subject. I agree that evaluation of performance can be relatively subjective, but I am not sure if I think that is a bad thing or good thing. I just know that is the way it is. You have to have an opinion to make a judgment on anything. I quess it would depend on the character of the person as to whether that judgement was fair and not influenced by irrelevant or personal biases. We make judgements in regards to our patients, but we are trained to acknowledge our culture, beliefs, biases, prejudices etc in hopes that it will not negatively affect our care. I hope as an instructor that I don't let my beliefs etc negatively affect my evaluation on my students. I am interested in research regarding the reliability and validity of current clinical evaluation tools being used in undergraduate nursing education. If anyone has any resources or ideas to share please do so. I am aslo interested in evaluation tools being used in other programs around the country if anyone is willing to share let me know. Thanks. Lisa

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Specializes in Internal Medicine.

Hi,

I think I can offer a completely different perspective as I am a clinical instructor from Canada and we use a GPA-based grading system for clinical performance. There are 20 categories of evaluation based on competencies and we assign a performance value 1 through 4. We justify the number with actual examples of what the student did (anecdotes from each clinical week). It is very labor intensive and a source of much debate among both instructors and students. When I first started I was overwhelmed by it but I am starting to get better at being very specific with my anecdotes.

The main issue is the lack of control that we have over the types of challenges that each student is presented with in clinical settings and the inability to witness all each student does. With these limitations, the assigning of a number grade to performance seems like more of a guessing game at times. For some students it can also seem unfair. If a clinical area presents few real challenges, it is difficult to ensure all students are given equal opportunity to demonstrate all their clinical knowledge and skills.

This grading system is imposed by the University as they mandate that all courses are awarded a GPA.

So the grass isn't always greener as the majority of instructors I work with would prefer pass/fail as it seems like it is based more in reality than our current system. It is easier to justify why a student does not meet the minimum requirements to pass the course, however, when you are supplying week by week anecdotes of issues with safety or performance. I just feel like giving someone a letter grade causes quite a bit of anxiety for everyone.

Brenda

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