Running head: CRITIQUE OF STUDENT CLINICAL COMPETENCE 1

Critique of Student Clinical Competence

Kristen Eden

Bethel College
CRITIQUE OF STUDENT CLINICAL COMPETENCE 2

Critique of Student Clinical Competence

Evaluating the effectiveness of nursing students’ learning in the clinical setting is a

detailed process requiring much attention and observation by the clinical faculty. Faculty must be

present to assess the student’s level of competence during performance of nursing skills such as

foley insertions, medication administrations, and performance of head-to-toe assessments. This

attention to the performance of one’s students allows the educator to confidently evaluate the

student and decide whether the student will pass the clinical rotation satisfactorily or fail due to

not meeting the expectations listed in the clinical syllabus.

Evaluation of nursing students is an ongoing process that must start at the beginning of

the clinical rotation. When an educator observes a deficiency in the performance of a student,

they must provide immediate feedback to correct the mistake. It is not enough to provide

feedback and evaluation at the end of the clinical rotation in the form of a final or summative

evaluation. Students must be provided with frequent, detailed formative evaluations on their

performance throughout the duration of the clinical rotation (Billings & Halstead, 2016).

Formative Evaluation

The Bethel nursing students I have been working with are evaluated weekly in the form

of an e-journal. The students must write about how they successfully met the six clinical

outcomes in the body of their e-journal. These clinical outcomes include:

1. Identify nursing judgment when making effective decisions regarding potential and

chronic alterations in health while providing holistic patient/family-centered care in the

acute care setting

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2. Effectively communicate with patients having alterations in health, families, and

members of the health care team in acute care settings.

3. Apply the nursing process to deliver safe, quality care to patients experiencing

potential and chronic alterations in health.

4. Recognize evidence-based practice when making nursing judgments about potential

and chronic alterations in health while providing patient/family-centered care in the acute

care setting.

5. Describe how nursing informatics supports quality improvement, communication, and

nursing judgment while caring for patients with potential and chronic alterations in health

in the acute care setting.

6. Practice nursing behaviors of leadership and professionalism consistent with legal and

ethical while caring for patients with potential and chronic alterations in health in the

acute care setting.

The students are required to self-evaluate their performance of each of the outcomes

using ratings of satisfactory (S), needs practice (NP), unsatisfactory (U), and not applicable

(NA). The clinical faculty and I then read the e-journals and determine whether the students’ self-

evaluation is accurate based on our observation of their performance during the clinical day. We

make comments in the body of the e-journal and then include our evaluations of their completion

of the outcomes at the end. This weekly evaluation enables us to provide suggestions for

improvement as well as encouragement. The weekly e-journal also provides documentation of

poor performance and behaviors should we have to fail a student based on their failure to meet

the clinical outcomes.

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Clinical Assignments

These medical-surgical level two students are each assigned one patient to care for during

the clinical day. They are required to attend pre-conference to receive their patient assignment

and be informed of any announcements the clinical faculty has for that day. Students are then

dismissed to the nursing unit and instructed to begin their shift by reviewing their patient’s

electronic medical record (EMAR). They are expected to review the patient’s diagnoses,

treatment plan, orders, and medications. By reviewing the patient’s chart, they develop an

understanding of the overall treatment plan for the patient and may safely begin their clinical

day. They will meet outcome five if they are familiar with gathering information from EMAR.

After reviewing the chart, the students are expected to request report from the nurse that

is caring for their patient. This allows the student to gain experience communicating with nursing

colleagues. The students include this information in their SBAR clinical paperwork which is

submitted for faculty review after the clinical week is complete. Successful communication

throughout the clinical day allows the student to meet outcome two.

The students are then required to complete a full head-to-toe assessment of their patient

by the third hour of clinical. This allows the student to become familiar with the assessment

findings associated with their patient’s disease or condition. Performing this assessment at the

beginning of the shift allows the student to note any changes to their patient condition and react

accordingly. If the student successfully completes their assessment and documents accurately,

they will meet outcome one, three, and four.

Throughout the shift students are encouraged to perform their nursing skills such as foley

catheter insertions, colostomy system changes, and surgical dressing changes. The faculty and I
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are able to assess the student’s competence in performing these skills to ensure they are

performed safely. If a student is planning to perform a clinical skill, they are instructed to first

review the skill using the Mosby nursing skill guide provided on the hospital’s intranet. They are

provided with instruction while performing the skill and feedback after they complete the skill.

Their performance is assessed and included in their weekly e-journal. If they successfully

complete the skill they meet outcome three.

Medication administration is one of the main focuses of this clinical rotation. Students

must have a thorough understanding of the medication including which class it is in, why their

patient is receiving the medication, and any safety implications of administering the medication.

Students are encouraged to bring their drug guides to review their patient’s medications and then

transcribe that information on their medication clinical paperwork. If a student is not prepared to

pass medications and answer the faculty’s questions they are deemed unsafe to administer that

clinical day and are given a U for outcome four.

Students are also instructed to seek out learning opportunities throughout the clinical day.

Sometimes students are assigned a patient with less needs and medications to administer. Instead

of sitting idle, students are encouraged to ask their peers, nurses, and patient care assistance if

they have any patient care needs they need assistance with. This allows the student to gain a

greater amount of experience and see a variety of conditions and treatment plans.

Unsafe Students

Students are deemed to be safe when they perform nursing skills according to policy and

best practice. When they fail to perform these skills safely, they are counseled to spend time in

the nursing lab to practice these skills so that they may competently perform them at a later time
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in the clinical setting. If they continue to fail to perform the skill they receive a U for outcome

four.

When administering medications, students are required to review their drug guides or the

reference manual in the medication administration record (MAR). Before they administer the

medications to their patients, they must tell faculty what the medication is, what class the

medication is in, why the patient is receiving the medication, and what safety indications exist

for the medication. If the student is unable to do so they are deemed unsafe to administer the

medications and are not allowed to administer medications that clinical day. They will also

receive a U for outcome four. Faculty will counsel the student on the importance of safe

medication administration and encourage better preparation before passing medications the next

clinical day.

When students fail to succeed in the nursing program, remediation is prescribed.

Remediation in the form of a learning contract provides students with an understanding of the

deficiencies in their meeting the clinical outcomes and a detailed plan to improve their

performance. A learning contract is a written document detailing the problems with the student’s

performance in relation to the clinical outcomes. The document should list available resources to

assist the student in improving their performance and include detailed activities required to meet

the learning outcomes in the future. The learning contract must then be discussed with the

student in private to formulate a plan for future success. The student must be given detailed

examples of how they have currently failed to meet expectations and the actions that they must

take to improve their performance. Once the plan has been made, the student and faculty must

sign the document. The learning contract will be used to determine a student’s continuation in

the program (Gardener & Suplee, 2010).

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Student Comparison

During my time working with the medical-surgical level two students from Bethel

College I have been able to observe the clinical competence of 12 students. The degree of

competence and skill varied among the students. Some were better at medication administration

skills while others were better with patient communication.

I used the clinical course outcomes in the clinical syllabus to evaluate the performance of

two students in the clinical setting. I chose to evaluate Beth and Jackie and compare and contrast

their clinical performance. The comparisons are observations that have been made weekly and

included in their e-journals.

Beth has shown to perform at a higher degree of competence than Jackie. She is prepared

for clinical and has been on time to clinical each day. She speaks respectfully to her patients,

peers, and clinical faculty. She has also demonstrated leadership skills when offering to pray for

the clinical group and patients during preconference. Because of this she has received an S for

each day of clinical for outcome six.

In comparison, Jackie has been late to clinical twice. She was unprepared on the first day

of clinical because she had forgotten her clinical paperwork at home. When asked why she had

forgotten her paperwork she stated that she was rushing out the door. She stated she felt like an

idiot and hated herself for forgetting, calling herself a derogatory term. Because of these

behaviors she has received a U for outcome six for the first two weeks of clinical and has also

been placed on a learning contract.

Beth has shown competence in her assessment and charting of her patients. She can relate

how her assessment findings correlate with her patients’ diseases and charts those findings
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accurately and in a timely manner. She has received an S for outcomes three and five. Jackie,

however, struggled to recognize that her patient with COPD needed to have oxygen applied

when her patient’s oxygen saturation was at 86%. She did not recognize this as a significant

finding and struggled to chart these findings at an appropriate time. She also did not

communicate these findings with me or the patient’s nurse. It was by chance that I saw her

charting and brought the finding to her attention. Because of the failure to recognize an abnormal

assessment finding, communicate this finding, and chart appropriately she has received a NP for

outcomes one, two, and five.

Summative Evaluation

At the end of the clinical rotation, each student will be provided a summative or final

evaluation that will ultimately determine their passing or failing the clinical rotation. Page five of

the clinical syllabus provided the students with the summative evaluation criteria. Faculty will

review the weekly evaluations and outcomes to determine if the student is safe and competent

enough to pass the course. The form used is provided on page 12 of the clinical syllabus and

includes a section on student strengths, suggestions for improvement, comments, and signatures

of faculty and student

I chose to complete theoretical summative evaluations on two students that I feel have

vastly different levels of knowledge, level of competence when performing skills, and overall

display of professionalism. The evaluations below have been reviewed by the clinical faculty

member. Final evaluations were determined based on weekly formative evaluation.

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Bethel College School of Nursing

NUR 310 Medical Surgical I
Clinical Evaluation Tool
Faculty Evaluation

Student: Jackie Blauwkamp Faculty: Lisa Ericson, Kristen Eden (MSN student)

Semester: Fall, 2018

Absence/Tardy Dates: 10/16/18, 10/23/18, 10/24/18, 10/30/18 Make-up Dates: 10/30/18

Math Score: 84% Course Grade: 72%

Recommendation: Pass Fail

1. Strengths:

 Seeks out learning opportunities during clinical day

 Asks pertinent questions regarding patient conditions

2. Suggestions for improvement:

 Work on professionalism as it relates to timeliness

 Work on professional demeanor and communication with faculty and patients
 Continue to build on knowledge of pathophysiology to formulate a complete care plan
 Reevaluate reasons for interest in the nursing profession

3. Comments:

Jackie has consistently failed to meet outcome 6 of professionalism due to her lack of preparedness for
clinical and timeliness. She failed to meet the requirements of her learning contract when she was 30
minutes late to clinical on 10/30/18. She shows a lack of safety when performing skills and administering
medications as evidenced by failure to meet outcome 4 on week 2, 4, 5, and 7. Week 5 she attempted to
insert a foley catheter on her patient but contaminated the sterile field. She was instructed to practice
the skill in the nursing lab but refused to do so stating “I don’t have time for this!”.

These assessments combined with her failure to pass the course requirement of an average test score
of 78% prevent her from successfully passing this clinical course.

Faculty Signature _______________________________ Date___________

Student’s Signature _____________________________ Date _________

(Signature indicates you have read the weekly faculty feedback.)
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Bethel College School of Nursing

NUR 310 Medical Surgical I
Clinical Evaluation Tool
Faculty Evaluation

Student: Beth Hawley Faculty: Lisa Ericson, Kristen Eden (MSN student)

Semester: Fall, 2018

Absence/Tardy Dates: none Make-up Dates: NA

Math Score: 94% Course Grade: 89%

Recommendation: Pass Fail

1. Strengths:

 Leadership as evidenced by willingness to pray during pre-conference

 Competence in knowledge of medications, good technique when administering
 Effective communication with patients, fellow nursing students, and staff

2. Suggestions for improvement:

 Continue to build knowledge of disease entities, treatments

 Ask for assistance from faculty when unsure of physical assessment findings
 Continue to seek out learning opportunities with other staff members during downtime

3. Comments:

Beth has shown competence in the clinical setting. She performs nursing skill safely such as successful
insertion of foley catheter on week 2 and tracheostomy care on week 3. She is knowledgeable of
medications and administers safely with correct technique. She shows leadership skills and effective,
respectful communication with peers, staff, and faculty.

Faculty Signature _______________________________ Date___________

Student’s Signature _____________________________ Date _________

(Signature indicates you have read the weekly faculty feedback.)
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The above final evaluations are a result of the observations I made of these two students

while working with them in the clinical setting. Beth has shown competence in the clinical

setting by meeting the six clinical outcomes on a consistent basis. She displays respectful and

effective communication to her peers, patients, and faculty. She demonstrates consistent intent to

improve in her knowledge of disease entities and nursing care. Because of her performance in the

clinical setting it is determined that she will pass the clinical rotation and continue on in the

nursing program at Bethel.

Jackie, however, has shown to be clinically incompetent and unsafe to advance to the

next clinical rotation due to her lack of safety when performing clinical nursing skills and

administering medications. Her lack of professionalism and respectful communication is also of

concern. Because of the observations made weekly, it has been determined that she will not pass

the medical-surgical two rotation. Should she desire to challenge the faculty on her failure of the

course, she must appeal to the Progression Committee. Her weekly e-journals with faculty

comments and evaluations, learning contract, and final evaluation would all be sent to the

committee for review to determine if she should be allowed to pass the clinical rotation and

continue on in the nursing program.

In conclusion, determining the clinical competence of a nursing student requires

consistent observation by the clinical faculty. Students must be evaluated based on the criteria

provided to them in the clinical syllabus. Clinical outcomes must be clearly defined and

understood if students are to succeed. During the clinical rotation, faculty must provide frequent,

detailed feedback to the student on the quality of their performance and deficiencies in their

practice. A quality summative evaluation must be preceded by frequent, detailed formative

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evaluation provided to students on a weekly basis. This ensures that students are aware of their

areas of practice that need improvement as well as their strengths.

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References

Billings, D. & Halstead, J. (2016). Teaching in nursing: A guide for faculty. St Louis, MO:

Elsevier.

Gardner, M. & Suplee, P. (2010). Handbook of clinical teaching in nursing and health sciences.

Sudbury, MA: Jones and Bartlett Publishers.