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Welcome to this episode of NLN podcast Nursing EDge Unscripted the Scholarship track. I am your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. Nursing EDge Unscripted and our track entitled Scholarship celebrates the published work of select nurse educators from the NLN's official journal Nursing Education Perspectives and the NLN Nursing EDge blog.
The conversations embrace the author's unique perspectives on teaching learning innovations and the implications for nursing program development and enhancement. This episode is on the issue of clinical evaluation of prelicensure BSN students. We will discuss the author's article, Clinical Evaluation in Prelicensure Baccalaureate Nursing Programs A Qualitative Descriptive Study.
The discussion will focus on the unique findings of the author who published a manuscript in the January February 2022 issue of Nursing Education Perspectives, volume 43 issue one. Our speaker today is Dr. Patsy J. Butts, who is an associate professor at Middle Georgia State University Department of Nursing. I want to welcome Dr. Butts to the conversation. And I'm going to ask her to briefly summarize her study and her findings and the relevance to the conversation today.
Welcome Dr. Butts. Thank you. Thank you for having me. So my study, the aim of my study was to provide a current description of what the clinical or nurse educators, how they were going about doing clinical evaluation across the
United States. So I set out to try to include faculty from small universities larger universities private and state universities and I was able to get a good sample from all the different regions in across the United States and what I found was that in the past decade since Dr. Benner released the transformation of nursing education and the two national surveys that were done on clinical evaluation and assessment of nursing students that we really haven't made very much
progress and things stay pretty much the same this people are still doing clinical evaluation the same way and I found that most of the clinical nurse educators that were doing the evaluation did not really understand evaluation did not have a background in education and just really kind of tweaked it basically when they were doing evaluation so it's not surprising that we are still struggling with the competency levels of our students because we just haven't made much ground
Yeah I found the article interesting and just the fact that it's discussing the same thing we've been talking about for 20 or 30 years but this seems to be a theme in nursing right. We'd revisit things over and over again without making
much progress and moving forward. You know we talk about this and the nursing programs I've been involved in over the years the inconsistency in the qualitative nature of course of the evaluations in the clinical setting and you know you can have two different instructors of course evaluating the same student and come to two very different conclusions about the student's success or progress in the program and so I know we talk about a way of standardizing our clinical tools
across the board and I know many schools like you know look at other schools and kind of mimic some of the things they're doing but you're right the nature of clinical evaluation is very qualitative in nature of course very subjective in many ways we're looking at task attainment for the most part it's difficult sometimes to gauge a student's as Dr. Benner calls it you know the knowing that is the kind of the skill and the knowing how and annoying why is that situated practice-based
kind of learning that we sometimes have difficulty describing in an evaluation and so that leads me to the question I wanted to ask you it seems we've been evaluating like I said clinical competencies of students in the clinical setting the same way for decades you know the skills list with the task accomplishment the students do their large you know cumbersome care plans usually still written or you know now on the computer despite research that Dr. Benner has
conducted that describes clinical reasoning and situated thinking in action is a more effective way to evaluate student outcomes I know Dr. Benner's developing this work has been developing this work to use in a more contextual way what are your thoughts on this as it relates to your findings in this study well when I was talking to nurse educators from across the country it was clear that they did not have a good grasp on how to do evaluation or basically they use
their past experiences in nursing school to determine what they should ask the student to do and some of us have been out of nursing school for quite a long time and they need some values in medicine so it's I found that astonishing there was a lot of autonomy amongst even the educators in their programs they were able to do whatever they would like to do they based it on I had some clinical educators tell me that they base students evaluation on a ranking system they would
rank their students from strongest to weakest they did not really have a clear picture of what competency was so I find it difficult or not really difficult to understand I understand why we have not made the grounds toward what Dr. Benner was speaking of because you know it's quite it's complicated to try to teach that situated thinking in action because we don't really have any control over what the patient's going to be that day when we take our students
into the clinical setting so it's difficult to actually make sure that we're meeting those types of objectives for a skilled knowledgeable educator so when you have someone who is inexperienced it's very difficult for them to even fathom how to go about doing that.
We're sometimes talking about it of course a nursing student who's inexperienced with an inexperienced educator and maybe not an inexperienced nurse right but an inexperienced educator so not understanding even how to you know look at the student through the lens of a student where they should be at the place they are in the program yeah you know with the new centrals are here obviously and I know all of us across the country will be working with implementing those new essentials over the
next several years and looking at competency-based evaluation which is what the essentials are saying and this is a good opportunity I think for us to reimagine how we can evaluate students in the clinical setting and the clinical setting now includes the virtual setting right the not only the simulations in the labs but the virtual simulations that are now happening mostly because of covid you know they were they've been there but we didn't really start working on them looking
at them until covet and I know there was a recent article that Dr. Benner sent me and I forgive me I don't remember the name at the moment that talked about the value and looking at the success of those virtual simulations and how you can get to still get to that situated thinking and practice through those virtual simulations not in the same way obviously as having somebody there with you at the side of the vet but so what are your as we can do the conversation around the way we evaluate
students what are your thoughts about evaluating them as we're talking about the new essentials and this competency based type of evaluation which is not looking just at task and checking off on a list right when I was talking to the clinical educators and we were talking about how what was their process of actually doing clinical evaluation I actually chose to seek out a recruitment of educators that were CCNA accredited and that you know actually in that accreditation
they require the essentials to be part of the overall curriculum embedded in threaded throughout the curriculum interesting enough I believe only one or two educators ever brought up the essentials so I think we have a lot of work to do they actually did not really base their evaluation on the essentials of a baccalaureate education that the nurse needs so we have some work I think we really need to work on educating our faculty on how to do evaluation first but I do
agree with the simulations I think that building us a more simulation into our programs is going to help us educate our evaluators but also to ensure our students are meeting those objectives and developing that situated thinking in action because it gives us a little bit more control over the type of patients and situations that we want our students to actually have practice with but we're you know covet has also caused some issues with us being in the hospital
here in the south we have been fortunate enough to actually be back into the hospital almost from the beginning but we did have some areas that students can go to but across the nation there are many nursing students who have not even been able to get into clinical really good clinical situations and experiences to help develop that level of competency and I saw an article recently it was talking about crisis in competency and they spoke to our competency levels of new graduate
registered nurses had fallen down to about nine percent of those that are entering into practice actually being at the level of property so we do have some serious work that we need to work on you well you touched on that we've been discussing the lack of clinical nurse educator training would you please provide us with your thoughts on how this inconsistency in standardizing our training impacts student success well I think it's I think it really is one of the major keys to
student success for instance where I'm where I am we have been working on developing ourselves because we really feel like that's the key to helping the student success and we are working on developing our part-time our adjunct who do a lot of our clinicals having an orientation working on evaluation making sure they understand the tools and you know the next step is we're going to have to work on integrator reliability with our tools that we use that like you said before the evaluators
can have inconsistencies evaluating the same student and I really think that goes back to the fact that they don't understand real evaluation there were when I was interviewing the educators the backgrounds you know were all work from various things we had master's level nurse practitioners there were a few that had doctorates in nursing education most were doctorates in nursing practice and we had some PhD prepared educators as well and most of them did not have
any additional coursework in nursing education so they weren't familiar with curriculum and really objectives and how to meet those objectives and what the clinical tools actually were measuring and actually they told me that the tools were afterthoughts they did not actually relate them to the objectives of the curriculum for their program clinical objectives so it's no wonder that the students are not getting a clear we're not getting a clear picture of competency
when we're when we are evaluating students I think that the nursing programs are going to have to develop their own educational training for much of the educators because they're not getting that coursework it's not part of the program their curriculum when they're getting their doctorates to actually have teaching and learning and evaluation how to do evaluation in their programs so we're going to have to take it upon ourselves recognize that it is an issue and that it is
impacting our student success do it ourselves
Right, right. And cloven certainly didn't help it helped expose a lot of this and certainly you know his unique situation that we've been through the last two years that you know it's taken away some of the lens we were looking through as far as how we are doing clinical evaluation because of the move towards simulation virtual stimulation and just you know and I think we should be clear here that this is not a personal criticism of any of our clinical partners who
are we are so grateful for the work they do with our students it's more about the system in which we design these partnerships and you know the lack of you know educating new instructors that are coming out to join us and there's a variety of reasons why that happens you know time money it's regional amount of people available et cetera things like that but it's a huge problem with training are yeah ourselves it's very difficult we can't we can't put our hand or our finger
on exactly what competency means ourselves it's difficult so right you know it's partly it's a big problem and it's complicated it's a very that's the reason why it's been 10 years and we still
have made exactly extremely complicated. Yes. Yes and you know my hope is with the new essentials it's going to be a new direction for us a nursing education and an opportunity for us to be innovative and look at things a little bit differently and come up with some really outside the box type of opportunities here for us to educate our students and evaluate our students in a way that's different than we've been doing in the past so it'll be interesting to see
what programs are coming up with over the next several years to meet the new essentials and yeah I'm looking forward to it and the next gen comes out it'll be interesting to see maybe
Yes. Yes. Something that helped push just a little bit forward is is those next gen exams we already have our cohorts in that are going to be taking that exam and we're already think ahead and the best way to tie it all together is clinical so maybe we'll get a little bit more intentional and that's going to help I think.
That's a great point. Well I want to thank you so much for joining us for this conversation I really appreciate your time and expertise in sharing your work and broadening our understanding of the work you did and just you know stimulating a conversation around this topic to our listeners if you have not had the opportunity to read this work you can find the manuscript published in nursing education perspectives clinical evaluation and pre-licensure baccalaureate nursing programs
a qualitative descriptive study published in the manuscript in the January February of this year volume 43 issue number one. And thank you for joining us and thank you very much to Dr. Butts. [Music]