Assessing practice of student nurses: methods, preparation of assessors and student views

To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution.

Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable.

All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed.

Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views.

There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.