Failing underperforming students: the role of grading in practice assessment

Nursing is essentially a practice discipline, informed by a theoretical base. It is crucial that students have a rigorous preparation in both theoretical and practical elements during their pre-registration programme. The aim of educationalists is to produce students fit for purpose and practice, but concerns have been raised internationally regarding students competence at the point of registration. There is evidence that some practice based assessors experience difficulties in failing incompetent students. Assessment of practice is often judged on a pass/fail rather than a graded basis in a number of health professional programmes. It could be argued that pass or fail provides limited feedback to students concerning exactly how well or poorly they have performed. This paper will explore these issues through focusing on selected findings from a service evaluation of a practice assessment tool incorporating grading of practice of pre-registration nursing students from one university in the United Kingdom (UK). Using convenience sampling, a questionnaire survey was completed by 107 adult, mental health and child health nursing students (51% response) and 112 mentors (practice-based assessors) (86% response) from all nursing fields. Amongst other issues, the evaluation identified that whilst mentors valued the opportunity to grade practice and perceived that the tool enabled them to be more discerning in the allocation of pass grades, some lacked confidence in failing students. The findings are discussed in the context of the wider debate around clinical competence in new nurse registrants and it is concluded that whilst assessing 'borderline' students will always be a testing experience, grading systems may help the assessor to be more discriminatory.