Author: Linda Flores, MSN-Educator; CEN, RN
Title: Assistant Professor
Institution: Western University of Health Sciences College of Graduate Nursing
Coauthors: Patricia Shakhshir, PhD, CNS, RN-BC, Mary Lopez, PhD, RN
1) Utilize Clinical Evaluation Tools containing observable scaffolded competencies embodying the American Association of Colleges of Nursing BSN essentials and 6 QSEN knowledge, skills, and attitudes (KSA): Safety, evidenced based practice, patient centered care, team work/ collaboration, informatics, and quality improvement. The added core of professionalism embodies the spirit of the school’s clinical handbook and hospital’s mission statements. Tools range from semester I-IV, Fundamentals, Medical Surgical Nursing; Advance Medical Surgical Nursing; Pediatrics, and Community Health. (Obstetrical Nursing and Psychiatric Nursing pending).
2) Provide a numeric grade–The tool utilizes a numeric system 0-4 for each of the 6 QSEN competencies KSAs totaling 100 points for a “grade” in clinical (instead of pass/fail).
3) Document reflection of values and attitudes in the clinical setting with the use of exemplars (narrative pedagogy).
1) Students utilize the clinical evaluation tool to self-grade at midterm and final week. Clinical faculty agreement or recommend changes both at midterm and final week.
2) At Mid-term, a numeric value of 2 is acceptable since continued growth is expected until completion of clinical hours.
a. When a QSEN competency KSA falls “below expectations,” a score of 2 out of 4; a remediation plan for competency I-VI and KSA a-f will be documented on the Performance Improvement Form. Agreement from student, clinical faculty, lead faculty, and director(s) signatures required.
b. When remediation requirements meet time frames & criteria, the grade for the specific competency and KSA increases to “met” at 3 out of 4.
3) Early identification of areas falling below expectations and a clear action plan with time frames for student success facilitate clear communication and documentation of efforts.
4) Narrative Pedagogy (exemplar) required for a score of 4 documents personal knowledge application of skills and attitude changes while providing quality safe care for the sick client. One clinical exemplar may embody several competencies I-VI and KSAs a-f.
Level IV Community Health Clinical Evaluation tool available per request to Linda Flores firstname.lastname@example.org
Audio Power Point Presentation (18 minutes) explaining the quality improvement group activities (Level III) in post conference or debriefing available, please contact Linda Flores. Level IV Psychiatric Nursing tool in progress.
OB and Community clinical evaluation tools will be available upon request.
Teaching strategy enhancement from the version presented at QSEN 2012 by Nicholls State presenters:
Eymard, A., Davis, A., & Lyons, R. (2012). Progressive clinical performance evaluation tools incorporating the QSEN competencies. Podium presentation at the Innovation to Transformation: 2012 QSEN National Forum, Tucson, Arizona.
Since utilizing these tools, clinical grades range from 77% (passing) to 100% (above expectations). Those students achieving higher than 77% wrote clinical exemplars capturing their previous misconceptions and changes in attitudes or values; desiring methods for changing the system (blameless communication); creating opportunities for patient centered pain management or goals; and lastly reporting off during interdisciplinary rounds at bedside to advocate for the patient or family.
Post conference discussion contain aspects of the tool such as quality improvement and safety. Embedded within the tool are post conference exercises such as root cause analysis of a “work around” of an active or latent safety failure. The critical care semester clinical evaluation tool (Level III) also highlights the hospital report card so that early introduction of measurable nurse sensitive indicators become part of their language, values, and evidenced based practice. Another activity embedded within the tool is the identification of the “sacred cow” or traditional “way of doing” thing. An audio PPP or 1:1 meeting with adjunct clinical faculty enhances their ability to decipher use of the clinical evaluation tool. Weekly e-mails from the lead course faculty member connects weekly course content to clinical assignments and aspects of the tool.
Early identification of several students who did not meet performance improvement criteria at Midterm help all parties develop a plan for clinical progression. Several solutions included switching medical surgical units, additional clinical/ lab hours, and case study worksheets. The student, clinical faculty, lead course faculty, and director of the program agree upon solutions that consider the student’s ability, clinical site, patient, and course objectives.
Outcome based competencies: Our clinical unit nurse educators also provided input such as customer service criteria. While the acronyms vary, the concept consistently contained themes such as immediate trouble shooting, acknowledgment, prevention, and service. The relationship with clinical site nurse educators will be integral for the future. When active or latent safety infractions occur on the unit, a post conference debriefing included a root cause analysis (level III clinical evaluation tool, Quality Improvement competency). Under the guidance of the clinical faculty, an option includes a plan, do, study, act proposal to bring to the unit nurse educator (to achieve a score of “4” above expectations). Without a “just culture” environment, the students might not feel safe to bring forth their quality improvement suggestions. The group exercise facilitates team work and collaboration.
A score of 4 requires a clinical exemplar as recommended by Drs. Benner, Sutphen, Leonard, and Day’s (2010) Educating Nurses: Call for Radical Transformation suggestion of critical reflection for finding new meaning within context of practice.
Use of exemplars create connections between their knowledge integrated from the classroom into the clinical practice and the humanistic science of caring.
One exemplar may capture several QSEN KSA areas as “exceeds” semester expectations. Usually 2-4 exemplars total document their development of attitude and values while providing safe, evidence based, patient centered care. Post conference debriefings facilitate student recognition of their success.