Background Information
1 Clinical Underperformance
Maggie Convey
Student attrition, whether voluntarily or involuntary, is of particular concern to nursing programs due to loss in revenue and impact on program reputation. However, nursing programs need to ensure that students graduating have sufficient knowledge, skills, and abilities to be safe practitioners in increasingly complex practice settings. When students demonstrate behaviours or actions that do not align with their Code of Ethics, or expected behaviours congruent with their year and sequence of the program, they are at risk of clinical failure. Early identification of student underperformance or unsafe practice is necessary, in order to protect public safety whilst supporting overall student success.
Underperformance or Unsafe Practice
In general, safe, successful students come prepared to clinical, they communicate well, have positive attitudes, adapt to the clinical setting, are willing to receive and act on feedback, and are eager to learn while demonstrating progress in meeting course outcomes. In contrast, unsuccessful students may be unprepared or underprepared, have ineffective communication, and do not function well in new or unfamiliar settings (Craven, 2015; Lewallen & Debrew, 2012).
It is important to note that students will often have deficiencies in practice across many areas. The following table includes the more common attributes of underperformance or unsafe practice:
|
Cognitive |
Affective |
Psychomotor |
|
Difficulty in communication (written or verbal) with others.
May limit communication to superficial/casual conversation |
May be flippant, cocky, arrogant, angry or defensive.
Lacks insight into own performance; does not see potential for harm. |
Unable to demonstrate appropriate organization, time management skills.
May be disorganized in their approach to care |
|
Difficulties in connecting previous knowledge (clinical, theoretical) to current practice or current client context.
Does not/cannot apply previously learned material to clinical context. |
May freeze, be overwhelmingly anxious or fearful, and unable to function |
Assessments, medications, and documentation may be late and/or poorly performed |
|
Knowledge is superficial or consists of rote memorization. Does not demonstrate independent clinical judgement |
Is not accountable to own practice, may blame others/the setting, or deflect practice concerns (“of course I wouldn’t do that if I were on my own”). |
May not have a solid understanding of medication math principles, or has made/nearly made medication errors.
Motor skills lead to clinical error |
|
Sets inappropriate priorities or cannot demonstrate flexibility in priority-shifting when necessary. Poor clinical judgement. |
Does not follow or take direction, leaves the unit without permission/reporting off.
Avoidance or hiding from others |
Unprepared or underprepared for practice; lacks appropriate plan of care.
Unaware of or does not follow policy. |
Grounds for Immediate Clinical Removal
- There are behaviours for which there is Zero Tolerance: actions or behaviours that violate ethical standards. This includes presenting to clinical under the influence of drugs/alcohol; abusive, harassing, or discriminatory towards others; theft; and failing to comply with confidentiality. Certainly, care that results in significant actual OR potential harm to a client may warrant immediate clinical failure based upon the context of the clinical environment and the student’s expected performance for the year/term of the program.