Comparison of Nurse Mentor and Instructor Evaluation of Clinical Performance

The evaluation of nursing students in the clinical setting is a challenging aspect of nursing education. New models of clinical education, such as dedicated educational units and modified preceptorships (Moscato, Miller, Logsdon, Weinberg, & Chorpenning, 2007), have added to the challenges inherent in evaluating how students apply the theories and skills they learn in the classroom and skills laboratory to actual patients in a real-life setting. One problem is that many newer models of clinical education employ a team-based approach (Nabavi, Vanaki, & Mohammadi, 2011) involving nursing staffwho serve as preceptors or mentors to students (Beerman, 2001). Often these nurses have not received training in student evaluation. New partnerships between hospitals and universities formed to improve education and maximize resources (Nabavi et al.) present additional challenges for faculty.A review of the literature found only one study that compared student clinical evaluations by nurse mentors (n = 98) and instructors (n = 17) (Ferguson & Calder, 1993). While significant differences were found in only 13 percent of the clinical competency ratings, it is important to point out that this study was conducted well before many of the conditions currently affecting health care and nursing education came into being. Our study compared the level of agreement between nursing instructors and mentors in student clinical evaluation in a new model of clinical education.METHODSetting and SampleIn 2007, the University of Michigan School of Nursing and University of Michigan Hospital formed a partnership to create a new model of clinical education in which students are embedded in hospital units in specific clinical clusters. To increase stability and build relationships, students and nursing instructors remain in the same clinical cluster for the duration of their undergraduate education. Students are paired with nurse mentors on the unit, with the instructor providing support and oversight.Each week, the nurse mentors use an online evaluation tool to evaluate students. Based on recommendations from the Commission on Collegiate Nursing Education (2009), the scores are used as data by faculty when preparing end-of-term clinical performance grades. This study involved 81 nurse mentors for 81 students and 20 instructors.InstrumentsThe Clinical Evaluation Tool, administered online, was based on competencies in the Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 2008). The tools used by nursing instructors and nurse mentors evaluated professionalism/accountability; communication; the nursing process; patient education/self-management; safety; and evidence-based practice. The instructor tool also evaluated clinical reasoning, and the wording of some questions varied slightly between the tools. Each tool used a Likert scale scored as follows: 1 (cannot perform), 2 (consistent guidance), 3 (occasional guidance), and 4 (independent).Data Collection ProceduresData were collected during week 8 of the winter term (September 2011 to March 2012). This week was selected because it allowed students to become oriented to their units and evaluators to gain experience completing the tool. Each nurse mentor and instructor completed the tool independently for students on the same day and shift. Only students with both a mentor and instructor evaluation on the same day were compared.Data AnalysisCronbach's alpha was used to assess reliability of the nurse mentor and instructor tools. The internal consistency for items on these tools was found to be high (alpha = .93, mentor; alpha = .96, instructor).To assess level of agreement between instructors and mentors, the kappa statistic was used on a scale of 0 to 1 as follows: level of agreement considered almost perfect (.81 to 1.0); substantial (.61 to .80); moderate (. …