Understanding the phenomenon of failure to fail in unsafe prelicensure nursing students in the clinical setting: A grounded theory approach

Background

Failure to fail involves assigning passing grades to students who have not achieved course or clinical objectives at a satisfactory level. The literature has shown that this phenomenon occurs more frequently in the clinical setting due to several issues, including the increased subjectivity of clinical evaluation tools and processes, unclear policies, and lack of administrative support to fail students. The question remains: What is the thought process that is used by faculty to determine if a student passes or fails in a clinical experience?

Purpose

To explore the decision-making process used by pre-licensure clinical nursing faculty when they are determining whether to pass or fail an unsafe student enrolled in a clinical course.

Methods

A qualitative constructivist grounded theory design was selected. Grounded theory explores a process about which little is known. The decision-making process used by faculty to determine if a student passes or fails a clinical course has never been described in literature. Participants were sixteen prelicensure clinical nursing faculty from associate degree, diploma and baccalaureate programs located in ten United States. Participants were recruited from multiple Facebook nurse educator websites and a group of diploma programs in Western Pennsylvania. A link to the study and consent was provided to each potential participant. Following signing of the consent and providing contact information, faculty were contacted by the investigator. Two semi-structured interviews were conducted with each participant. Data was coded with SPSS version 26, NVivo Pro version 12, and analyzed manually.

Results

Six unsafe clinical behaviors that caused students to reach the failure threshold were identified; lack of ability to synthesize the client's plan of care, ineffective interpersonal communication, unacceptable pattern of skills performance, disrespectful mindset/attitude, and deceitful/amoral conduct. Six reasons for faculty failing to fail were also discovered; lack of administrative support to fail unsafe students, ineffective clinical evaluation tools, inconsistent policy enforcement, time pressures, fear of appeals, grievances and lawsuits, and the core category which was identified as role conflict. Lack of support from administration was defined as an absence of backing from the faculty member's immediate supervisor when presented with written documentation proving that a student was clearly unsafe in the clinical setting. In this study, there was a refusal by the administration to allow the faculty member to fail the unsafe student. A substantive theory emerged from the data and was entitled “The Complex Conundrum of Clinical Evaluation.” The theory contained four phases: seeing red flags (identifying the unsafe behaviors), seeking validation (meeting with administration), selecting an outcome (pass or fail), and failure to fail.

Conclusion

Failure to fail remains a significant problem in nursing education which has the potential to harm clients, staff, the reputation of the nursing program, and the profession.