NR 537 Week 6 Clinical Evaluation Tool Critique Example

Clinical Evaluation Tool Critique: The Twenty-Two Behaviors Our Maternity Instructors Rate Satisfactory, Needs Improvement or Unsatisfactory Each Week, Tested for What They Measure While the Student Is Standing There

Student Name

College of Nursing, Chamberlain University

NR 537: Assessment and Evaluation in Education

Instructor Name

Month Day, Year

Clinical Evaluation Tool Critique: The Twenty-Two Behaviors Our Maternity Instructors Rate Satisfactory, Needs Improvement or Unsatisfactory Each Week, Tested for What They Measure While the Student Is Standing There

The Tool

Our BSN program uses one clinical evaluation tool across its clinical courses, adapted slightly for each specialty. For the maternal-newborn rotation, it lists 22 behaviors grouped under six program outcomes: safety, communication, clinical judgment, professionalism, teaching and collaboration. Each week, the clinical instructor rates each behavior as satisfactory, needs improvement or unsatisfactory, and writes a short comment. Passing the rotation requires a final-week rating of satisfactory on all 22 behaviors. Instructors, most of whom also work as staff nurses elsewhere, complete the tool on the unit, often during or right after the shift, with the student present.

This critique tests the tool against four questions: does it measure what the rotation aims to teach, do different instructors apply it consistently, is it practical to use in the conditions of a clinical shift and does it help students improve? Most evaluation instruments in a program are read after the fact. A clinical evaluation tool is used while its subject is standing there, which makes each of these questions sharper.

Does It Measure What the Rotation Teaches?

The tool's six outcomes match the program's outcomes, which is appropriate. But its behaviors are generic. The clinical judgment outcome contains three behaviors: "uses the nursing process," "prioritizes care" and "recognizes changes in patient condition." None refers to maternity or newborn care. A student could be rated satisfactory on "recognizes changes in patient condition" for noticing a fever, without ever being assessed on recognizing a boggy fundus or a newborn's temperature instability, which are the changes this rotation exists to teach.

The clinical judgment behaviors are also broad enough to hide the parts of judgment where students most often struggle. Lasater (2007) developed a clinical judgment rubric that separates noticing, interpreting, responding and reflecting, each with its own descriptors. The licensing board's clinical judgment model likewise divides judgment into steps from recognizing cues through evaluating outcomes (Dickison et al., 2019). A student may notice well and interpret poorly. The current tool cannot show that, because it rates judgment as a whole.

Do Instructors Apply It Consistently?

The three rating levels have no descriptors, and the program's instructor orientation does not discuss how to apply them. What counts as "needs improvement" is left to each instructor. To test consistency, four maternity instructors rated the same written account of a student's shift, a composite drawn from real situations. On the 22 behaviors, all four agreed on 11. On the other 11, at least one instructor gave a different rating, and on two behaviors the ratings ranged from satisfactory to unsatisfactory. When we discussed the differences, each instructor's reasoning was sound; they were simply applying different standards to the same words.

Evaluation texts for nurse educators note that clinical evaluation is inherently subjective and recommend clear, specific criteria and shared understanding among evaluators to reduce inconsistency (Oermann & Gaberson, 2019). The tool supplies neither. A student's rating on a given week may depend more on which instructor observed them than on what they did.

Is It Practical on the Unit?

The tool is practical in one respect: it is short and familiar. In another, it is not. Rating 22 behaviors every week for eight students, often on a unit where half the students had no chance to demonstrate some behaviors, leads instructors to rate behaviors they did not observe. Two instructors told me, without prompting, that they mark "satisfactory" by default when a behavior did not come up, because "unsatisfactory" would be unfair and there is no "not observed" option. The result is that many ratings record the absence of a problem rather than the presence of a skill. On a maternity unit where one week may bring several births and the next none, opportunity varies greatly between students.

Does It Help Students Improve?

The weekly comments are the tool's most useful part, and they vary widely in length and in how much they describe. Some instructors write specific observations; others write "doing well." Work on the mini clinical evaluation exercise in medical education showed how much of an observation's value lies in specific feedback given right after the observed encounter (Holmboe et al., 2004). The tool asks for a rating first and a comment second, which encourages the rating to carry the message and the comment to be brief. When I reviewed a semester of completed forms for one clinical group, 61% of weekly comments were five words or fewer, and the most common single comment was "good week." Students told me they read the ratings and skipped the comments, because the ratings were almost always satisfactory and the comments rarely said anything they could act on. A tool whose ratings rarely vary and whose comments rarely inform leaves students without the one thing clinical evaluation should give them: a specific account of what to do differently next week.

Recommendations

Five changes would address these problems while keeping the tool recognizable. First, add two or three maternity-specific behaviors under clinical judgment, such as recognizing signs of postpartum hemorrhage and newborn instability, so that the rotation's core content is assessed. Second, divide the clinical judgment outcome into noticing, interpreting and responding, following the published models, so that instructors can see which part a student struggles with. Third, write a descriptor for each rating level on every behavior, beginning with the eight behaviors on which the instructors disagreed most. Fourth, add a "not observed" option and require at least two observations of a behavior across the rotation before a final rating, so that ratings reflect evidence. Fifth, reverse the order on the form: write the observation first, then the rating, so that each rating rests on a described event.

None of these changes would make the tool longer to complete, because the descriptors replace judgment rather than adding steps, and the maternity behaviors replace three generic ones. The instructors will rate the same composite account again after the descriptors are written, to check whether agreement improves. The revised tool will be piloted in one rotation before it is used across the program, because a tool used on students who are standing there should be tested before it affects their grades.

References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

Holmboe, E. S., Yepes, M., Williams, F., & Huot, S. J. (2004). Feedback and the mini clinical evaluation exercise. Journal of General Internal Medicine, 19(5), 558-561. https://doi.org/10.1111/j.1525-1497.2004.30134.x

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04

Oermann, M. H., & Gaberson, K. B. (2019). Evaluation and testing in nursing education (6th ed.). Springer Publishing.