Clinical grading: A pilot study to evaluate the implementation and effectiveness of mentor and student preparation for clinical grading

Background Clinical grading is one approach to assuring newly registered nurses have the knowledge and skills to provide safe and competent nursing care; that offers employers the chance to differentiate between newly qualified nurses’ clinical abilities, assists newly qualified staff to identify ongoing learning needs and meets Nursing and Midwifery Council standards for assessing practice (Amicucci, 2012; NMC, 2010). The development of new curricula from September 2013 enabled changes to the pass/fail system. Formative clinical grading was introduced at the end of year 2 and summative grading at the end of the final placement. A pilot grading exercise was undertaken to evaluate preparatory materials for relevance and clarity and the process by which students and mentors were prepared for functionality. Recruitment and ethics The project was reviewed by the Faculty Research Ethics Committee. Students from all four nursing branches due to begin final placement were invited via email and meetings to take part in the pilot, which would be in addition to their usual assessments. Eleven students (4 adult nursing, 3 child health nursing, 2 learning difficulties nursing and 2 mental health nursing) gave written informed consent. Each student’s mentor was then approached by the project team and invited to take part, all consented. Mentor and student preparation Members of the project team delivered educational material to the mentors and students. This consisted of written information, a DVD showing grading interviews and access to online materials including a ‘frequently asked question’ facility. Mentors and students were all visited by members of the project team during the placement. Mentors were asked to undertake their normal assessment at mid-point and the end of the placement. If the student passed their placement, mentors graded practice using six grades ranging from C (Acceptable) to A+ (Exceptional) against the four Nursing and Midwifery (Ref) domains: professional values, communication and interpersonal skills, nursing practice and decision making, leadership and team-working. Data collection and analysis Semi-structured telephone interviews were undertaken with students and mentors following grading, these were transcribed and the project team undertook thematic analysis using established qualitative analysis techniques to ensure rigour and transparency. Findings All of the interviewees expressed some support for clinical grading and felt that this may be an effective approach to assessing student nurses’ clinical practice. One student expressed concern about objectivity and one mentor did not like the grading grid. Mentors felt the written material gave them the information they needed, few watched the DVD mainly because they no longer owned anything on which to play a DVD. However all felt watching examples of grading interviews, particularly potentially difficult grading interviews, would be helpful. Some mentor and student dyads read through the material together. The most valued source of information was the project team who visited the clinical placements. Some students appeared as passive recipients, leaving it to mentors to interpret guidance and grade practice. Others used the information as guidance and were creative in presenting evidence of skills and competencies. Conclusion The pilot suggested mentors appreciated one to one support with their first grading interview, commenting on the importance of clarity in the grading criteria, the usefulness of practical examples and the use of patient and carer feedback. Some students needed support to understand how they could best demonstrate the level of their clinical practice to their mentor. The importance of the midpoint review in preparing students to achieve their best mark for the final grading was evident. Successfully beginning clinical grading needs a front end commitment, to mentors from academic staff. Students need to consider how they can be pro-active within this process and demonstrate knowledge and skills.