Nursing Ethics and Failure to Fail in Clinical Nursing Education

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University of Alabama Libraries

The phenomenon of failure to fail (FTF) was introduced into nursing literature in 1990 by Annette Lankshear, a British nurse educator who published a study examining nurse preceptors' failure to fail students performing poorly during a clinical preceptorship (Duffy, 2013). In the United States (US), most undergraduate nursing programs utilize full-time faculty to teach in the classroom and clinical settings. Clinical nursing faculty (CNF) are responsible for training, evaluating, and assigning clinical performance grades for up to 10 students who may be enrolled in their clinical group. Limited research has been published in the US exploring the phenomenon of FTF in clinical nursing education. A gap in the literature also exists examining the level of ethical responsibility a clinical nursing faculty believes they assume after evaluating a student's clinical performance as unsatisfactory. This cross-sectional, descriptive qualitative study was guided by deonance theory and duty orientation and focused on eight female CNF who teach, evaluate, and assign clinical performance grades to groups of students enrolled in two associate and two bachelor's degree nursing programs in the south part of a southern state. This study sought to answer two research questions: 1) what reasons do clinical nursing instructors provide for assigning a passing clinical performance grade to a student they assess as unsatisfactory; and 2) what ethical responsibility does a clinical nursing instructor assume in the student clinical performance evaluation and grade assignment process? The study produced evidence of inconsistencies in the clinical performance evaluation systems used by each program, variances in reporting student failure to meet clinical performance objectives, subjective descriptors used on current clinical performance evaluation tools, and grading leniency that could be factors contributing to FTF in clinical nursing education.

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