Policies and Guidelines
'Unsatisfactory' Clinical Practice
The evaluation of clinical practice involves ongoing feedback and documentation
of student performance. Related policies include “Professional Conduct” and “Clinical
Practice Grading”.
The clinical practice component of any course is graded as Pass or Fail.
- Course outcomes and all evaluative methods are clearly identified in each course
syllabus and are discussed with students at the beginning of the course.
- Successful completion of all clinical course outcomes (and of all clinical portions
of courses where there are two or more elements) is required in order to be eligible
to sit the final examination and to obtain credit for satisfactory course completion.
- Both the student and faculty involved are responsible for early identification of
student clinical practice difficulties, which may include input from practice colleagues.
Ongoing and timely verbal and written feedback and discussion between faculty and
student about apparent performance problems is the expected norm.
- Consultation between faculty and student with regard to knowledge application, practice
skill development and ongoing learning is both facilitative and evaluative. This
consultation involves both written and verbal exchanges over the course of the clinical
learning experience.
- When the faculty member identifies a pattern of behaviour that may be indicative
of impending unsatisfactory outcomes early in a clinical learning experience, the
faculty member is expected to provide the student with written documentation (which
could include email communication, considered to be part of a legal record of communication)
to this effect, indicating the particular clinical outcome(s) in jeopardy. The student
will have an opportunity to discuss the issues raised in the documentation with
the faculty member, who will propose a plan for remedial action. In all such instances,
the course leader (or the program coordinator if the course leader is the clinical
instructor in this instance) should be consulted; such consultation may be initiated
by either the student or the faculty member at any time during the clinical experience.
- Where there is agreement between the faculty and student with regard to a plan of
remedial action, the agreement is ideally articulated in the form of a learning
contract (see footnote). The learning contract sets out clear expectations for performance,
including the length of the contract, and is signed by both parties and placed in
the student’s file. Referral to other support resources (such as the Learning
Resource Centre) may be appropriate; referrals and assistance will also be documented
in the student's record.
- Where there is disagreement between the student and the faculty member with regard
to the issues documented or the proposed remedial action, the student will be invited
to provide a written response to the documentation, and the response will also be
placed on file.
- If such a concern remains unresolved, written documentation related to the problem
or concern (jeopardized clinical practice outcome; faculty & student views;
remedial plan; signatures) will be maintained in the student's record. Progress,
or its lack, will be clearly indicated and the student's status regarding potential
unsatisfactory/fail grade will be clearly stated. The student will receive copies
of all documentation.
- Faculty will inform the course leader of the student's status on an ongoing basis.
Unresolved concerns may be brought to Program Coordinator and/or the Director for
discussion and advisement
- Clinical learning inevitably represents a delicate balance between the student’s
right to learn and the rights of patients or clients to safe and ethical care as
well as the rights of clinical institutions to ensure such care. Because the clinical
practice expectations articulated for each level of the program include explicit
requirements with regard to consistent demonstration of such qualities as responsibility,
ethical behavior, professional conduct, and safe, effective client care, there are
some acts on the part of the student that, even in isolation and not part of an
identified pattern, may be of significant concern in the professional judgement
of the clinical faculty as to justify clinical failure and/or immediate withdrawal
from the clinical learning experience. In all such instances, faculty member will
obtain consultation from the course and program coordinator as soon as possible
with regard to the decision. The student must be provided with written documentation
of the nature and seriousness of the act and an explanation of the basis for the
decision that was reached by the faculty member. The student will be given an opportunity
to respond in writing to the written documentation before it is placed on his/her
file and will be informed of the implications of the decision for his/her academic
progression.
This policy is informed by the College of Registered Nurses of British Columbia
(CRNBC) Standards for Practice and the Canadian Nurses Association (CNA) Code of
Ethics.
Footnote: A learning contract is a negotiated written agreement developed
collaboratively between a student and faculty member that specifies learning activities
to be undertaken in order to achieve course learning objectives/outcomes and professional
practice standards. Learning gaps or deficits related to the course outcomes are
identified and specific learning objectives are established. Strategies and resources
are identified to assist and support the student in meeting the learning objective(s).
Establishing a learning contract highlights the responsibilities of the parties
involved and encourages the student to be a reflective active participant and to
take ownership in his/her learning while promoting achievement of competencies.
Approved July 2002, Faculty Caucus, UBC School of Nursing
Draft revision approved by Undergraduate Programs Committee, April 2006
Approved April, 2006, Faculty Caucus, UBC School of Nursing
