Assessing a learner’s clinical performances is a complex process that is vital to nursing.
Learner assessment is used to describe the learner’s abilities to perform skills with appropriate knowledge and attitudes, and to determine if capability for practice is demonstrated (Helminen, Coco, Johnson, Turunen & Tossavainen, 2016). In Australia, capability for practice is measured against the standards of practice for registered nurses (Nursing and Midwifery Board of Australia (NMBA), 2016). Assessment against these standards is an important component of initial and continuing nursing registration.
Being an assessor of learner performance can be fraught with challenges including:
The apparent subjectivity of assessment;
The range of assessment methods;
Impacts of organisational culture; and
Lack of assessor experience and preparation.
To help guide learner assessment, the NMBA released a framework as a resource for assessors that encompasses five principles for assessing leaner performance (NMBA, 2015). These are often somewhat complex and overlapping.
Here is a brief overview of each principle followed by some take home messages which will help the assessor navigate this potentially challenging process.
The first principle the NMBA framework outline is that assessors are accountable to the public and profession to ensure learners are suitable for registration; learners who have not demonstrated competence should not be recommended for registration (NMBA, 2015).
If this accountability is not maintained, then patient safety is potentially jeopardised. Accordingly, the International Council of Nurses (ICN) outlines safety as the most important principle in the assessment of nursing students (ICN, 2006).
To ensure accountability is maintained, assessors must ensure the assessment process is transparent, valid and reliable. Assessors are the gatekeepers for the profession. This means it is every assessor’s responsibility to ensure they only pass learners who are able to meet the practice standards to protect the vulnerable public and maintain professional integrity.
The second principle is that learner assessment should be performance-based, undertaken in a context that reflects the demands of a practice situation (NMBA, 2015). This requires global assessment, where the learner’s performance across knowledge, skills, values and attitudes are all assessed in a contextually meaningful manner.
The context in which the learner assessment occurs is an essential component of the standards of practice assessment framework and this should influence and help guide the methods of assessment. Therefore, assessment of capability for practice should be conducted in an authentic environment as much as possible.
3. Evidence-Based Assessment
The third principle outlined is the concept of evidence-based assessment. This principle outlines the requirement that assessing competence requires an accumulation of data and quality evidence about the performance of the learner over a period of time and in a range of clinically-related contexts (NMBA, 2015).
Assessors must work with and observe the learner in the practice context to gather such pieces of evidence.
In addition, the assessor needs to gather evidence from multiple sources: self-assessment, peer-assessment, interview, observation and documentation in a range of contexts to support their assertion that a learner does or does not meet the standards for practice.
The assessor must, however, always validate the assessment decision with evidence (NMBA, 2015).
4. Validity and Reliability in Assessment
The fourth principle focuses on the need for validity and reliability of assessments.
In the context of the learner assessment framework, validity refers to the extent to which the assessment meets the intended outcomes. Therefore, to ensure validity, the assessment must consider the learner’s knowledge, skills, values and attitudes in a context which most reflects practice, measured against the professional (NMBA) standards of practice.
The reliability in this context is the consistent and accurate assessment of performance evidenced by the collection of a large array of data. This should be done through a validated tool (for example the ANSAT).
This principle dictates that assessors need to be knowledgeable about the practice standards and the application of these standards to the assessment.
5. Participation and Collaboration
The final principle highlights the role of participation and collaboration between the assessor and the learner as an essential part of the assessment process, for example through progress interviews.
It is during such interviews that assessors collect more data, reflect on the data that has been gathered, reinterpret the data on the basis of student and other novel inputs, and validate their decision. This requires high levels of communication, reflection and reinterpretation of performance by both the assessor and student (NMBA, 2015).
This collaborative relationship between the assessor and student helps ensure that the assessment process is transparent and rigorous. Through a collaborative partnership, learners become more confident about the assessment methods.
This principle also requires formalised review and grievance processes to enhance rigour of the assessment.
Take Home Points:
Only pass learner performances that clearly meet the standards for practice – if they don’t clearly meet standards of practice, seek advice;
Maintain confidentiality and professionalism throughout the assessment process – no tea room “debrief”;
Assess learner performance in an authentic environment;
Assess a learner’s knowledge, skills, values, attitudes and their capacity to integrate these;
Assess learner performance over a period of time, in different contexts;
Collect data, interpret data and reinterpret data before making your decision;
Conduct an interview with the learner to ensure collaboration;
Know the standards of practice like the back of your hand!
The NMBA principles of assessment and the standards of practice provide a broad framework for the assessment of clinical competence.
The role of learner assessment is to arrive at a conclusion about the learner’s performance based on the accumulation of evidence collected over a period of time.
This assessment should ideally occur in the clinical context where a global assessment can occur looking at knowledge, skills, values and attitudes. Specific examples using cues to substantiate the performance of either meeting the standards of practice or not meeting them enables transparency and accountability in the assessment process.
Helminen, K., Coco, K., Johnson, M., Turunen, H., & Tossavainen, K. 2016, Summative assessment of clinical practice of student nurses: A review of the literature. International Journal of Nursing Studies, 53, pp. 308-319.
International Council of Nurses 2006, Continuing competence as a professional responsibility and a public right, International Council of Nurses, Geneva.