Evaluating Safe Clinical Performance in Nursing Education

Nursing, historically, has been interested in safe patient care in the clinical and educational settings. Previous studies show that 1 in 10 patients experience an adverse event due to medical error. Clinical policies and work place training are not sufficient to prevent errors. It is essential that nursing curriculums at all levels explicitly include safety discussion throughout the curriculum and that nursing students be assessed in the clinical setting for safety-related behaviors and attitudes. Assessment of such behaviors and attitudes requires a consistent approach with a valid instrument. Currently, no universally-accepted, standardized assessment tool for clinical performance in nursing students is available. The Clinical Performance Evaluation Tool (CPET) is one of the few clinical performance tools available. This tool is aligned with the Quality and Safety Education in Nursing (QSEN) standards. The evidence shows that best practice in selecting clinical performance instruments should begin with alignment of the outcomes and assessment criteria with the current curriculum.  Without a standardized tool, the alignment process must be done by individual programs. This report discusses the process adopted in one baccalaureate nursing program to align clinical performance with the QSEN competencies. The initial step towards changing the curriculum included an assessment of current clinical evaluation tools using the CPET tool based on the QSEN competencies. This assessment compared existing clinical evaluations methods among courses and determined the depth or frequency of each QSEN competency in each of the 12 courses with clinical components in the BS curriculum. An expert panel review using accepted definitions and discussion to reach consensus was the procedure used in the study.  Results: The two reviewers with experience in nursing education arrived at a 91% consensus on the presence of the QSEN competencies and the frequency in each course. All but one course matched QSEN competencies in part or whole. Evaluation of the frequencies showed a strong patient-centered care focus present throughout the courses while quality improvement and informatics were least present. The next step in the process is for faculty to determine through value clarification if the frequency of each QSEN competency is appropriate for the desired outcomes of the program. Supervising faculty must modify the exemplars used in the assessment tool to describe the valued behaviors under each competency for the program.  This project has limited generalizability since only one baccalaureate program was included in this project; however the approach can be considered as a possible option for baccalaureate and non-baccalaureate programs in evaluating safe clinical performance utilizing best-practice guidelines.