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Edmonds, M. L. (2012). An integrative lit- erature review of study abroad pro- grams for nursing students. Nursing Education Perspectives, 33(1), 30–34.
doi:10.5480/1536–5026-33.1.30
Kolb, D. A. (1984). Experiential learning: Experi- ence as the source of learning and develop- ment. Englewood Cliffs, NJ: Prentice Hall.
Kuh, G. D. (2008). High-impact educational practices: What they are, who has access to them, and why they matter. Washington, DC: Association of American Colleges and Universities.
Maier-Lorentz, M. (2008). Transcultural nurs- ing: Its importance in nursing practice.
Journal of Cultural Diversity, 15(1), 37–43.
McKinnon, T. H., & Fealy, G. (2011). Core principles for developing global service- learning programs in nursing. Nursing Education Perspectives, 32(2), 95–100.
doi:10.5480/1536–5026-32.2.95
McKinnon, T. H., & McNelis, A. M. (2013).
International programs in United States schools of nursing: Driving forces, obsta- cles, and opportunities. Nursing Education Perspectives, 34(5), 323–328.
Smith, B., Fitzpatrick, J., & Hoyt-Hudson, P.
(2011). Problem solving for better health: A global perspective. New York, NY: Springer Publishing.
Tremethick, M. J., & Smit, E. M. (2009).
Preparing culturally competent health educators: The development and evalu- ation of a cultural immersion service- learning program. International Electronic Journal of Health Education, 12, 185–193.
Tamara Hertenstein McKinnon
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RADEI
NFLATIONDEFINITION
Scholars defi ne grade infl ation as an increase in student grades without a concomitant increase in ability (Cacamese, Elnicki, &
Speer, 2007; Donaldson & Gray, 2012; Fazio, known about the effects on partner communi-
ties. Measuring the outcomes of GSL programs on partner communities is the only way to ensure ethical, evidence-based programs.
McKinnon and Fealy (2011) propose core principles for GSL programs. Core principles, referred to as the “Seven Cs,”
include compassion, curiosity, courage, col- laboration, creativity, capacity building, and competence. According to McKinnon and Fealy, “the articulation of core principles pro- vides for consistency across programs while allowing individual programs to maintain their uniqueness at the level of program content and focus. Incorporating these prin- ciples provides for enhanced communication among programs, increased opportunity for collaborative research, and consistency of evaluation criteria” (p. 99).
Credit toward major (CTM) refers to the provision of school-of-nursing credit for course- work. A study by McKinnon and McNelis (2013) identifi ed a lack of clarity among schools regarding regulations pertaining to provision of CTM for international practicum experi- ences. This uncertainty has been identifi ed as a signifi cant barrier to adoption of GSL pro- grams by SON. As a result, many schools have resorted to creating high unit courses and applying extra units for the international expe- rience. The extra units in these “work-around”
offerings present a barrier to students who cannot afford to pay the additional fees, thus creating exclusionary programs. Providing CTM for global clinical courses creates oppor- tunities for increased student participation (cost and time) and sustainability of programs (cost and faculty time), which ultimately lead to higher-quality programs.
Enhanced use of technology presents unique opportunities for GSL partners. The use of simulation to train students prior to the immersion experience, using modali- ties such as Skype to communicate with global partners during the planning phase, and connecting students on-site during the immersion with students in the classroom at the home institution are all examples of ways in which technology can enhance the GSL experience for all partners.
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164 ■ GRADE INFLATION
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student evaluations may underlie faculty practices to assign higher clinical grades in the belief that these higher grades will lead to better student evaluations of teaching effectiveness.
Another factor related to grade infl ation is the use of part-time faculty as preceptors for students in clinical practice (Bickes &
Schim, 2010; Roman & Trevino, 2006; Scanlan
& Care, 2008). These nurses, while skillful practitioners, are not familiar with the nurs- ing curriculum, intended clinical outcomes, nor the theoretical underpinnings of evalu- ation. In addition, the relationship with the student can interfere with the preceptor’s ability to make a reasoned judgment (Bickes
& Schim, 2010; Donaldson & Gray, 2012;
O’Flynn-McGee & Clauson, 2013; Scanlan &
Care, 2008; Sowbel, 2011). More importantly, these part-time faculty lack experience and the confi dence to make a determination that the student does not have the requisite knowledge and understanding to pass the course (Heaslip & Scammell, 2012).
SYNOPSIS
In reviewing the literature, there are con- sistent themes regarding the reasons for grade infl ation that include rising consum- erism among students, institutional policies such as mandatory teaching evaluations and threat of appeal, use of part-time fac- ulty, lack of faculty understanding regard- ing evaluation practices, and completion of assigning a grade-to-clinical practice (Bickes
& Schim, 2010; Germain & Scandura, 2005;
O’Flynn-McGee & Clauson, 2013; Scanlan
& Care, 2004, 2008; Schneider, 2013; Weaver et al., 2007). Although there are some empiri- cal studies (Bickes & Schim, 2010; Donaldson
& Gray, 2012; O’Flynn-McGee & Clauson, 2013; Scanlan & Care, 2004, 2008), there is no sustained body of empirical evidence that addresses grade infl ation in nursing, particu- larly in clinical practice.
Grade infl ation in clinical practice is particularly important to nurse educators as gatekeepers of the profession. The under- lying factors of use of part-time clinical Papp, Torre, & DeFer, 2013; Scanlan & Care,
2004, 2008). Although the issue of grade infl a- tion has been a concern in academia for more than four decades, grade infl ation is still rampant across disciplines and universities (O’Flynn-McGee & Clauson, 2013; Scanlan &
Care, 2004, 2008; Weaver, Humbert, Besinger, Graber, & Brizendine, 2007).
APPLICATION
The issue of grade infl ation is important to nurse educators as gatekeepers to a prac- tice profession (Fazio et al., 2013; O’Flynn- McGee & Clauson, 2013; Roman & Trevino, 2006; Scanlan & Care, 2008; Sowbel, 2011).
According to these authors, the purpose of grades is to provide the student with infor- mation regarding the ability to master knowl- edge of nursing, as well as the application of knowledge to practice. If students have over- infl ated perceptions of their knowledge and competence as a nurse, the concern for safe practice is real. Furthermore, in a consumer- driven era, students may focus on attaining high grades, rather than learning (Duane &
Satre, 2014; O’Flynn-McGee & Clauson, 2013;
Scanlan & Care, 2004). Nurse educators expe- rience uneasy feelings when a marginal stu- dent graduates. The question faced is “What will be the long-term impact on patient care for a student whose practice was, at best, marginal?”
In universities, student evaluations of teaching performance and course delivery are integral factors considered in promotion and tenure decisions; there is widespread belief that higher grades lead to better teach- ing evaluations (Fazio et al., 2013; Germain &
Scandura, 2005; O’Flynn-McGee & Clauson, 2013; Scanlan & Care, 2004, 2008). Faculty question the validity and reliability of stan- dardized evaluation tools (Donaldson &
Gray, 2012; Germain & Scandura, 2005), an issue that is particularly critical when clini- cal practice is graded. For example, if tools designed to evaluate classroom teaching are mandated for use by students in clini- cal practice courses, student feedback may not be useful. Nonetheless, fear of poor
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reliable evaluation tools, and review of university policies (Cacamese et al., 2007;
Heaslip & Scammell, 2012; O’Flynn-McGee
& Clauson, 2013; Scanlan & Care, 2004, 2008). Clear criteria that address clinical practice outcomes could ameliorate grade infl ation in clinical practice courses. In an effort to address grade infl ation in clini- cal grades, nurse educators have moved to a pass/fail in clinical courses. However, as Heaslip and Scammell (2012) contend, even pass/fail clinical evaluations are subjective and not value free. The evaluations depend on an assessment by the evaluator.
Conceptually, the defi nition of grade infl ation as described is the accepted defi ni- tion in the literature across a wide range of university disciplines. However, is there con- ceptual clarity regarding grade infl ation? Are the studies in the current literature studying the same phenomenon? A rigorous concept analysis of grade infl ation would add clarity to the literature.
Nurse educators teach the nurses of tomorrow. As the entry point to the profes- sion, it is incumbent upon nurse educators to ensure that feedback to students is genu- ine and refl ects nursing practice abilities.
Ongoing research addresses the issues nec- essary to ensure that graduates of nursing programs are clearly able to provide safe and competent nursing care.
Bickes, J. T., & Schim, S. M. (2010). Righting writing: Strategies for improving nurs- ing student papers. International Journal of Nursing Education Scholarship, 7(1), Article 8.
Cacamese, S. M., Elnicki, M., & Speer, A.
J. (2007). Grade infl ation and the inter- nal medicine subinternship: A national survey of clerkship directors. Teaching and Learning in Medicine: An International Journal, 19(4), 343–346.
Donaldson, J. H., & Gray, M. (2012). Systematic review of grading practice: Is there evi- dence of grade infl ation? Nurse Education in Practice, 12, 101–114.
Duane, B. T., & Satre, M. E. (2014). Utilizing constructivism learning theory in teachers, lack of understanding of evaluation
practices, and university policies contribute to grade infl ation and allow marginal stu- dents to graduate.
There is a reluctance to fail students clinically, especially in the fi rst year of clini- cal practice because faculty may believe it is important to give students a second chance (Heaslip & Scammell, 2012; Scanlan & Care, 2004, 2008). Clinical evaluations are fur- ther compromised when one considers the complexity of professional values and the impact of regulatory requirements inher- ent in nursing practice (O’Flynn-McGee
& Clauson, 2013). Without genuine feed- back, students may proceed with the pro- gram without addressing underperforming issues.
University policies contribute to the potential for grade infl ation (Donaldson &
Gray, 2012; Fazio et al., 2013; Scanlan & Care, 2004, 2008). Students who perform poorly in a course may voluntarily withdraw late in the term. More troubling is the threat that a student may appeal to a low grade. Students view themselves as consumers and believe that hard work equals a high grade (Germain
& Scandura, 2005; Scanlan & Care, 2004).
When the grade desired is not forthcoming, students can appeal the grade. Rather than face the prospects of an appeal, faculty fi nd it easier to assign a higher grade in keeping with the grade the student expects (Bickes &
Schim, 2010; Fazio et al., 2013; Scanlan & Care, 2004, 2008). An unintended consequence of assigning higher grades when not war- ranted is that the grade scale becomes com- pressed and truly good work and effort are not rewarded (O’Flynn-McGee & Clauson, 2013; Scanlan & Care, 2004, 2008). Students quickly learn that minimal effort is all that is required for a “good” grade.
RECOMMENDATIONS
There are few solutions to grade infl a- tion that have not been discussed in the discourse concerning grade infl ation, including faculty development regard- ing evaluation practices, use of valid and
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166 ■ GRADING
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RADINGDEFINITION
Grading involves assigning a level of merit to a student’s work. A grade can be a letter, a number, or pass/fail, and represents the stu- dent’s effort and abilities on an assignment or in a course. Letter and number grades are on a ratio scale, which allows comparison between students.
APPLICATION
In nursing, grades are assigned in both theory and clinical courses. It is generally thought that theory course grades are more objective than clinical course grades. In a recent national survey of nursing faculty, the grade for a theory course was primarily com- prised of test grades, and then papers and projects (Oermann, Saewert, & Charasika, 2009). The survey also assessed how nurs- ing faculty assign grades in clinical courses, which are primarily pass/fail as opposed to letter or number grades, and found that most faculty use a rubric that is often the same across courses, but altered slightly to address the specifi c learning goals of each course (Oermann, Yarbrough, Saewert, Ard,
& Charasika, 2009).
Three key themes are present in the nurs- ing literature around grading: grade infl a- tion, disparity between clinical and theory course grades, and challenges in assigning failing clinical grades.
Grade infl ation refers to giving higher grades for lower levels of effort and ability over time. Some reasons for grade infl ation are due to faculty concerns around receiving good student evaluations that determine their rank and tenure and ensuring high enroll- ment in their courses (Shoemaker & DeVos, 1999). Another reason cited is that when a C grade is considered the lowest acceptable grade rather than D, there is upward pressure on grades (Walsh & Seldomridge, 2005). One of the biggest concerns with grade infl ation collaborative testing as a creative strategy
to promote essential nursing skills. Nurse Education Today, 34, 31–34.
Fazio, S. B., Papp, K. K., Torre, D. M., & DeFer, T. M. (2013). Grade infl ation in the inter- nal medicine clerkship: A national survey.
Teaching and Learning in Medicine, 25(1), 71–76.
Germain, M. L., & Scandura, T. A. (2005).
Grade infl ation and student individual differences as systematic bias in fac- ulty evaluations. Journal of Instructional Management, 32(1), 58–66.
Heaslip, V., & Scammell, J. M. E. (2012). Failing underperforming students: The role of grading in clinical practice assessment.
Nurse Education in Practice, 12, 95–100.
O’Flynn-Magee, K., & Clauson, M. (2013).
Uncovering nurse educators’ beliefs and values about grading academic papers:
Guidelines for best practices. Journal of Nursing Education, 52(9), 492–499.
Roman, B. J. B., & Trevino, J. (2006). An approach to address grade infl ation in a psychiatry clerkship. Academic Psychiatry, 30(2), 110–115.
Scanlan, J. M., & Care, W. D. (2004). Grade infl ation: Should we be concerned? Journal of Nursing Education, 43, 475–478.
Scanlan, J. M., & Care, W. D. (2008). Issues with grading and grade infl ation in nurs- ing education. In M. H. Oermann (Ed.), Annual review of nursing education (Vol.
6, pp. 173–188). New York, NY: Springer Publishing.
Schneider, G. (2013). Student evaluations, grade infl ation and pluralistic teaching:
Moving from customer satisfaction to stu- dent learning and critical thinking. Forum for Social Economics, 122–134.
Sowbel, L. R. (2011). Gate keeping in fi eld per- formance: Is grade infl ation a given? Journal of Social Work Education, 47(2), 367–377.
Weaver, C. S., Humbert, A. J., Besinger, B. R., Graber, J. S., & Brizendine, E. J. (2007). A more explicit grading scale decreases grade infl ation in a clinical clerkship. Academic Emergency Medicine, 14(3), 283–286.
Judith M. Scanlan
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marginal students to pass. For instance, some areas of the evaluation may be seen as more important to clinical performance;
however, all areas are weighed the same, so if a student does well in the less important areas, he or she may still be able to satis- factorily complete clinical courses (Walsh
& Seldomridge, 2005). Another issue with rubrics is that clinical experiences are var- ied; instructors cannot ensure that each stu- dent will have the opportunity to exhibit all of the skills listed on the rubric (Walsh &
Seldomridge, 2005).
One option explored by a university in the United Kingdom was allowing clinical faculty to use an evaluation tool with a grade scale for clinical practice rather than using a pass/fail system (Heaslip & Scammell, 2012).
Although most faculty (64.2%) reported they liked the tool and grading on a scale allowed for greater differentiation of students’ perfor- mance, 67.9% wanted more training on how to grade and 59.8% reported wanting more training on how to work with failing stu- dents (Heaslip & Scammell, 2012).
Because failing students for poor clinical performance is such a diffi cult endeavor for preceptors, it is important to consider what can be done to support them in the grad- ing process. The consensus from precep- tors is that patient safety is the key criterion in assessing student clinical performance (Amicucci, 2012). One possibility would be to make patient safety carry more weight on clinical rubrics. Some suggestions that came out in a qualitative study of preceptors were to have clinical liaisons who are supportive and listen to a preceptor’s concerns regard- ing student safety, speak to the student with the preceptor, and follow up with the pre- ceptor after failing a student (Hrobsky &
Kersbergen, 2002).
SYNOPSIS
Grading in nursing education is a complex matter that has differing challenges in the- ory and clinical courses. Some key themes in the literature involve grade infl ation, lack of failing grades for poor clinical performance, is ensuring nurses who graduate are able
to provide safe and skilled care to patients, and elevated grades may make it diffi cult to determine who will pass the National Council Licensure Examination (NCLEX) as well as who is adequately prepared for grad- uate studies (Shoemaker & DeVos, 1999). One solution to address grade infl ation involves training faculty to improve grading practices (Shoemaker & DeVos, 1999).
Grade infl ation may be related to the increasing disparity between theory and clinical grades, whereby clinical grades are helping to infl ate course grades. It is assumed that theory underlies excellent nursing prac- tice; therefore, a correlation is expected between grades in theory and corresponding clinical courses (Walsh & Seldomridge, 2005).
In a study comparing clinical and theory grades, the authors found that clinical grades were higher than theory grades (Walsh &
Seldomridge, 2005). The reasons cited for the disparity primarily involve the challenging nature of clinical grading.
Clinical grades are seen as more subjec- tive than theory grades, and are therefore more challenging to determine. In a qualita- tive study of clinical faculty, faculty admit- ted overseeing students who did not meet safe patient-handling standards in clini- cal settings, but were reluctant to fail them (Luhanga, Yonge, & Myrick, 2008). Some rea- sons for not failing unsafe students included concern for how the failing grade might affect the student right before he or she was to graduate, feeling they did not have enough time to observe the student in clinical, and empathy for the amount of money spent on the course (Luhanga et al., 2008).
One way to objectify clinical grades is to create clear evaluation standards and share these with students ahead of time.
As Isaacson and Stacy (2009) suggest, cre- ating a rubric that clearly explains what clinical skills students are to demonstrate to meet the course objectives is one way to assist clinical faculty in ranking student performance. However, clinical evaluation tools have been criticized for their lack of differentiation among students, allowing
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