Human influences impacting assessors’ experiences of marginal student performances in clinical courses

  • Lynda J. Hughes
    Corresponding author at: Griffith University, School of Nursing and Midwifery, Building N48 Nathan, Qld, 4111, Australia.
    School of Nursing and Midwifery, Griffith University, Nathan, Qld, 4111, Australia

    Menzies Health Institute Queensland, Griffith University, Nathan, Qld, 4111, Australia
    Search for articles by this author
  • Amy N.B. Johnston
    School of Nursing and Midwifery, Griffith University, Nathan, Qld, 4111, Australia

    Menzies Health Institute Queensland, Griffith University, Nathan, Qld, 4111, Australia

    Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Blvd, Southport, Qld, 4215, Australia
    Search for articles by this author
  • Marion L. Mitchell
    School of Nursing and Midwifery, Griffith University, Nathan, Qld, 4111, Australia

    Menzies Health Institute Queensland, Griffith University, Nathan, Qld, 4111, Australia

    Nurse Practice Development Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Qld, 4102, Australia
    Search for articles by this author
Published:February 08, 2018DOI:



      Bachelor of Nursing programmes are designed to prepare nurses to be capable of providing safe and competent, individualised patient care. While research literature is rich with information exploring clinical competence and assessment in nursing programmes, there is a paucity of information on nursing students’ performances in clinical assessment when their capacity to provide quality care is less evident.


      Herein, we describe university employed assessors’ perceptions of the human influences that impact their experiences of grading students’ performances in clinical practice and other assessments within clinical courses when that performance is marginal; not a clear pass or fail.


      Two focus groups and 14 semi-structured one-on-one interviews were conducted with assessors at a multi-campus Australian university.


      Our findings indicated that assessors experience a range of challenges when grading student performances in clinical assessments when that performance is not a clear pass or fail. Thematic analysis identified ‘human influences’ significantly impact assessor experiences.


      The findings provide an understanding around the human influences of assessors’ experiences. Theses influences include: the role of the assessor as gatekeeper, the impact of significant conversations; and assessor supports. Providing appropriate support through meaningful education appears to be the most needed and feasible intervention for this group of assessors. Thus, by understanding assessors’ perceptions of the impact that human influences have on their experiences, supportive measures may be able to be developed to ensure assessors can enact the role of gatekeeper appropriately.


      This study has contributed insights into assessors’ experiences in grading marginal student performance in clinical courses in an Australian context. Gaining insight into assessors’ individual experiences, enables planning and implementation of supportive measures, including clearly articulated guidelines, for assessors and potentially students.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Benner P.
        From novice to expert.
        The American Journal of Nursing. 1984; 82: 402-407
        • Black S.
        • Curzio J.
        • Terry L.
        Failing a student nurse: A new horizon of moral courage.
        Nursing Ethics. 2014; 21: 224-238
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qualitative Research in Psychology. 2006; 3: 77-101
        • Butler M.P.
        • Cassidy I.
        • Quillinan B.
        • Fahy A.
        • Bradshaw C.
        • Tuohy D.
        • et al.
        Competency assessment methods – tool and processes: A survey of nurse preceptors in Ireland.
        Nurse Education in Practice. 2011; 11: 298-303
        • Cant R.
        • McKenna L.
        • Cooper S.
        Assessing preregistration nursing students’ clinical competence: A systematic review of objective measures.
        International Journal of Nursing Practice. 2013; 19: 163-176
        • Duffy K.
        Failing students: A qualitative study of factors that influence the decisions regarding assessment of students’ competence in practice.
        Caledonian Nursing and Midwifery Research Centre, Glasgow2003
        • Earle-Foley V.
        • Myrick F.
        • Luhanga F.
        • Yonge O.
        Preceptorship: Using an ethical lens to reflect on the unsafe student.
        Journal of Professional Nursing. 2012; 28: 27-33
        • Fusch P.I.
        • Ness L.R.
        Are we there yet? Data saturation in qualitative research.
        The Qualitative Report. 2015; 20: 1408
        • Gainsbury S.
        Nurse mentors still failing to fail students.
        2010 ([Nursing . Available:])
        • Helminen K.
        • Coco K.
        • Johnson M.
        • Turunen H.
        • Tossavainen K.
        Summative assessment of clinical practice of student nurses: A review of the literature.
        International Journal of Nursing Studies. 2016; 53: 308-319
        • Hughes L.J.
        • Mitchell M.
        • Johnston A.N.
        ‘Failure to fail’ in nursing – a catch phrase or a real issue? A systematic integrative literature review.
        Nurse Education in Practice. 2016; 20: 54-63
        • Hunt L.A.
        • McGee P.
        • Gutteridge R.
        • Hughes M.
        Assessment of student nurses in practice: A comparison of theoretical and practical assessment results in England.
        Nurse Education Today. 2012; 32: 351-355
        • Hunt L.A.
        • McGee P.
        • Gutteridge R.
        • Hughes M.
        Failing securely: The processes and support which underpin English nurse mentors’ assessment decisions regarding under-performing students.
        Nurse Education Today. 2016; 39: 79-86
        • Hunt L.A.
        • McGee P.
        • Gutteridge R.
        • Hughes M.
        Manipulating mentors’ assessment decisions: Do underperforming student nurses use coercive strategies to influence mentors’ practical assessment decisions?.
        Nurse Education in Practice. 2016; 20: 154-162
        • Jeffreys M.R.
        Tracking students through program entry, progression, graduation, and licensure: Assessing undergraduate nursing student retention and success.
        Nurse Education Today. 2007; 27: 406-419
        • Koch J.
        • Everett B.
        • Phillips J.
        • Davidson P.M.
        Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review.
        Collegian. 2015; 22: 307-318
        • Luhanga F.
        • Yonge O.J.
        • Myrick F.
        Failure to assign failing grades: Issues with grading the unsafe student.
        International Journal of Nursing Education Scholarship. 2008; 5: 1-14
        • Luhanga F.
        • Myrick F.
        • Yonge O.
        The preceptorship experience: An examination of ethical and accountability issues.
        Journal of Professional Nursing. 2010; 26: 264-271
        • Mason M.
        Sample size and saturation in PhD studies in qualitative interviews.
        Forum: Qualitative Social Research. 2010; 11
        • Morgan D.L.
        Focus groups.
        Annual Review of Sociology. 1996; 22: 129-152
        • Nursing and Midwifery Board of Australia
        Registered nurse standards of practice.
        Nursing and Midwifery Board of Australia, Canberra2016
        • Purkey W.W.
        • Novak J.M.
        Fundamentals of invitational education.
        2nd ed. International Alliance for Invitational Education, Nicholasville2016
        • Purkey W.W.
        An introduction to invitational theory.
        Journal of Invitational Theory and Practice. 1992; 1: 5-15
        • Tracy S.J.
        Qualitative quality: Eight big-tent criteria for excellent qualitative research.
        Qualitative Inquiry. 2010; 16: 837-851
        • Tuckett A.G.
        Applying thematic analysis theory to practice: A researcher’s experience.
        Contemporary Nurse. 2005; 19: 75-87
        • Yanhua C.
        • Watson R.
        A review of clinical competence assessment in nursing.
        Nurse Education Today. 2011; 31: 832-836
        • Yepes-Rios M.
        • Dudek N.
        • Duboyce R.
        • Curtis J.
        • Allard R.J.
        • Varpio L.
        The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42.
        Medical Teacher. 2016; 38: 1092-1099