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Assigning a failing grade to a student in the final clinical semester 1993

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ASSIGNING A FAILING GRADE TO A STUDENT IN THE FINAL CLINICAL SEMESTER by SUSAN ELIZABETH GREATHOUSE B.N., The U n i v e r s i t y of C a l g a r y , 1981 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES The S c h o o l of N u r s i n g We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d stj^ndard THE UNIVERSITY OF BRITISH COLUMBIA December, 1993 Susan E. Greathouse In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, 1 agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allov^ed without my written permission. Department of The University of British Columbia Vancouver, Canada Date DE-6 (2/88) A b s t r a c t The purpose of t h i s s t u d y was t o e x p l o r e the p e r c e p t i o n s and f e e l i n g s of n u r s e e d u c a t o r s on a s s i g n i n g a f a i l i n g grade t o s t u d e n t s e n r o l e d i n t h e f i n a l semester i n a d i p l o m a n u r s i n g program. U s i n g p h e n o m e n o l o g i c a l methodology, and L a z a r u s ' s p r o c e s s - o r i e n t e d t h e o r e t i c a l framework, n i n e i n f o r m a n t s employed i n B r i t i s h Columbia Lower M a i n l a n d d i p l o m a n u r s i n g programs were i n t e r v i e w e d and a u d i o - t a p e d . Data a n a l y s i s sought t o i d e n t i f y t h e e x i s t e n c e of the phenomena and d e s c r i b e the essence of t h e e x p e r i e n c e . The f i n d i n g s of the s t u d y i l l u s t r a t e t h a t a s s i g n i n g a f a i l i n g grade i n t h e f i n a l c l i n i c a l semester i s a s t r e s s f u l event f o r n u r s e e d u c a t o r s . The prominent o v e r r i d i n g theme wh i c h emerged from t h e d a t a was s t r e s s . Two o t h e r i n t e r r e l a t e d themes, u n c e r t a i n t y and i s o l a t i o n , were a l s o embedded i n t h e i n f o r m a n t s ' d e s c r i p t i o n s o f t h e i r e x p e r i e n c e s . These themes were s t r e s s o r s i n t h e m s e l v e s . Nurse e d u c a t o r s d e s c r i b e d immediate and l o n g - t e r m e f f e c t s of l i v i n g t h r o u g h t h e i r e x p e r i e n c e s . Immediate e f f e c t s i n c l u d e d b e i n g more on guard, as w e l l as m o d i f y i n g and r e f i n i n g t h e i r approach t o c l i n i c a l e v a l u a t i o n . The l o n g - t e r m e f f e c t s r e s u l t e d i n t h e s e n u r s e e d u c a t o r s b e i n g q u i t e s i g n i f i c a n t l y a f f e c t e d by e v e n t s . They c o u l d v i v i d l y r e c a l l t h e d e t a i l s of t h e i r e x p e r i e n c e s w h i c h l e f t them w i t h l a s t i n g i m p r e s s i o n s . These e x p e r i e n c e s s e r v e d as p o i n t s o f r e f e r e n c e f o r nu r s e e d u c a t o r s when f a c e d w i t h o t h e r s t u d e n t s h a v i n g s i m i l a r problems. Three major c o n c l u s i o n s were i d e n t i f i e d . F i r s t , a s s i g n i n g a f a i l i n g grade t o a s t u d e n t i s s t r e s s f u l . I n f o r m a n t s d e s c r i b e d t h e e x p e r i e n c e as more s t r e s s f u l when t h e s t u d e n t l a c k e d i n s i g h t . Second, nurse e d u c a t o r s e x p r e s s e d a need f o r e m o t i o n a l support from t h e i r p e e r s . They r e p o r t e d f e e l i n g i s o l a t e d and unsu p p o r t e d . They were a c u t e l y aware o f the p o t e n t i a l r a m i f i c a t i o n s of a s s i g n i n g o r not a s s i g n i n g a f a i l i n g grade. T h i s c r e a t e d an element of u n c e r t a i n t y t h a t a f f e c t e d t h e i r d e c i s i o n - m a k i n g a b i l i t y . T h i r d , t h e nu r s e e d u c a t o r s b e l i e v e d t h a t program a d m i n i s t r a t o r s c o u l d and s h o u l d have been more s u p p o r t i v e i n two major a r e a s : 1) acknowledgement and r e a s s u r a n c e and 2 ) c o n s i s t e n t a d m i n i s t r a t i o n of e d u c a t i o n a l p o l i c i e s . T a b l e of Con t e n t s Page A b s t r a c t i i Ta b l e of Co n t e n t s i v L i s t o f F i g u r e s v i i Acknowledgements v i i i CHAPTER ONE INTRODUCTION 1 Background t o the Problem 1 Res e a r c h Q u e s t i o n 2 C o n c e p t u a l Framework 3 D e f i n i t i o n of Terms 6 Assumptions 7 L i m i t a t i o n s 8 S i g n i f i c a n c e o f the Study 8 O r g a n i z a t i o n o f t h e T h e s i s 9 CHAPTER TWO REVIEW OF THE LITERATURE 10 F e e l i n g s , P e r c e p t i o n s , and E x p e r i e n c e s 10 Impact on F a c u l t y 12 Summary IV CHAPTER 3 METHODOLOGY 2 0 I s s u e s of V a l i d i t y and R e l i a b i l i t y 23 S e l e c t i o n of In f o r m a n t s 24 C r i t e r i a 24 Procedures 25 E t h i c a l C o n s i d e r a t i o n s 26 Data C o l l e c t i o n 27 Data A n a l y s i s 28 CHAPTER FOUR PRESENTATION AND DISCUSSION OF FINDINGS 3 0 C h a r a c t e r i s t i c s of In f o r m a n t s 30 Content A n a l y s i s 31 S t r e s s 32 U n c e r t a i n t y 3 6 I s o l a t i o n 42 Lack of A d m i n i s t r a t i v e Support 44 V a r i a b l e s t h a t I n f l u e n c e A p p r a i s a l s 50 Nurse E d u c a t o r 51 Student 61 Environment 67 Coping 74 Prob l e m - f o c u s e d S t r a t e g i e s 76 E m o t i o n - f o c u s e d S t r a t e g i e s 82 Immediate and Long Term E f f e c t s 89 Summing Up 92 CHAPTER FIVE SUMMARY, CONCLUSIONS, AND IMPLICATIONS 97 Summary 97 C o n c l u s i o n s 100 I m p l i c a t i o n s f o r N u r s i n g 101 N u r s i n g E d u c a t i o n 101 N u r s i n g R e s e a r c h 102 Re f e r e n c e s 104 Appendices 108 A. E x p l a n a t o r y L e t t e r t o A g e n c i e s . . . . 108 B. Agency Consent Form I l l C. L e t t e r t o In f o r m a n t s 113 D. S u b j e c t Consent Form 116 E. Demographic Data Sheet 118 F. I n t e r v i e w Q u e s t i o n s 120 A d a p t a t i o n of L a z a r u s ' s Framework t o D e p i c t Nurse E d u c a t o r s ' E x p e r i e n c e s W i t h A s s i g n i n g a F a i l i n g Grade ACKNOWLEDGEMENTS I would l i k e t o ex p r e s s my a p p r e c i a t i o n t o the nu r s e e d u c a t o r s who sh a r e d t h e i r e x p e r i e n c e s w i t h me thus making t h i s s t u d y p o s s i b l e . I n a d d i t i o n , I would l i k e t o thank my husband Wayne, f o r h i s unending s u p p o r t and encouragement. F i n a l l y , I would l i k e t o acknowledge Dr. M a r i l y n W i l l m a n , Dr. S o n i a A c o r n , and Ray Thompson f o r t h e i r feedback and e d i t o r i a l comments n e c e s s a r y t o complete t h i s work. CHAPTER ONE I n t r o d u c t i o n Background t o t h e Problem E m p i r i c a l o b s e r v a t i o n s o f s i t u a t i o n s i n v o l v i n g n u r s e e d u c a t o r s and f a i l i n g s t u d e n t s have shown t h a t f a i l i n g a s t u d e n t i s a s t r e s s - p r o d u c i n g p a r t o f t h e f a c u l t y member's r o l e . I t i s t h i s r e s e a r c h e r ' s c o n t e n t i o n t h a t t h e s t r e s s r e l a t e d t o c l i n i c a l e v a l u a t i o n appears t o be g r e a t e s t f o r the nurse e d u c a t o r who e n c o u n t e r s a s t u d e n t unable t o meet t h e program o b j e c t i v e s i n the f i n a l term of a d i p l o m a n u r s i n g program. F or s t u d e n t s , t h e r e a l i t y of b e i n g u n a b l e t o f u l f i l t h e i r e d u c a t i o n a l a s p i r a t i o n s o f t e n i n i t i a t e s a h i g h l y e m o t i o n a l r e s p o n s e . I n g e n e r a l , f a i l u r e t o complete t h e f i n a l semester of the program seems t o r e s u l t i n s t u d e n t responses d i f f e r e n t from, and o f t e n more e x a g g e r a t e d than, f a i l u r e i n e a r l i e r s e m e s t e r s . These responses t r i g g e r a v a r i e t y o f tho u g h t s and f e e l i n g s i n t h e n u r s e e d u c a t o r who i s r e s p o n s i b l e f o r i s s u i n g t h e f a i l i n g grade. These s i t u a t i o n s , w h i c h a r e o f t e n c o u p l e d w i t h h i g h l y e m o t i o n a l l y charged s t u d e n t r e s p o n s e s , may have a major and l a s t i n g impact on the f a c u l t y member. Recent r e s e a r c h f i n d i n g s l e n d s u p p o r t t o t h i s v i e w i n d i c a t i n g t h a t " f a i l i n g c l i n i c a l l y u n s a t i s f a c t o r y s t u d e n t s " was one of the items most f r e q u e n t l y r a t e d as h i g h l y s t r e s s f u l by e d u c a t o r s of b a c c a l a u r e a t e n u r s i n g s t u d e n t s (Goldenberg & W a d d e l l , 1990, p. 537). There i s g e n e r a l consensus among n u r s i n g a u t h o r s t h a t d e a l i n g w i t h t h e c l i n i c a l l y f a i l i n g s t u d e n t i s o f t e n a n e g a t i v e , d e b i l i t a t i n g , and d e m o r a l i z i n g e x p e r i e n c e f o r nu r s e e d u c a t o r s ( C a r p e n i t o , 1983; Goldenberg & W a d d e l l , 1990; Spink, 1983; Symanski, 1991; T u r k e t t , 1987). Most of the l i t e r a t u r e w h i c h makes r e f e r e n c e t o t h e impact on t h e nu r s e e d u c a t o r o f f a i l i n g a s t u d e n t i s based on o p i n i o n o r s p e c u l a t i o n . L i t t l e has been w r i t t e n about the nurse e d u c a t o r ' s p e r c e p t i o n s and what i s w r i t t e n may o r may not c o r r e s p o n d w i t h r e a l i t y . R e s e a r c h Q u e s t i o n The q u e s t i o n a d d r e s s e d i n t h i s s t u d y was: What a r e t h e e x p e r i e n c e s and p e r c e p t i o n s of nurse e d u c a t o r s i n d i p l o m a n u r s i n g programs r e l a t e d t o a s s i g n i n g f a i l i n g grades t o s t u d e n t s i n t h e i r f i n a l c l i n i c a l semester? C o n c e p t u a l Framework The p h e n o m e n o l o g i c a l t r a n s a c t i o n a l model of L a z a r u s and Folkman (1984a) i s a u s e f u l framework f o r enhancing one's u n d e r s t a n d i n g o f t h i s e x p e r i e n c e . U n l i k e e a r l y r e s e a r c h on s t r e s s by S e l y e , w h i c h f o c u s e d p r i m a r i l y on p h y s i o l o g i c a l s t r e s s r e s p o n s e s , L a z a r u s and h i s c o l l e a g u e s a d d r e s s e d mental and p s y c h o l o g i c a l r e sponses t o s t r e s s . They p a r t i c u l a r l y f o c u s e d on t h o s e c o g n i t i v e , a f f e c t i v e , and a d a p t i v e responses a r i s i n g from person-environment t r a n s a c t i o n s . I n t h i s i n d i v i d u a l i s t i c , p r o c e s s - o r i e n t e d model, t h e n o t i o n of s t r e s s w h i c h a r i s e s from t h e i n t e r p l a y between person-environment t r a n s a c t i o n s i s m e d i a t e d by two p r i m a r y p r o c e s s e s : c o g n i t i v e a p p r a i s a l and c o p i n g . An event i n t h e environment i s c o n s i d e r e d a s t r e s s o r o n l y when an i n d i v i d u a l a p p r a i s e s i t as e x c e e d i n g h i s o r h e r r e s o u r c e s and d e t e r m i n e s t h a t i t i s t h r e a t e n i n g o r d i s t u r b i n g ( Lazarus & Folkman, 1984a). The t e a c h i n g - l e a r n i n g p r o c e s s , p a r t i c u l a r l y i n r e l a t i o n t o d e a l i n g w i t h t h e c l i n i c a l l y u n s a t i s f a c t o r y s t u d e n t , has been i d e n t i f i e d as a s o u r c e of s i g n i f i c a n t s t r e s s and p o t e n t i a l cause of burnout f o r nurse e d u c a t o r s (Fong, 1990; Goldenberg & W a d d e l l , 1990; Ray, 1984; Symanski, 1991; Welborn & Thompson, 1982). M u l t i p l e person-environment t r a n s a c t i o n s a r e i n v o l v e d i n i s s u i n g f a i l i n g grades t o n u r s i n g s t u d e n t s i n t h e f i n a l semester of a di p l o m a n u r s i n g program. By u t i l i z i n g L a z a r u s ' s d e f i n i t i o n o f s t r e s s o r i d e n t i f i c a t i o n , the r e s e a r c h e r w i l l be a b l e t o i d e n t i f y how nurse e d u c a t o r s a p p r a i s e t h e i r e x p e r i e n c e s . L a z a r u s and Folkman (1991) b e l i e v e t h a t c o g n i t i v e a p p r a i s a l s a r e i n f l u e n c e d by a v a r i e t y o f p e r s o n and e n v i r o n m e n t a l v a r i a b l e s . P e r s o n a l c h a r a c t e r i s t i c s may i n c l u d e such v a r i a b l e s as one's v a l u e s and b e l i e f s , s e l f - e s t e e m , p r i o r l i f e e x p e r i e n c e s , and t h e a b i l i t y t o r e c o g n i z e p e r s o n a l r e s o u r c e s w h i c h may enhance o r impede c o p i n g . These may be t h i n g s such as f i n a n c i a l means, s o c i a l and p r o b l e m - s o l v i n g s k i l l s , h e a l t h , and energy. E n v i r o n m e n t a l v a r i a b l e s i n c l u d e t h e n a t u r e of the s t r e s s , the t i m i n g , d u r a t i o n and a m b i g u i t y of t h e s i t u a t i o n , o t h e r s i t u a t i o n a l demands and c o n s t r a i n t s , and t h e e x i s t e n c e and q u a l i t y o f s o c i a l s u p p o r t r e s o u r c e s w h i c h may f a c i l i t a t e c o p i n g (Lazarus & Folkman, 1984a; 1991). M u l t i p l e f a c t o r s have been i d e n t i f i e d i n t h e l i t e r a t u r e as s o u r c e s o f s t r e s s a s s o c i a t e d w i t h the a s s i g n i n g of f a i l i n g grades t o c l i n i c a l l y u n s a t i s f a c t o r y s t u d e n t s . Many of t h e s e f a c t o r s a r i s e from p r e s s u r e s and c o n f l i c t s i n h e r e n t i n m a i n t a i n i n g h i g h s t a n d a r d s of n u r s i n g p r a c t i c e w h i l e d e a l i n g w i t h p r e s s u r e s t o pass s t u d e n t s . Other v a r i a b l e s p e r c e i v e d by n u r s e e d u c a t o r s as s o u r c e s o f s t r e s s i n c l u d e r o l e c o n f l i c t , r o l e a m b i g u i t y , f e a r of l i t i g a t i o n , and l a c k of s u p p o r t ( D i c k , 1986; Fain,1987; L e s s n e r , 1990; O'Connor, 1978; P o l l o k & P o t e e t , 1983). F a i n (1987) p o s t u l a t e s t h a t r o l e a m b i g u i t y and r o l e c o n f l i c t may l e a d t o j o b d i s s a t i s f a c t i o n . Coping, a c c o r d i n g t o L a z a r u s and Folkman (1991), i s a m u l t i d i m e n s i o n a l p r o c e s s and c o n s i s t s of c o g n i t i v e and b e h a v i o r a l a t t e m p t s t o manage p e r c e i v e d s t r e s s o r s t h a t a r e a p p r a i s e d as e x c e e d i n g t h e r e s o u r c e s o f t h e i n d i v i d u a l . I n t h i s model, c o p i n g i s i d e n t i f i e d as b e i n g e i t h e r p r o b l e m - f o c u s e d o r e m o t i o n - f o c u s e d . P r o b l e m - f o c u s e d c o p i n g p r o c e s s e s a r e d i r e c t e d toward a l t e r i n g t h e person-environment r e l a t i o n s h i p , w h i l e e m o t i o n - f o c u s e d c o p i n g s t r a t e g i e s a r e p r i m a r i l y d i r e c t e d toward managing e m o t i o n a l d i s t r e s s r a t h e r t h a n c h a n g i n g t h e person-environment r e l a t i o n s h i p ( Lazarus & Folkman, 1991). I n t h i s way, t h e i n d i v i d u a l ' s a p p r a i s a l of t h e s t r e s s f u l s i t u a t i o n , i n f l u e n c e d by pe r s o n and e n v i r o n m e n t a l v a r i a b l e s , a f f e c t s the i n d i v i d u a l ' s c o p i n g r e s p o n s e s . These c o p i n g responses i n t u r n a l t e r t h e person-environment r e l a t i o n s h i p and a f f e c t t h e q u a l i t y and i n t e n s i t y of the i n d i v i d u a l ' s e m o t i o n a l response. By examining t h e v a r i a b l e s t h a t i n f l u e n c e n u r s e e d u c a t o r s ' a p p r a i s a l s o f e v e n t s , b o t h c o g n i t i v e and b e h a v i o r a l c o p i n g p r o c e s s e s may be i d e n t i f i e d and p a t t e r n s of c o p i n g may be r e v e a l e d . T h i s h u m a n i s t - o r i e n t e d model d i r e c t e d toward e v a l u a t i n g an i n d i v i d u a l ' s p e r c e p t i o n o f , and r e a c t i o n t o , s i t u a t i o n s w h i c h s/he a p p r a i s e s as b e i n g t h r e a t e n i n g o r s t r e s s f u l , i s congruent w i t h t h e phénomènelogical methodology used i n t h i s s t u d y . The t h e o r e t i c a l framework and methodology d e s c r i b e t h e i n d i v i d u a l ' s p e r c e p t i o n and e x p e r i e n c e a r i s i n g from the s i t u a t i o n i n v o l v i n g c l i n i c a l l y f a i l i n g s t u d e n t s . D e f i n i t i o n of Terms Words and p h r a s e s used i n t h i s s t u d y a r e d e f i n e d as f o l l o w s : Impact : t h e e f f e c t s , o r t h e p e r c e p t i o n o f t h e e f f e c t s , r e s u l t i n g from t h e e x p e r i e n c e of f a i l i n g s t u d e n t s on t h e i n f o r m a n t s . Nurse e d u c a t o r : an i n d i v i d u a l who i s a p r a c t i c i n g member of the R e g i s t e r e d Nurses' A s s o c i a t i o n of B r i t i s h Columbia, who i s t e a c h i n g i n a d i p l o m a n u r s i n g program, i n t h e f i n a l c l i n i c a l semester. T h i s term i s used synonymously w i t h t h e term " n u r s i n g f a c u l t y . " F a i l i n g s t u d e n t s : s t u d e n t s who have been c l i n i c a l l y e v a l u a t e d by a q u a l i f i e d n u r se e d u c a t o r and have been i d e n t i f i e d as not m e e t i n g t h e c o u r s e o b j e c t i v e s i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program. Diploma n u r s i n g programs: n u r s i n g programs based i n p o s t - s e c o n d a r y i n s t i t u t i o n s t h a t g r a n t diplomas i n n u r s i n g i n the p r o v i n c e of B r i t i s h Columbia. F i n a l c l i n i c a l semester: t h e f i n a l c l i n i c a l semester p r i o r t o g r a d u a t i n g from a d i p l o m a n u r s i n g program. Assumptions The w r i t e r assumes t h a t any n u r s e e d u c a t o r who has f a i l e d one o r more n u r s i n g s t u d e n t s i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program i s q u a l i f i e d t o speak about h i s / h e r e x p e r i e n c e s r e l a t e d t o the impact of f a i l i n g a s t u d e n t and t h a t t h e e x p e r i e n c e s a r e v a l i d a c c o r d i n g t o p h e n o m e n o l o g i c a l t h e o r y . L i m i t a t i o n s Sample s e l e c t i o n was l i m i t e d t o n u rse e d u c a t o r s i n t h e p r o v i n c e o f B r i t i s h Columbia who had f a i l e d a t l e a s t one n u r s i n g s t u d e n t c l i n i c a l l y , i n a d i p l o m a n u r s i n g program. The sample, a p u r p o s i v e , c o n v e n i e n c e sample, was drawn from o n l y two d i p l o m a programs and t h e r e f o r e , t h e f i n d i n g s cannot be g e n e r a l i z e d t o a l l n u rse e d u c a t o r s . S i g n i f i c a n c e of t h e Study Nurse e d u c a t o r s ' p e r c e p t i o n s and f e e l i n g s r e s u l t i n g from w o r k i n g w i t h c l i n i c a l l y f a i l i n g s t u d e n t s may have a s i g n i f i c a n t impact on n u r s i n g e d u c a t i o n . V a r i o u s a u t h o r s have p o s t u l a t e d t h a t t h e m u l t i p l e s t r e s s e s i n h e r e n t i n t h e s e s i t u a t i o n s may l e a d t o s t r e s s and b urnout, and may a c t u a l l y r e s u l t i n n u r s e e d u c a t o r s l e a v i n g c l i n i c a l t e a c h i n g ( C a r p e n i t o , 1983; G oldenberg & W a d d e l l , 1990; L e n h a r t , 1980; O'Connor, 1978; Ray, 1984; T u r k e t t , 1987). B e i n g aware o f , and b e t t e r a b l e t o a n t i c i p a t e , t h e f e e l i n g s t h a t may r e s u l t from t h e s e d i f f i c u l t s i t u a t i o n s may a s s i s t n u rse e d u c a t o r s t o d e a l w i t h t h i s a s p e c t of c l i n i c a l e v a l u a t i o n more e f f e c t i v e l y . A d d i t i o n a l r e s e a r c h may g e n e r a t e f i n d i n g s t o i n c o r p o r a t e i n t o g r a d u a t e programs t h a t p r e p a r e nurse e d u c a t o r s . N o v i c e n u r s e e d u c a t o r s may b e n e f i t from t h e f i n d i n g s of t h i s s t u d y by g a i n i n g an i n c r e a s e d awareness of t h e p e r c e p t i o n s and f e e l i n g s r e s u l t i n g from i n t e r a c t i o n s w i t h f a i l i n g c l i n i c a l s t u d e n t s . As a r e s u l t , t h ey may f i n d themselves b e t t e r a b l e t o cope w i t h the impact of the c h a l l e n g i n g s i t u a t i o n s w h i c h t h e y w i l l i n e v i t a b l y have t o f a c e . O r g a n i z a t i o n o f t h e T h e s i s T h i s t h e s i s i s o r g a n i z e d i n t o f i v e c h a p t e r s . I n C h a p t e r One, the c o n t e x t o f the problem, purpose of the s t u d y , and t h e o r e t i c a l framework have been d e s c r i b e d . In a d d i t i o n , key terms were d e f i n e d and t h e s i g n i f i c a n c e and l i m i t a t i o n s o f t h e s t u d y d e l i n e a t e d . C h a p t e r Two p r e s e n t s a r e v i e w of the r e l e v a n t l i t e r a t u r e d e s c r i b i n g t h e f e e l i n g s , p e r c e p t i o n s and e x p e r i e n c e s of nurse e d u c a t o r s , t h e impact on n u r s e e d u c a t o r s of i n t e r a c t i n g w i t h f a i l i n g s t u d e n t s , and t h e c o n f l i c t s i n h e r e n t i n t h e nurse e d u c a t o r ' s r o l e . I n C h a p t e r Three, the p h e n o m e n o l o g i c a l method used i n t h i s s t u d y i s d e s c r i b e d and an o u t l i n e of t h e c r i t e r i a used t o s e l e c t i n f o r m a n t s p r e s e n t e d . Chapter Four i n c l u d e s the p r e s e n t a t i o n and d i s c u s s i o n of t h e s t u d y ' s f i n d i n g s . C h apter F i v e i n c l u d e s t h e summary, c o n c l u s i o n s and i m p l i c a t i o n s . CHAPTER TWO Review o f the L i t e r a t u r e The r e v i e w o f the l i t e r a t u r e f o c u s e s on two a r e a s . The f i r s t i s r e l a t e d t o nu r s e e d u c a t o r s ' f e e l i n g s , p e r c e p t i o n s , and e x p e r i e n c e s a r i s i n g from i n t e r a c t i o n s w i t h n u r s i n g s t u d e n t s who have been i s s u e d a f a i l i n g c l i n i c a l grade. The second r e l a t e s t o the impact on nur s e e d u c a t o r s of t h i s event. F e e l i n g s , P e r c e p t i o n s and E x p e r i e n c e s O'Connor (1978) s p e c u l a t e d t h a t the t e a c h i n g - l e a r n i n g p r o c e s s , p a r t i c u l a r l y i n t h e c l i n i c a l s e t t i n g , can s e t t h e scene f o r c o n f l i c t s t h a t prove troublesome f o r a l l n u r s e e d u c a t o r s . V a r i o u s a u t h o r s have made r e f e r e n c e t o t h e e m o t i o n a l l y d r a i n i n g e x p e r i e n c e of d e a l i n g w i t h s t u d e n t s who p e r f o r m u n s a t i s f a c t o r i l y i n the c l i n i c a l s e t t i n g (Lankshear, 1990; L e n h a r t , 19 80; Symanski, 1991; T u r k e t t , 1987; Wood, 1971). The l i t e r a t u r e t h a t a d d r e s s e s the p r o c e s s of c l i n i c a l e v a l u a t i o n as i t r e l a t e s t o f a i l i n g a s t u d e n t i s f i l l e d w i t h s t a t e m e n t s d e s c r i b i n g f e e l i n g s a r i s i n g out of t h i s p r o c e s s . T u r k e t t (1987) s t a t e s t h a t "when f a c e d w i t h t h e r e a l i t y o f f a i l u r e b o t h s t u d e n t and n u r s e e d u c a t o r become u n c o m f o r t a b l e , t e n s e and depres s e d " (p. 246). F e e l i n g s o f i n s u f f i c i e n c y and p o w e r l e s s n e s s may s u r f a c e . F r u s t r a t i o n may be e x p e r i e n c e d by the nurse e d u c a t o r (Anderson & Saxon, 1968; C a r p e n i t o , 1983; K e l l y , 1973). C a r p e n i t o (1983) p o i n t s out t h a t n u r s e e d u c a t o r s may d i s t a n c e themselves b o t h p h y s i c a l l y and e m o t i o n a l l y i n response t o s t u d e n t anger and h o s t i l i t y . Nurse e d u c a t o r s a r e o f t e n l e f t w i t h doubts a r i s i n g from the c l i n i c a l e v a l u a t i o n p r o c e s s . They wonder whether they have "done the r i g h t t h i n g , " knowing f u l l w e l l t h a t o p i n i o n s would v a r y among e q u a l l y competent e d u c a t o r s (Brozenec, M a r s h a l l , Thomas, & Walsh, 1987, p. 4 2 ) . In a r e c e n t e x p l o r a t o r y s t u d y , Goldenberg and Waddell (1990) examined s o u r c e s and l e v e l s of p e r c e i v e d s t r e s s among 7 0 female b a c c a l a u r e a t e n u r s e e d u c a t o r s i n e i g h t O n t a r i o u n i v e r s i t i e s . They found t h a t t h e major s t r e s s e s were p r i m a r i l y c l i n i c a l l y - o r i e n t e d and i n c l u d e d " r e t a i n i n g f a i l i n g s t u d e n t s and f a i l i n g c l i n i c a l l y u n s a t i s f a c t o r y s t u d e n t s " (p.537). A l t h o u g h some l i m i t a t i o n s were n o t e d i n t h e s t u d y , t h e f i n d i n g s s u p p o r t e d t h e i n v e s t i g a t o r s ' c o n t e n t i o n t h a t d e a l i n g w i t h f a i l i n g s t u d e n t s i s s t r e s s f u l . I n a s t u d y d e s i g n e d t o i n v e s t i g a t e the a t t i t u d e s of 34 c l i n i c a l " a s s e s s o r s " and nurse t e a c h e r s from two d i f f e r e n t s c h o o l s of n u r s i n g i n n o r t h e r n England, t h e p a r t i c i p a n t s were asked t o d i s c u s s i s s u e s r e l a t e d t o c l i n i c a l e v a l u a t i o n and f a i l i n g s t u d e n t s (Lankshear, 1990). U s i n g . . . " s t r u c t u r e d e a v e s d r o p p i n g methodology" . . . ( p . 350), a term not d e f i n e d by t h e a u t h o r , t h e p a r t i c i p a n t s took p a r t i n seven d i s c u s s i o n groups. Respondents d e s c r i b e d i n t h e i r own words how t h e y f e l t about f a i l i n g n u r s i n g s t u d e n t s . For example, they f e l t t h e y e x p e r i e n c e d " f l a k , " c o u l d be made t o f e e l l i k e "ogres," and f e l t i t was a h a s s l e h a r d l y w o r t h t h e outcome. W h i l e t h e s e comments may be o f some v a l u e , t h e f a c t t h a t they a r e t a k e n out of c o n t e x t makes i t d i f f i c u l t t o d e t e r m i n e t h e i r m e r i t . Impact on F a c u l t y V a r i o u s a u t h o r s have d e s c r i b e d the p o s s i b l e impact on f a c u l t y of h a v i n g t o work w i t h f a i l i n g s t u d e n t s (Goldenberg & W a d d e l l , 1990; L e n h a r t , 1980; Ray, 1984). The l i t e r a t u r e c o n t a i n s numerous a r t i c l e s t h a t p r o v i d e a n e c d o t a l commentary on t h e s t r e s s - f i l l e d r o l e of t h e n u r s e e d u c a t o r ( C a r p e n i t o , 1983; L e n h a r t , 1980; Ray, 1984; T u r k e t t , 1987); however, r e s e a r c h - b a s e d l i t e r a t u r e on s t r e s s and burnout among academic f a c u l t y i s l i m i t e d . T y p i c a l of t h i s t y p e of l i t e r a t u r e i s Ray's a r t i c l e (1984), on the p o t e n t i a l problem o f burnout f o r n u r s i n g f a c u l t y . The a u t h o r d e s c r i b e s t h e p r e s s u r e s and c o n f l i c t s t h a t a r e i n h e r e n t i n m a i n t a i n i n g h i g h s t a n d a r d s of n u r s i n g p r a c t i c e w h i l e d e a l i n g w i t h the p r e s s u r e s t o pass s t u d e n t s . I n a d e s c r i p t i v e - c o r r e l a t i o n a l s t u d y w h i c h examined burnout i n c o l l e g i a t e n u r s i n g programs, D i c k (1986) d e s c r i b e s a s i g n i f i c a n t n e g a t i v e r e l a t i o n s h i p between burnout o f n u r s i n g f a c u l t y and i n t e n s e s t u d e n t and collégial i n t e r p e r s o n a l r e l a t i o n s h i p s . The s u b j e c t s i n t h i s s t u d y spent a p p r o x i m a t e l y h a l f of t h e i r time i n c o n t a c t w i t h s t u d e n t s . The a u t h o r c o n c l u d e d t h a t w h i l e t h e r e was a s l i g h t r e l a t i o n s h i p between c l i n i c a l s u p e r v i s i o n and burnout, c o n t i n u o u s c o n t a c t i n i n t e n s e i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h s t u d e n t s and c o l l e a g u e s was an i m p o r t a n t f a c t o r i n bur n o u t . T h i s f a c t o r was c i t e d as b e i n g more i m p o r t a n t t h a n t h e hours worked o r c a s e l o a d of the f a c u l t y member. An a d d i t i o n a l s t r e s s f o r t h e nu r s e e d u c a t o r i s t h e f e a r a r i s i n g from t h e p r o s p e c t o f b e i n g sued ( L e s s n e r , 1990; P o l l o k & P o t e e t , 1983). Many f a c u l t y a r e f e a r f u l of a g r i e v a n c e o r l a w s u i t f o r a v a r i e t y of r e a s o n s . Most n u r s i n g e d u c a t i o n programs today have d e v e l o p e d academic and c l i n i c a l s t a n d a r d s f o r s t u d e n t performance and a p p e a l mechanisms t o address s t u d e n t g r i e v a n c e s . I f c a r e f u l l y d e s i g n e d , t h e s e p r o c e d u r e s , w h i l e s t r e s s f u l , s h o u l d s a f e g u a r d the r i g h t s of b o t h e d u c a t o r s and s t u d e n t s (Orchard, 1992). In t h e p a s t t h r e e decades, i n t h e U n i t e d S t a t e s , t h e r e i s e v i d e n c e s u g g e s t i n g a g e n e r a l i n c r e a s e i n l i t i g a t i o n i n v o l v i n g n u r s i n g e d u c a t i o n programs (Helms & W e i l e r , 1991). I n t h e U n i t e d S t a t e s , s u i t s a g a i n s t n u r s i n g e d u c a t i o n programs a r e more l i k e l y t o be brought by s t u d e n t s and they a r e o f t e n s u c c e s s f u l (Helms & W e i l e r , 1991). I t i s r e a s o n a b l e t o assume t h a t t h i s p a t t e r n l i k e l y m i r r o r s t h a t of Canada; however, no l i t e r a t u r e c o u l d be found t o support t h i s c o n t e n t i o n . The advent of s t u d e n t consumerism demands t h a t s t u d e n t s be t r e a t e d f a i r l y and t h a t the e d u c a t i o n a l program p r o v i d e t h e s k i l l s n e c e s s a r y f o r t h e new g r a d u a t e t o f u n c t i o n as a competent p r o f e s s i o n a l . G o c l o w s k i (1985) i d e n t i f i e s a " c a t c h 22" s c e n a r i o where i t i s p o s s i b l e f o r n u r s e e d u c a t o r s t o be sued f o r b o t h f a i l i n g and not f a i l i n g a s t u d e n t . For example, g r a d u a t e s of n u r s i n g programs d i s m i s s e d from employment f o r incompetence may sue f o r not r e c e i v i n g an e d u c a t i o n t h a t p r e p a r e d them t o f u n c t i o n as competent p r o f e s s i o n a l s ; and s t u d e n t s d i s m i s s e d from n u r s i n g programs may sue a f a c u l t y member f o r f a i l i n g t o t r e a t them i n a f a i r and r e a s o n a b l e manner G o c l o w s k i (1985), O'Connor (1978) and Symanski (1991) p o s t u l a t e t h a t t h e m u l t i p l e s t r e s s e s i n h e r e n t i n d e a l i n g w i t h f a i l i n g s t u d e n t s may a c t u a l l y r e s u l t i n a l o s s o f n u r s e e d u c a t o r s from c l i n i c a l t e a c h i n g . F a c t o r s r e l a t e d t o the m u l t i f a c e t e d and somewhat ambiguous r o l e of n u r s e e d u c a t o r s , and the c o s t l y d r a i n on f a c u l t y energy e x a c t e d by t h e f a i l i n g s t u d e n t have a l s o been i d e n t i f i e d as p o t e n t i a l causes of s t r e s s and b u r n o u t . From t h i s p e r s p e c t i v e . F a i n (1987) and O'Connor (1978) found t h a t n u r s e e d u c a t o r s e x p e r i e n c e r o l e c o n f l i c t and r o l e a m b i g u i t y from w e a r i n g two h a t s ; t h o s e of p r o f e s s i o n a l n u r s e and e d u c a t o r . R o l e c o n f l i c t and r o l e a m b i g u i t y may l e a d t o s t r e s s w h i c h has been l i n k e d t o low j o b s a t i s f a c t i o n ( S c h u l e r , 1975; S c h u l e r , A l d a g & B r i e f , 1977) . Numerous n u r s i n g a u t h o r s have c o n t r i b u t e d t o an u n d e r s t a n d i n g of t h e r e s p o n s i b i l i t i e s and c o n f l i c t s i n h e r e n t i n t h e n u r s e e d u c a t o r ' s r o l e (Batey, 1969; Kramer, 1966; O'Connor, 1978; W i l l i a m s o n , 1972). O'Connor (1978) i d e n t i f i e s a f u r t h e r c o n f l i c t a r i s i n g from t h e t e a c h i n g - l e a r n i n g p r o c e s s . F a c u l t y members o f t e n have t o make d i f f i c u l t c h o i c e s between what ought t o be done and what w i l l g a i n s t u d e n t a p p r o v a l and thus p r o v i d e them w i t h some i n t r i n s i c reward f o r t h e work t h e y a r e d o i n g . D i m i n i s h e d j o b s a t i s f a c t i o n has been l i n k e d t o s t r e s s a r i s i n g from the r o l e c o n f l i c t and r o l e a m b i g u i t y e x p e r i e n c e d by many nu r s e e d u c a t o r s ( M a r r i n e r & C r a i g i e , 1977). I n t h i s s t u d y , j u n i o r f a c u l t y members i n p a r t i c u l a r , h i r e d i n t o t h e i r f i r s t t e a c h i n g p o s i t i o n , e x p r e s s e d more j o b d i s s a t i s f a c t i o n t h a n s e n i o r f a c u l t y members. Because of j o b d i s s a t i s f a c t i o n a t t r i b u t e d t o r o l e c o n f l i c t , a m b i g u i t y and o v e r l o a d , j u n i o r f a c u l t y were more l i k e l y t o be p l a n n i n g t o l e a v e t h e i r p o s i t i o n . F a i n (1987), i n a s t u d y t h a t examined b a c c a l a u r e a t e nurse e d u c a t o r s ' p e r c e p t i o n s o f r o l e c o n f l i c t and r o l e a m b i g u i t y as compared t o j o b s a t i s f a c t i o n , found t h a t r o l e c o n f l i c t and r o l e a m b i g u i t y were b o t h a s s o c i a t e d w i t h low l e v e l s of j o b s a t i s f a c t i o n . M a r r i n e r and C r a i g i e ' s (1977) s u r v e y of 822 n u r s e e d u c a t o r s i n b a c c a l a u r e a t e and h i g h e r degree programs i n 13 American w e s t e r n s t a t e s r e p o r t e d t h a t t h e q u a l i t y of s t u d e n t s was one of the v a r i a b l e s w h i c h c o r r e l a t e d w i t h g e n e r a l j o b s a t i s f a c t i o n . The h i g h e r t h e q u a l i t y o f the s t u d e n t s , t h e more g e n e r a l l y s a t i s f i e d e d u c a t o r s were, and the more l i k e l y t h ey were t o remain t e a c h i n g a t t h a t i n s t i t u t i o n . Wood (1971) d e s c r i b e s how, i n n u r s i n g programs i n O n t a r i o and Quebec, competent f a c u l t y w o r k i n g w i t h " b o r d e r l i n e " s t u d e n t s may l e a v e n u r s i n g programs w h i c h have a h i g h a t t r i t i o n r a t e f o r o t h e r s w i t h more r e w a r d i n g t e a c h i n g environments. However, no s t a t i s t i c a l d a t a a r e g i v e n t o s u p p o r t t h e a u t h o r ' s c o n t e n t i o n . Summary The l i t e r a t u r e r e v i e w has i d e n t i f i e d t h a t t h e r e i s a d e a r t h o f r e s e a r c h - b a s e d i n f o r m a t i o n on t h e t h e s i s t o p i c . R e l e v a n t c u r r e n t American l i t e r a t u r e i s l i m i t e d , and Canadian-based l i t e r a t u r e on t h e t o p i c i s abs e n t . A r e v i e w o f the l i t e r a t u r e r e v e a l s t h e r e i s l i t t l e more than o p i n i o n and a n e c d o t a l commentary t o d e s c r i b e t h e e x p e r i e n c e s of nu r s e e d u c a t o r s h a v i n g t o a s s i g n f a i l i n g c l i n i c a l grades t o s t u d e n t s i n g e n e r a l . and no a r t i c l e s c o u l d be found t h a t d e s c r i b e d t h e e x p e r i e n c e of h a v i n g t o a s s i g n f a i l i n g grades t o s t u d e n t s i n t h e f i n a l c l i n i c a l semester. T h i s r e v i e w h i g h l i g h t s t h e c o m p l e x i t i e s of c l i n i c a l e v a l u a t i o n and d e s c r i b e s the r o l e a m b i g u i t y and r o l e c o n f l i c t e x p e r i e n c e d by p r o f e s s i o n a l n u r s e e d u c a t o r s as t h e y c a r r y out t h e i r r e s p o n s i b i l i t i e s . S t r e s s , b urnout, and r o l e c o n f l i c t a r e predominant c o n c e p t s t h a t emerged from t h e s t u d i e s examined. I n a d d i t i o n , some i s s u e s a r e i d e n t i f i e d r e l a t e d t o the impact on n u r s e e d u c a t o r s of i s s u i n g f a i l i n g c l i n i c a l g r a d e s . The l o n g and s h o r t term e f f e c t s on f a c u l t y members o f h a v i n g t o i n t e r a c t w i t h f a i l i n g s t u d e n t s have not been s p e c i f i c a l l y a d d r e s s e d i n t h e n u r s i n g l i t e r a t u r e (Symanski, 1991) . I n f a c t , a s e a r c h of t h e r e l a t e d l i t e r a t u r e i n g e n e r a l e d u c a t i o n r e v e a l s t h a t l i t t l e has been w r i t t e n about the impact on f a c u l t y i n g e n e r a l of f a i l i n g s t u d e n t s . Whether t h e s e concerns a r e s p e c i f i c a l l y r e l a t e d t o nu r s e e d u c a t o r s i n dipl o m a n u r s i n g programs i s not known s i n c e no a r t i c l e s c o u l d be found t h a t examined the e x p e r i e n c e s of d i p l o m a n u r s i n g f a c u l t y . The p o t e n t i a l s i g n i f i c a n c e o f the impact on nurse e d u c a t o r s , and n u r s i n g e d u c a t i o n as a whole, of h a v i n g t o a s s i g n a f a i l i n g grade t o a s t u d e n t m t h e f i n a l c l i n i c a l semester, combined w i t h t h e l a c k o f r e s e a r c h i n t h i s a r e a , has p r o v i d e d t h e impetus f o r t h i s s t u d y . CHAPTER THREE Methodology I n t h i s c h a p t e r , t h e methodology used i n t h e s t u d y i s d e s c r i b e d . Sample s e l e c t i o n c r i t e r i a , i s s u e s of v a l i d i t y and r e l i a b i l i t y , e t h i c a l c o n s i d e r a t i o n s , and d a t a c o l l e c t i o n and a n a l y s i s a r e a l s o a d d r e s s e d . Methodology S p i e g e l b e r g ' s p h i l o s o p h i c a l , i n t r o s p e c t i v e p h e n o m e n o l o g i c a l method was used f o r t h i s s t u d y . The aim o f phenomenology i s t o d e s c r i b e human e x p e r i e n c e t h r o u g h the p e r c e p t i o n of t h e i n d i v i d u a l as l i f e i s e x p e r i e n c e d (Munhall & O i l e r , 1986). W i t h S p i e g e l b e r g ' s (1960) approach, t h e r e s e a r c h e r can s y s t e m a t i c a l l y e x p l o r e meaning i n t h e human e x p e r i e n c e . From t h i s e x p l o r a t i o n , t h r o u g h the i n f o r m a n t s ' p e r c e p t i o n s , c o n s e n s u a l l y v a l i d a t e d knowledge can be d e r i v e d , a t t e m p t i n g as f u l l y as p o s s i b l e t o d e p i c t the t o t a l i t y of an e x p e r i e n c e as i t i s l i v e d (Munhall & O i l e r , 1986). S u b j e c t i v e phenomena a r e s t u d i e d t o uncover the o b j e c t i v e essences about t h e r e a l i t y o f t h e phenomena under e x a m i n a t i o n ( S p i e g e l b e r g , 1960). The s u b j e c t i v i t y o f t h e phenomenon r e l a t e s o n l y t o the c o n t e n t of t h e s i t u a t i o n and d e s c r i p t i o n o f t h e p e r s o n a l e x p e r i e n c e s as r e l a t e d by the i n f o r m a n t s ( S p i e g e l b e r g , 1960). S p i e g e l b e r g (1960) i d e n t i f i e s seven s t e p s i n h i s approach t o p h e n o m e n o l o g i c a l r e s e a r c h . They i n c l u d e , i n t h e f o l l o w i n g o r d e r : i n v e s t i g a t i n g p a r t i c u l a r phenomena; i n v e s t i g a t i n g g e n e r a l e s s e n c e s ; apprehending e s s e n t i a l r e l a t i o n s h i p s among ess e n c e s ; w a t c h i n g modes of a p p e a r i n g ; w a t c h i n g the c o n s t i t u t i o n o f phenomena i n c o n s c i o u s n e s s ; suspending b e l i e f s i n t h e e x i s t e n c e o f phenomena; and i n t e r p r e t i n g t h e meaning of phenomena. The f i r s t t h r e e s t e p s r e q u i r e t h e r e s e a r c h e r t o i n t u i t i v e l y g r a s p t h e p a r t i c u l a r phenomenon and a n a l y t i c a l l y examine and d e s c r i b e i t . T h i s must be done w i t h o u t p r e c o n c e p t i o n s . The i n v e s t i g a t o r " b r a c k e t s " o r c o n s c i o u s l y p u t s a s i d e h i s / h e r o p i n i o n s and u n d e r s t a n d i n g of the e x p e r i e n c e under i n v e s t i g a t i o n . I n t h i s s t u d y , t h e i n v e s t i g a t o r had t o b r a c k e t t h o u g h t s and e x p e r i e n c e s a r i s i n g out of b e i n g a n u r s e e d u c a t o r and h a v i n g i s s u e d f a i l i n g grades t o s t u d e n t s i n the c l i n i c a l s e t t i n g . T h i s e n a b l e d t h e r e s e a r c h e r t o v i e w the r e a l i t y from t h e i n f o r m a n t s ' p e r s p e c t i v e and e n a b l e d the i n f o r m a n t s t o f u l l y e x p r e s s t h e i r v iews o f the phenomenon. The f o u r t h s t e p , "watching modes of a p p e a r i n g " r e f e r s t o the need f o r the i n v e s t i g a t o r t o e x p l o r e not o n l y what essences appear but t o examine t h e way g e n e r a l essences appear. E x p l o r a t i o n o f the c o n s t i t u t i o n of t h e phenomenon i n c o n s c i o u s n e s s c o n s i s t s of d e t e r m i n i n g how t h e i n v e s t i g a t o r p e r c e i v e s t h e phenomenon has t a k e n shape ( S p i e g e l b e r g , 1960). The purpose o f the f i f t h s t e p i s t o "determine the t y p i c a l s t r u c t u r e of a c o n s t i t u t i o n i n c o n s c i o u s n e s s by means of a n a l y s i s of t h e e s s e n t i a l sequence o f i t s s t e p s " ( S p i e g e l b e r g , 1 9 6 0 ) . Suspending b e l i e f i n e x i s t e n c e , t h e s i x t h s t e p , m a i n t a i n s t h e p r a c t i c e o f b r a c k e t i n g , e n s u r i n g t h a t the r e s e a r c h e r w i l l c o n s i d e r a l l t h e d a t a on an e q u a l b a s i s p r e s e r v i n g t h e c o n t e n t as p u r e l y as p o s s i b l e . The aim o f t h i s phase i s t h e f a c i l i t a t i o n o f genuine i n t u i t i n g , a n a l y z i n g , and d e s c r i b i n g o f the g i v e n d a t a ( S p i e g e l b e r g , 1960). The f i n a l s t e p i n t h i s p r o c e s s , t h a t i s , i n t e r p r e t i n g c o n c e a l e d meanings, aims a t d i s c o v e r i n g meanings not i m m e d i a t e l y apparent from t h e r e s e a r c h e r ' s p r e v i o u s i n t u i t i n g , a n a l y z i n g and d e s c r i b i n g . S p i e g e l b e r g (1960) s u g g e s t s t h a t t h e r e i s "scope and r e a s o n t o l o o k f o r deeper h i d d e n meanings whenever the c o n s c i o u s meanings do not a d e q u a t e l y account f o r a phenomenon" (p. 698). S p i e g e l b e r g ' s p h e n o m e n o l o g i c a l approach p r o v i d e s a s y s t e m a t i c methodology t o e x p l o r e meanings of e x p e r i e n c e s and i s an a p p r o p r i a t e methodology t o use i n t h i s t y p e o f r e s e a r c h problem where l i t t l e i s known about th e s u b j e c t under s t u d y . I s s u e s of V a l i d i t y and R e l i a b i l i t y I n q u a l i t a t i v e r e s e a r c h , the d e t e r m i n a t i o n o f v a l i d i t y and r e l i a b i l i t y i s d i r e c t e d toward u n d e r s t a n d i n g t h e phenomenon under s t u d y i n n a t u r a l s e t t i n g s w i t h few c o n t r o l l i n g c o n d i t i o n s . I n t e r n a l v a l i d i t y i s u l t i m a t e l y based on whether th e d a t a and a n a l y s i s s t a n d t h e t e s t of time and whether the f i n d i n g s of t h e s t u d y " f i t " t h e d a t a . I f v a l i d i t y e x i s t s , o t h e r s who have e x p e r i e n c e d t h e phenomenon w i l l r e c o g n i z e the f i n d i n g s as b e i n g t r u e (Munhall & O i l e r , 1986) . T h i s means t h a t one would expect t h a t b o t h i n f o r m a n t s and o t h e r s f a m i l i a r w i t h t h e e x p e r i e n c e would v i e w the e x p e r i e n c e i n a s i m i l a r o r comparable, but not c o n t r a d i c t o r y , manner. O b t a i n i n g v a l i d a t i o n from i n f o r m a n t s t h r o u g h a sequence of i n t e r v i e w s , as was done i n t h i s s t u d y , i s one way t o c l a r i f y t h a t t h e d e s c r i p t i o n i s a c c u r a t e . A c c o r d i n g t o L e i n i n g e r (1985), i n q u a l i t a t i v e r e s e a r c h r e l i a b i l i t y s h o u l d f o c u s on " i d e n t i f y i n g and documenting r e c u r r e n t , a c c u r a t e and c o n s i s t e n t (homogeneous) o r i n c o n s i s t e n t (heterogeneous) f e a t u r e s , as p a t t e r n s , themes, v a l u e s , w o r l d v i e w s , e x p e r i e n c e s , and o t h e r phenomena c o n f i r m e d i n s i m i l a r o r d i f f e r e n t c o n t e x t s " (p. 69). R e c u r r e n t themes wh i c h can be e x t r a c t e d from t h e d a t a r e v e a l t o what e x t e n t the phenomenon under s t u d y c o n s i s t e n t l y r e f l e c t s meanings and t r u t h s about t h a t p a r t i c u l a r phenomenon. R e l i a b i l i t y can a l s o be e s t a b l i s h e d by c l e a r l y d e s c r i b i n g the p r o g r e s s i o n of events so t h a t o t h e r s can f o l l o w the t h i n k i n g of t h e r e s e a r c h e r . T h i s s h o u l d a l l o w o t h e r r e s e a r c h e r s t o a r r i v e a t s i m i l a r o r comparable, but not c o n t r a d i c t o r y , c o n c l u s i o n s . S e l e c t i o n o f I n f o r m a n t s C r i t e r i a The i n f o r m a n t s c o n s i s t e d o f a p u r p o s i v e , c o n v e n i e n c e sample of 9 q u a l i f i e d n u r s e e d u c a t o r s who met t h e f o l l o w i n g c r i t e r i a : 1. C u r r e n t l y employed as e d u c a t o r s i n d i p l o m a n u r s i n g programs i n t h e B r i t i s h Columbia Lower M a i n l a n d . 2 . Have a s s i g n e d f a i l i n g c l i n i c a l grades t o one o r more n u r s i n g s t u d e n t s c l i n i c a l l y i n t h e f i n a l c l i n i c a l semester. 3. W i l l i n g t o be i n t e r v i e w e d and a u d i o - t a p e d on one o r more s e p a r a t e o c c a s i o n s . The adequacy o f the sample s i z e was a s s e s s e d by a n a l y s i s o f t h e d a t a o b t a i n e d from the i n f o r m a n t s . The i n t e r v i e w d a t a were a s s e s s e d a c c o r d i n g t o the r e l e v a n c e , completeness, and amount of i n f o r m a t i o n o b t a i n e d as t h e s t u d y p r o g r e s s e d . A n a l y s e s i n d i c a t e d t h a t t h e s a t u r a t i o n p o i n t had been reached, and an adequate amount of i n f o r m a t i o n f o r t h e s t u d y had been o b t a i n e d when " n o t h i n g new" was coming out of the i n t e r v i e w s . P r o c e d ures I n f o r m a n t s from two c o l l e g e d i p l o m a n u r s i n g programs known t o t h e r e s e a r c h e r t o have f i n a l c l i n i c a l semesters i n w h i c h the f a c u l t y members were r e s p o n s i b l e f o r c l i n i c a l s u p e r v i s i o n and e v a l u a t i o n o f s t u d e n t s were approached. A l e t t e r of e x p l a n a t i o n (Appendix A) was sent t o t h e program heads o f t h e two c o l l e g e s s e e k i n g consent t o d i s c u s s t h e s t u d y w i t h i n t e r e s t e d f a c u l t y and t o r e q u e s t an o p p o r t u n i t y t o meet w i t h f a c u l t y t o e x p l a i n t h e s t u d y . One program head s i g n e d t h e agency consent form (Appendix B) and the r e s e a r c h e r went t o t h i s agency t o p r e s e n t the p r o p o s a l . The o t h e r agency d i d not respond t o t h e r e q u e s t . T h e r e f o r e t h e r e s e a r c h e r p r e s e n t e d the p r o p o s a l t o members of t h e Nurse E d u c a t o r s I n t e r e s t Group of the R e g i s t e r e d Nurses A s s o c i a t i o n o f B r i t i s h Columbia. A l e t t e r b r i e f l y d e s c r i b i n g t h e s t u d y and the i n f o r m a n t ' s r o l e was c i r c u l a t e d t o i n t e r e s t e d i n d i v i d u a l s . I n d i v i d u a l s who met t h e c r i t e r i a and were w i l l i n g t o p a r t i c i p a t e were r e q u e s t e d t o c o n t a c t t h e r e s e a r c h e r by t e l e p h o n e . W i t h i n f o u r weeks, n i n e i n f o r m a n t s , f i v e from one agency and f o u r from the o t h e r , were o b t a i n e d . E t h i c a l C o n s i d e r a t i o n s The p r o c e d u r e s f o r p r o t e c t i o n of s u b j e c t s ' r i g h t s were approved by t h e U n i v e r s i t y of B r i t i s h Columbia B e h a v i o u r a l S c i e n c e s Committee f o r R e s e a r c h and Other S t u d i e s I n v o l v i n g Human S u b j e c t s . A f t e r a p p r o v a l was o b t a i n e d , i n f o r m a n t s were s e l e c t e d . Each was p r o v i d e d w i t h a l e t t e r b r i e f l y d e s c r i b i n g the s t u d y and what would be e x p e c t e d o f them (Appendix C ) . T h i s i n f o r m a t i o n was a g a i n r e v i e w e d a t the s t a r t o f t h e f i r s t i n t e r v i e w . A w r i t t e n consent form was then completed by each i n f o r m a n t who agreed t o p a r t i c i p a t e (Appendix D). Data C o l l e c t i o n P r o c e d ures A q u e s t i o n n a i r e was used t o o b t a i n demographic d a t a on each i n f o r m a n t f o r the purpose of d e s c r i b i n g t h e sample (Appendix E ) . T h i s q u e s t i o n n a i r e was completed by each i n f o r m a n t p r i o r t o t h e s t a r t of t h e f i r s t i n t e r v i e w . The f o l l o w i n g i n f o r m a t i o n was o b t a i n e d : t h e age o f t h e i n d i v i d u a l , number of y e a r s o f t e a c h i n g e x p e r i e n c e , l e n g t h of time i n c u r r e n t t e a c h i n g p o s i t i o n , number of s t u d e n t s i n f o r m a n t has f a i l e d , and t h e e d u c a t i o n a l q u a l i f i c a t i o n s of the i n f o r m a n t . Data r e l e v a n t t o the r e s e a r c h q u e s t i o n were c o l l e c t e d t h r o u g h u n s t r u c t u r e d i n t e r v i e w s a p p r o x i m a t e l y s i x t y minutes i n l e n g t h w h i c h were a u d i o - t a p e d . Two i n t e r v i e w s were needed t o c o l l e c t s u f f i c i e n t d a t a and t o v a l i d a t e themes and meanings d e r i v e d from a n a l y s i s of t h e f i r s t i n t e r v i e w . The second i n t e r v i e w was more s t r u c t u r e d s i n c e t h e r e s e a r c h e r needed t o seek c l a r i f i c a t i o n and o b t a i n f u r t h e r i n f o r m a t i o n from the i n f o r m a n t i n o r d e r t o v a l i d a t e d a t a o b t a i n e d i n the p r e v i o u s i n t e r v i e w . The r e s e a r c h e r e n c o u n t e r e d some d i f f i c u l t i e s w i t h s c h e d u l i n g of t h r e e second i n t e r v i e w s due t o w o r k l o a d , s c h e d u l i n g , and v a c a t i o n commitments on the p a r t of the i n f o r m a n t s . The time r e q u i r e d t o complete the d a t a c o l l e c t i o n was f o u r months. As i n d i c a t e d i n Appendix F, t h e p r i m a r y t r i g g e r q u e s t i o n was: D e s c r i b e what i t i s l i k e (from a n u r s e e d u c a t o r ' s p e r s p e c t i v e ) t o i n f o r m a n u r s i n g s t u d e n t t h a t he/she has not met the c l i n i c a l c o u r s e o b j e c t i v e s i n t h e f i n a l c l i n i c a l semester. Secondary t r i g g e r q u e s t i o n s used when t h e s e components were a d d r e s s e d i n the i n t e r v i e w by the i n f o r m a n t s i n c l u d e d : 1. D e s c r i b e how you f e l t when you had t o a s s i g n a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l semester o f a d i p l o m a n u r s i n g program. 2. What h e l p s you d e a l w i t h the f e e l i n g s t h a t may a r i s e i n t h i s s i t u a t i o n s ? 3. What makes the s i t u a t i o n more d i f f i c u l t ? T r a n s c r i p t i o n o c c u r r e d as q u i c k l y as p o s s i b l e a f t e r c o m p l e t i o n o f t h e i n t e r v i e w s . Data A n a l y s i s Data a n a l y s i s o c c u r r e d s i m u l t a n e o u s l y w i t h d a t a c o l l e c t i o n . Data from t h e i n t e r v i e w s were a n a l y z e d u s i n g S p i e g e l b e r g ' s p h e n o m e n o l o g i c a l approach as p r e v i o u s l y d e s c r i b e d ( S p i e g e l b e r g , 1960). The purpose of t h e a n a l y s i s was t o i d e n t i f y t h e forms and t y p e s o f phenomena and t o document t h e i r e x i s t e n c e ( F i e l d & Morse, 1985). W r i t t e n f i e l d n o t e s kept by the r e s e a r c h e r were u s e f u l i n d a t a a n a l y s i s . F i e l d n o t e s a r e d e s c r i p t i v e a c c o u n t s o f what the r e s e a r c h e r h e a r s , sees, e x p e r i e n c e s and t h i n k s about i n t h e c o u r s e o f c o l l e c t i n g and r e f l e c t i n g on t h e d a t a ( F i e l d & Morse, 1985). The d a t a were t r a n s c r i b e d , coded, c a t e g o r i z e d , and a n a l y z e d a l o n g w i t h t h e f i e l d n o t e s w h i c h h e l p e d t o d e s c r i b e the i n t e r v i e w c o n t e x t . CHAPTER FOUR P r e s e n t a t i o n and D i s c u s s i o n of F i n d i n g s I n t h i s c h a p t e r t h e demographic d a t a p r o v i d e d by the i n f o r m a n t s a r e p r e s e n t e d , a f t e r w h i c h t h e s t u d y ' s f i n d i n g s a r e d e s c r i b e d and d i s c u s s e d . U s i n g a p h e n o m e n o l o g i c a l approach and L a z a r u s ' s p r o c e s s - o r i e n t e d framework, th e r e s e a r c h e r examined th e n u r s e e d u c a t o r s ' a p p r a i s a l of each unique e x p e r i e n c e . The i n t e n t o f t h e e x a m i n a t i o n was t o i d e n t i f y r e c u r r e n t themes and s i g n i f i c a n t v a r i a b l e s d e s c r i b e d by t h e i n f o r m a n t s as h a v i n g an impact on the s i t u a t i o n . I n a d d i t i o n , c o p i n g responses and immediate as w e l l as l o n g - t e r m e f f e c t s of t h e e x p e r i e n c e a r e d i s c u s s e d . C h a r a c t e r i s t i c s o f the I n f o r m a n t s The n i n e i n f o r m a n t s , a l l female, were nurse e d u c a t o r s employed i n d i p l o m a n u r s i n g programs i n t h e B r i t i s h Columbia Lower M a i n l a n d . The m a j o r i t y ( s i x ) were 30 t o 39 y e a r s o l d . Two were 40-49 y e a r s o f age and one i n d i c a t e d she was o v e r 50 y e a r s of age. The i n f o r m a n t s ' e d u c a t i o n a l p r e p a r a t i o n was d i v e r s e . Two h e l d master's degrees, one i n n u r s i n g and t h e o t h e r i n e d u c a t i o n , f o u r were c u r r e n t l y p u r s u i n g s t u d i e s toward t h e MSN and one was c o m p l e t i n g work f o r the MEd. One of t h e i n f o r m a n t s h e l d a BScN and one a BA degree. A l l had one o r more y e a r s of t e a c h i n g e x p e r i e n c e w i t h t h r e e i n f o r m a n t s i n d i c a t i n g t e a c h i n g e x p e r i e n c e i n the t h r e e t o s i x y e a r c a t e g o r y , and f i v e r e p o r t i n g o v e r t e n y e a r s of t e a c h i n g e x p e r i e n c e . F i v e i n f o r m a n t s had been employed i n t h e i r c u r r e n t t e a c h i n g p o s i t i o n f o r one t o f i v e y e a r s and f o u r f o r ov e r t e n y e a r s . No i n f o r m a n t had ta u g h t f o r l e s s t h a n one y e a r . The number of s t u d e n t s i n t h e f i n a l c l i n i c a l semester t o whom th e y had a s s i g n e d f a i l i n g grades . ranged from one t o more than s i x . Three i n f o r m a n t s had a s s i g n e d f a i l i n g grades t o o n l y one s t u d e n t and two had a s s i g n e d f a i l i n g grades t o more th a n s i x s t u d e n t s . At the time of a s s i g n i n g t h e f a i l i n g g r a des, f o u r o f the i n f o r m a n t s c o n s i d e r e d themselves n o v i c e c l i n i c a l i n s t r u c t o r s w h i l e the o t h e r f i v e c o n s i d e r e d themselves e x p e r i e n c e d . At t h e time o f t h e i n t e r v i e w s , f i v e o f t h e i n f o r m a n t s were i n t h e p r o c e s s o f e v a l u a t i n g c l i n i c a l l y f a i l i n g s t u d e n t s . Content A n a l y s i s The c o n t e n t a n a l y s i s o f t h e d a t a r e v e a l e d t h e r e c u r r e n t themes o f s t r e s s , u n c e r t a i n t y , i s o l a t i o n , and l a c k o f a d m i n i s t r a t i v e s u p p o r t . S t r e s s The predominant f e e l i n g evoked by the e x p e r i e n c e o f h a v i n g t o a s s i g n a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l term of a d i p l o m a n u r s i n g program i s s t r e s s . The degree of s t r e s s p e r c e i v e d by t h e n urse e d u c a t o r i s dependent upon the e d u c a t o r ' s c o g n i t i v e a p p r a i s a l o f e v e n t s and what t h e y mean t o h e r w e l l - b e i n g . A p p r a i s a l can be v iewed as a c i r c u l a r p r o c e s s w h i c h may not be e n t i r e l y c o n s c i o u s , r a t i o n a l , o r d e l i b e r a t e (Lazarus & Folkman, 1984) . S t r e s s f u l a p p r a i s a l s can be c l a s s i f i e d i n t o t h r e e c a t e g o r i e s : h a r m / l o s s , t h r e a t , and c h a l l e n g e (Lazarus & Folkman, 1984). Harm/loss a p p r a i s a l s r e f e r t o damage the p e r s o n has a l r e a d y s u s t a i n e d , t h r e a t r e f e r s t o a n t i c i p a t e d harms o r l o s s e s , and c h a l l e n g e r e f e r s t o events t h a t h o l d the p o s s i b i l i t y of mastery o r g a i n . I t became e v i d e n t d u r i n g a n a l y s i s t h a t i n f o r m a n t s used a v a r i e t y of words and p h r a s e s t o d e s c r i b e s t r e s s . Some of them d e s c r i b e d t h e i r e x p e r i e n c e as b e i n g " d i f f i c u l t , " " s t r e s s f u l , " " s c a r y , " o r "worrisome." They e x p r e s s e d t h e i r f e e l i n g s i n terms of e x p e r i e n c i n g " f r u s t r a t i o n , " " d i s t r e s s , " "shock," "annoyance," "anger," o r "dread." D u r i n g t h e v a l i d a t i o n p r o c e s s , i n f o r m a n t s c o n f i r m e d t h a t t h e s e terms c o u l d be a c c u r a t e l y i n t e r p r e t e d as s t r e s s . The f o l l o w i n g p o r t i o n s of a t r a n s c r i p t i l l u s t r a t e how t h i s concept was i d e n t i f i e d and d e p i c t s t h e p r o c e s s of d a t a a n a l y s i s used i n t h i s s t u d y . Throughout th e t h e s i s , a c c o u n t s have undergone minor e d i t i n g t o d e l e t e d i s t r a c t o r s such as "um" and "eh" i n o r d e r t o enhance r e a d a b i l i t y . I n t h e f o l l o w i n g example, an i n f o r m a n t d e s c r i b e s b e i n g shocked and a n x i o u s . R: ... What was t h e impact on you o f h a v i n g t o a s s i g n t h i s f a i l i n g grade i n t h e s e c i r c u m s t a n c e s ? I : ...The impact on me was t h a t I was shocked t h a t she would a c t u a l l y even t h i n k about p u l l i n g i n somebody from t h e o u t s i d e such as a l a w y e r t o c o n t e s t my d e c i s i o n . So I t h i n k I was r e a l l y i n a s t a t e o f shock and a f a i r amount of a n x i e t y . . . One i n f o r m a n t a s s e r t e d t h a t : I : Out of e v e r y t h i n g I do i n my j o b I would say t h a t ' s p r o b a b l y t h e most s t r e s s f u l t h i n g I have t o do. *R: R e s e a r c h e r * I : Informant She went on t o say: I : W e l l , i f I t h i n k back i n terms of the amount of time and energy and a l l the c o n s c i o u s e f f o r t t o make s u r e t h i s s t u d e n t has a f a i r chance I'd say t h a t i t ' s v e r y s t r e s s f u l . . . I t h i n k when y o u ' r e g o i n g t h r o u g h i t you j u s t do i t . You j u s t do i t a u t o m a t i c a l l y because you know you have t o do i t . I t ' s y o u r j o b t o do i t . And y o u ' r e t r y i n g t o do the b e s t p o s s i b l e t h i n g f o r the s t u d e n t . So a t t h a t time i t i s s t r e s s f u l but y o u ' r e not c o n s c i o u s l y aware of i t u n t i l a f t e r w a r d s when i t ' s a l l o v e r and you s i t down and say thank God...and the n you move on. Some e x c e r p t s c o n t a i n e d a number of d e s c r i p t i v e terms as the i n f o r m a n t s a t t e m p t e d t o convey th e f e e l i n g s g e n e r a t e d by t h e e x p e r i e n c e ( s ) . I n t h e i r a c c o u n t s , a number of f e e l i n g s were i d e n t i f i e d t h a t were g e n e r a t e d i n t h e p e r s o n - s i t u a t i o n i n t e r a c t i o n s . The i n f o r m a n t spoke of f e e l i n g "angry," "annoyed," and " f r u s t r a t e d . " I n f o r m a n t s used s i m i l a r words t o d e s c r i b e t h e i r f e e l i n g s a l t h o u g h t h e s o u r c e s o f f r u s t r a t i o n t hey i d e n t i f i e d may have been somewhat d i f f e r e n t . W h i l e t h e m a j o r i t y o f i n f o r m a n t s e x p e r i e n c e d f r u s t r a t i o n , not a l l e x p e r i e n c e d anger o r annoyance. The e x c e r p t below t a k e n from a second i n t e r v i e w a t t e m p t s t o v a l i d a t e the i n f o r m a n t ' s f e e l i n g s . T h i s i n f o r m a n t d e s c r i b e s m u l t i p l e s o u r c e s o f f r u s t r a t i o n . R: Some i n f o r m a n t s s a i d t h a t t h e y e x p e r i e n c e d f e e l i n g s o f f r u s t r a t i o n , annoyance, and anger d u r i n g t h i s p r o c e s s . D i d you e x p e r i e n c e t h o s e f e e l i n g s ? I : I was f r u s t r a t e d i n h e r l a c k of response t o what seemed t o me r e a l l y major d e f i c i t s and f r u s t r a t e d i n terms of what seemed t o me, a f t e r a c o u p l e o f attemp t s a t r e m e d i a t i o n , no e v i d e n c e of progress...maybe t h a t was beyond h e r a b i l i t y , I don't know. But t h a t was f r u s t r a t i n g f o r me. I wouldn't say I was ever angry, my h e a r t went out t o h e r i n terms of w a n t i n g h e r t o be s u c c e s s f u l , and so I c e r t a i n l y wasn't angry w i t h t h a t , I was f r u s t r a t e d t o some degree as w e l l as w i t h the s t a f f who seemed t o be v e r y s u p p o r t i v e of her s k i l l a b i l i t y i n t h a t i t was a t a much lo w e r l e v e l t h a t what i t s h o u l d have been f o r a g r a d u a t e n u r s e . R: And annoyance? I : No, I c a n ' t say I f e l t annoyed, I t h i n k i t was j u s t an element of f r u s t r a t i o n from time t o t i m e . R: Throughout the t r a n s c r i p t , the theme t h a t kept r e c u r r i n g was t h a t t h i s was a p a r t i c u l a r l y s t r e s s f u l e x p e r i e n c e . Can you i d e n t i f y what th e p r i m a r y s o u r c e of s t r e s s was? I : I t h i n k perhaps the c o n c e r n t h a t the s t u d e n t had not had s u f f i c i e n t p r e p a r a t i o n t o r e a c h t h i s p a r t i c u l a r l e v e l , because th e b e h a v i o u r was c e r t a i n l y i n c o n g r u e n t w i t h what I would c o n s i d e r would be e x p e c t e d f o r e a r l i e r l e v e l s as w e l l , and I t h i n k t h a t was t h e g r e a t e s t f r u s t r a t i o n . . . . U n c e r t a i n t y U n c e r t a i n t y can be c o n c e p t u a l i z e d as t h e s e l f - doubt e x p e r i e n c e d by t h e n u r s e e d u c a t o r as t o whether "she was d o i n g t h e r i g h t t h i n g . " U n c e r t a i n t y i n c l u d e s an element of s e l f - e v a l u a t i o n and r e f l e c t i o n about t h e p r o c e s s e s and s t r a t e g i e s used t o e v a l u a t e t h e s t u d e n t . The l i t e r a t u r e s u p p o r t s t h e i n f o r m a n t s ' p e r c e p t i o n s t h a t the c l i n i c a l e v a l u a t i o n p r o c e s s c r e a t e s doubts i n t h e minds of n u r s e e d u c a t o r s as w e l l as an awareness t h a t o p i n i o n s as t o whether they have "done the r i g h t t h i n g " may v a r y among c o l l e a g u e s and agency s t a f f (Brozenec, M a r s h a l l , Thomas, & Walsh, 1987; C a r p e n i t o , 1983). The f o l l o w i n g quote e x p r e s s e s a n o v i c e n u r s e e d u c a t o r ' s p e r c e p t i o n : I : To be c e r t a i n , t o be c e r t a i n . I don't know how c e r t a i n anyone can ever r e a l l y be. And when yo u ' r e r e s p o n s i b l e f o r someone's f u t u r e o r t h e p a t i e n t ' s whoever t h e y may be... perhaps t h e i r l i v e s t h e n , i f you have t h i s k i n d of r e s p o n s i b i l i t y then i t ' s a l o t of w e i g h i n g . Am I b e i n g f a i r ? Am I d o i n g t h e r i g h t t h i n g ? So f o r me I had t o go t h r o u g h o t h e r p e o p l e t o t r y and v a l i d a t e . T h i s i s what I see, t h i s i s what I've documented, t h i s i s what I f e e l . R: And t h i s was y o u r f i r s t e x p e r i e n c e w i t h f a i l i n g a s t u d e n t a t t h a t l e v e l ? I : Yes. I : . . . I don't know i f i t ' s e x p e r i e n c e t h a t g e t s you t o a p o i n t where you t r u s t the t h i n g t h a t says t o you, you've got d a t a , you've got e x p e r i e n c e , you've seen t h i s b e f o r e . Or do you go t h r o u g h the p e r i o d where you say everybody i s an i n d i v i d u a l and I have t o l o o k a t t h i s i n d e p e n d e n t l y ? Which of c o u r s e I'm d o i n g anyway, w h i c h p e o p l e a r e d o i n g anyway and i s t h e r e more t o t h i s , and do I r e a l l y have a l l the i n f o r m a t i o n ? So I w i s h t h a t i t c o u l d be j u s t as c u t and d r i e d as i t was, but i t wasn't and sometimes when I'm comparing m y s e l f a g a i n s t p e o p l e who a r e seasoned t e a c h e r s then I am i t appears t h r o u g h c o n v e r s a t i o n t h a t t h e r e i s no doubts i n t h e i r minds and t h e y absolutely i t ' s v e r y c u t and d r i e d . T h i s p e r s o n c a n ' t do i t . And I t h i n k , w e l l , w i l l I get t o t h a t p o i n t ? An e x p e r i e n c e d n u r s e e d u c a t o r d i s c l o s e d s i m i l a r t h o u g h t s : I : . . . I t h i n k t h e r e i s always doubts. Am I making the r i g h t d e c i s i o n ? I s t h e r e something t h a t I have missed? Am I f o c u s i n g on more of the s t u d e n t ' s n e g a t i v e s ? Do I have a b i a s towards t h e s t u d e n t ? Am I g i v i n g them th e b e s t o p p o r t u n i t y t o demonstrate t h a t t h e y can meet the o b j e c t i v e s ? * B o l d t y p e = Emphasis by t h e i n f o r m a n t Another i n f o r m a n t v a l i d a t e d h e r thoughts w i t h t h e r e s e a r c h e r on a second i n t e r v i e w when asked t h i s q u e s t i o n : R: When you i s s u e d t h e f a i l i n g grade you mentioned t h a t i t was h a r d but you were p r e t t y c e r t a i n t h a t i t was t h e r i g h t t h i n g t o do. I : That's t r u e [pause] because as I s a i d e a r l i e r . . . i t ' s a b a l a n c e t h i n g f o r me and a t one p o i n t a r e the s c a l e s t i p p e d t o t h e o t h e r s i d e ? And I had s a i d e a r l i e r , t o o , t h a t I l i k e t h e n o t i o n of s m a l l measure of doubt. I n any d e c i s i o n , I t h i n k t h e r e always i s a s m a l l measure of doubt because t h e y ' r e d i f f i c u l t d e c i s i o n s and yo u ' r e second g u e s s i n g y o u r s e l f ... t h e r e ' s always some doubt. You q u e s t i o n y o u r s e l f c o n s t a n t l y . . . R: So i t c r e a t e s an element of u n c e r t a i n t y ? I : Yes. Some i n f o r m a n t s i n d i c a t e d t hey r e - e v a l u a t e d t h e i r f i n d i n g s a g a i n and a g a i n . Others d i a l o g u e d w i t h t hemselves about how t h e y f e l t toward t h e s t u d e n t . I : A l o t of d i a l o g u e w i t h m y s e l f about how do I r e a l l y f e e l about t h i s p e r s o n . And always w i t h t h e i d e a t h a t am I b e i n g f a i r t o her? Am I p i c k i n g on h e r more? F e e l i n g s of u n c e r t a i n t y a l s o a r o s e from d i f f e r i n g p e r c e p t i o n s among agency s t a f f and c o l l e a g u e s as t o t h e c r i t e r i a on w h i c h they were b a s i n g t h e i r judgements. D u r i n g t h e v a l i d a t i o n p r o c e s s , one i n f o r m a n t c o n f i r m e d t h a t d i f f e r i n g p e r c e p t i o n s r e l a t e d t o c l i n i c a l e v a l u a t i o n , b o t h from h e r c o l l e a g u e s and s t a f f i n t h e c l i n i c a l agency made h e r examine the c r i t e r i a on w h i c h she based h e r judgements. The i n f o r m a n t i n d i c a t e d t h a t t h i s e x p e r i e n c e caused h e r a t ti m e s t o doubt h e r own a b i l i t i e s and added t o h e r f e e l i n g s o f u n c e r t a i n t y . Some i n f o r m a n t s termed t h i s apparent d i f f e r e n c e i n s t a n d a r d s " i n c o n s i s t e n c y , " and a t t r i b u t e d t h e s e p e r c e i v e d d i f f e r e n c e s t o f a c u l t y h a v i n g v a r y i n g p h i l o s o p h i e s o f t e a c h i n g and e v a l u a t i o n . These d i f f e r e n c e s a l s o c r e a t e d s e l f - d o u b t and u n c e r t a i n t y . I:...You can j u s t p i n p o i n t p e o p l e who you know i f a s t u d e n t i s u n s a f e , o r i s not meeting o b j e c t i v e s you know t h e f a c u l t y w i l l not l e t the s t u d e n t go on... and on the o t h e r hand you know t h a t t h e r e ' s f a c u l t y who w i l l do n o t h i n g about i t . R: And how does t h a t make you f e e l ? I : W e l l t h a t divides y o u r c o l l e a g u e s . D i v i d e s you i n t o two camps. Another i n f o r m a n t e x p r e s s e d c o n c e r n about how she might be v iewed by c o l l e a g u e s . The f o l l o w i n g e x c e r p t d e s c r i b e s h e r u n c e r t a i n t y : I : I'm always concerned about what my c o l l e a g u e s t h i n k about my a b i l i t i e s . And my approach and my p h i l o s o p h y and t h o s e k i n d s of t h i n g s . I'm Interested and concerned t h a t I be v iewed w e l l by my c o l l e a g u e s . And sometimes when s t u d e n t s don't pass i n [the f i n a l semester] i s i t my l a c k ? A p p r a i s a l c o n t r i b u t e s t o n u rse e d u c a t o r s ' e v a l u a t i o n s of what i s a t s t a k e , i t s s i g n i f i c a n c e f o r t h e i r w e l l - b e i n g , and a i d s i n d e t e r m i n i n g what, i f a n y t h i n g , can o r s h o u l d be done (Lazarus & Folkman, 1984b). The n u r s e e d u c a t o r s i n t h i s s t u d y were a c u t e l y aware of t h e p o t e n t i a l r a m i f i c a t i o n s of a s s i g n i n g o r not a s s i g n i n g a f a i l i n g grade. T h i s c r e a t e d an element of u n c e r t a i n t y t h a t a f f e c t e d t h e i r a b i l i t y t o make a d e c i s i o n even i n l i g h t o f overwhelming e v i d e n c e t h a t j u s t i f i e d a s s i g n i n g a f a i l i n g grade. The n a r r a t i v e below i l l u s t r a t e s t h i s v i e w p o i n t . I:...upon r e f l e c t i o n , t h i s was a c l e a r - c u t d e c i s i o n . The d e c i s i o n was s e l f - e v i d e n t . The u n c e r t a i n t y o f how t h e d e c i s i o n w i l l be r e c e i v e d , the impact of the d e c i s i o n f o r t h a t i n d i v i d u a l , i n c l u d i n g m y s e l f , i s one t h a t might make one h e s i t a t e about g o i n g t h r o u g h w i t h the d e c i s i o n . . . Most s t r e s s f u l s i t u a t i o n s a r e ambiguous s i n c e i n f o r m a t i o n i s o f t e n m i s s i n g , o r t h a t w h i c h i s p r e s e n t may be u n c l e a r . A m b i g u i t y can i t s e l f be a s o u r c e o f s t r e s s and u n c e r t a i n t y (Lazarus & Folkman, 1984b). I n an ambiguous environment, a p p r a i s a l of s i t u a t i o n s becomes more d i f f i c u l t . The g r e a t e r t h e a m b i g u i t y , t h e more i n f l u e n c e v a r i a b l e s such as the i n d i v i d u a l ' s p e r s o n a l v a l u e s , b e l i e f s and e x p e r i e n c e s have i n d e t e r m i n i n g t h e meaning o f t h e s i t u a t i o n a l v a r i a b l e s ( L a z a r u s & Folkman, 1984b). I s o l a t i o n I s o l a t i o n d e s c r i b e s t h e p e r c e p t i o n s n u r s e e d u c a t o r s e x p r e s s e d about u l t i m a t e l y b e i n g s o l e l y r e s p o n s i b l e f o r the d e c i s i o n s they found n e c e s s a r y t o make. T h i s theme i n c l u d e d an element of p h y s i c a l i s o l a t i o n . I n f o r m a n t s d e s c r i b e d a t times f e e l i n g i s o l a t e d i n t h e c l i n i c a l s e t t i n g , d i s t a n c e d from c o l l e a g u e s who c o u l d u n d e r s t a n d the performance e x p e c t a t i o n s of t h e l e v e l , and thus a c t as a s o u r c e of s u p p o r t . • - 43 O f t e n t h e y i n d i c a t e d t hey f e l t u n s u p p o r t e d i n c a r r y i n g out t h e i r r o l e by c o l l e a g u e s and a d m i n i s t r a t o r s . I n f o r m a n t s i d e n t i f i e d t h a t t h e i r c o l l e a g u e s o f t e n had d i f f e r i n g p h i l o s o p h i e s of t e a c h i n g and e v a l u a t i o n . Because of t h i s t h e y c o u l d not always be s u r e t h a t c o l l e a g u e s would agree and su p p o r t t h e i r d e c i s i o n . And, f i n a l l y , even when s u p p o r t e d , some nurse e d u c a t o r s f e l t a degree o f i s o l a t i o n because i n the f i n a l a n a l y s i s t hey r e a l l y were on t h e i r own. The n a r r a t i v e s t h a t f o l l o w d e s c r i b e t h e s e f e e l i n g s : I : I t was my d e c i s i o n and mine a l o n e . That added t o my s t r e s s because a g a i n I was not c o m f o r t a b l e b e i n g s o l e l y r e s p o n s i b l e f o r t h i s d e c i s i o n . T h i s i n f o r m a n t i n d i c a t e d she " f e l t l i k e t h e odd man out i n t h e s c e n a r i o . " I : . . . I would say t h a t , even though I c o u l d be surrounded by p e o p l e who had been p r e v i o u s l y s u p p o r t i v e i n my r o l e as an e d u c a t o r i n g e n e r a l , I found m y s e l f w i t h p e o p l e around me, who had d e c i d e d t o t a k e the p o s i t i o n t o s i d e w i t h t h e Student, so t h a t d i d add t o t h e f e e l i n g of i s o l a t i o n . One i n f o r m a n t who was a n o v i c e r e p o r t e d f e e l i n g s u p p o r t e d but r e c o g n i z e d t h e r e were times when, i n f a c t . she d i d f e e l a l o n e . I : And d i d I f e e l a l o n e ? S u r p r i s i n g l y , I guess I f e l t f a i r l y w e l l - s u p p o r t e d by t h e p e o p l e h e r e but when i t got r i g h t down t o i t , i t was j u s t h e r and I ...so i t i s y o u ' r e v e r y much on y o u r own the n . An e x p e r i e n c e d n u r s e e d u c a t o r e x p r e s s e d s i m i l a r views i n t h i s way: I : ...You don't have a l o t o f c o n t a c t w i t h y o u r c o l l e a g u e s . . .but i t r e a l l y does come down t o you cause you're the one t h a t ' s t h e r e i n the c l i n i c a l a r e a . You're the one t h a t ' s s e e i n g the s t u d e n t ' s performance. Even i f you have a p a r t n e r i n t h e semester she's o n l y h e a r i n g your side o f the s t o r y . Lack o f A d m i n i s t r a t i v e Support The i n f o r m a n t s i n d i c a t e d t h a t a d m i n i s t r a t i v e s u p p o r t was l a c k i n g i n two major a r e a s : a) c o n s i s t e n t a d m i n i s t r a t i o n of e d u c a t i o n a l p o l i c i e s , and b) acknowledgement o f t h e s i t u a t i o n and r e a s s u r a n c e . Some i n f o r m a n t s c i t e d "the system" f o r l a c k of s u p p o r t . One i n f o r m a n t r e p o r t e d : I : . . . I guess i t ' s you f e e l t h a t the system had l e t you down or l e t you and the student down. And then t h e system doesn't o f f e r you the s u p p o r t . Or i t ' s so d i f f i c u l t t o f a i l a s t u d e n t . . . they've l e t you down up u n t i l t h a t p o i n t and now t h e y ' r e l e t t i n g you down y e t a g a i n because they a r e making you jump t h r o u g h h u r d l e s i n o r d e r t o f a i l t h i s s t u d e n t . R: When you say t h e system e x a c t l y what do you mean by t h a t ? , . > I : I guess our e v a l u a t i o n system. Our way of p r o m o t i n g s t u d e n t s from one semester t o t h e n e x t . A n o t h e r i n f o r m a n t e x p r e s s e d s i m i l a r i d e a s . I : Nobody has ever s a i d t h a t t h e a p p e a l s committee i s s u p p o r t i v e t o the i n s t r u c t o r s [laugh]....My exposure to them gave me t h e f e e l i n g t h a t t h e y thought t h e y had e x p e r t i s e where t h e y r e a l l y d i d not have i t . I n a d d i t i o n , i n f o r m a n t s d e s c r i b e d c o n f l i c t s r e s u l t i n g from t h e i r m u l t i f a c e t e d and somewhat ambiguous r o l e s as n u r s e e d u c a t o r s . On one hand, t h e y were charged w i t h t h e r e s p o n s i b i l i t y o f making a p r o f e s s i o n a l judgement about th e a b i l i t i e s of t h e s t u d e n t , and y e t , a t the same tim e , many of t h e i n f o r m a n t s p e r c e i v e d a l a c k of s u p p o r t from a d m i n i s t r a t o r s r e g a r d i n g t h e i r judgements. I n t h e s e s i t u a t i o n s , the nurse e d u c a t o r s ' v a l u e s and b e l i e f s seemed t o c o n f l i c t w i t h a d m i n i s t r a t i v e d i r e c t i v e s , c r e a t i n g f e e l i n g s of v u l n e r a b i l i t y and t h r e a t . The f o l l o w i n g e x c e r p t s summarize t h e s e f i n d i n g s : I : And so you were d e a l i n g w i t h a l o t of d i f f e r e n t i s s u e s w i t h h e r . But a g a i n i n t h a t s i t u a t i o n as an i n s t r u c t o r you d i d n ' t f e e l s u p p o r t e d , because what I was t o l d was t h a t t h i s s t u d e n t had t o p a s s . R: How d i d t h a t make you f e e l ? I : [laughs] W e l l , again from a p r o f e s s i o n a l p e r s p e c t i v e you j u s t c o u l d n ' t do i t i n a l l c o n s c i e n c e . I couldn't, t h i s woman couldn't practice as a safe nurse so you had t o a g a i n accumulate t h i s d a t a and i t seemed l i k e no m a t t e r what how much d a t a you c o l l e c t e d t hey would g i v e h e r a n o t h e r chance. T h i s i n f o r m a n t went on t o say: I : I t was c l e a r l y s a i d . I t was. I would l o s e my j o b i f I d i d not pass h e r [ l a u g h s ] . R: And was t h i s a t the team l e v e l , o r was t h i s a t a h i g h e r l e v e l ? I : I t was a h i g h e r l e v e l . I t h i n k i t was because of t h e ty p e of program. I t was d i f f e r e n t from a r e g u l a r c o l l e g e program i n t h a t i t was funded, the f i r s t p i l o t p r o j e c t . . . . I n c o n t r a s t , o t h e r i n f o r m a n t s had never been d i r e c t l y c o n f r o n t e d t o change t h e i r assessment o r t h r e a t e n e d w i t h l o s i n g t h e i r j o b s . They may, however, have thought about i t as i l l u s t r a t e d i n t h i s next quote. R: Some of t h e i n f o r m a n t s t h a t I have spoken t o have s a i d t h a t t h e r e have been s u b t l e i n d i c a t o r s t o t h e f a c u l t y member t o pass t h e s t u d e n t and o t h e r i n f o r m a n t s have s a i d t h e r e have been d i r e c t i v e s t o them t o pass the s t u d e n t o r t h e i r j o b was on t h e l i n e . Have you e x p e r i e n c e d e i t h e r o f t h o s e s i t u a t i o n s ? I : (Sigh) No, I have n o t . I mean, c e r t a i n l y d i r e c t o r s have a t tim e s asked me why I have t o f a i l them and (pause) but I never got the f e e l i n g t h a t they would say t h a t my j o b was i n j e o p a r d y . I t h i n k I m e n t a l l y thought t h a t . These e x c e r p t s i l l u s t r a t e t h a t t h e s e n u r s e e d u c a t o r s f e l t t h a t t h e i r p r o f e s s i o n a l judgement came under s c r u t i n y . They d e s c r i b e d f e e l i n g p r e s s u r e d , t h r e a t e n e d and cr o s s - e x a m i n e d . They d e s c r i b e d h a v i n g ' 48 t o jump t h r o u g h h u r d l e s . One i n f o r m a n t d i s c l o s e d : I ...And y e t she came back, a h a l f a y e a r o r a y e a r l a t e r w i t h a n o t h e r t e a c h e r and was v e r y s u c c e s s f u l . And t h a t was a n o t h e r v e r y i n t e r e s t i n g e x p e r i e n c e because I had no c o n t a c t w i t h h e r d u r i n g t h a t time but I c e r t a i n l y made a mental note of h e r p r o g r e s s . And I wasn't sure a t t h a t time who was b e i n g e v a l u a t e d more. Whether i t was I i n f a c t who was b e i n g e v a l u a t e d i n terms of whether I i n f a c t had made t h e b e s t judgement a t t h a t t i m e . So again I r e l i v e t he e x p e r i e n c e and r e l i v e i t many t i m e s . Going back t o what were th o s e competencies t h a t were so i m p o r t a n t a t t h a t time and I would make t h e same d e c i s i o n today. One i n f o r m a n t f e l t so s u r e t h a t h e r assessment was a c c u r a t e t h a t she s t a t e d : I : I 'd be w i l l i n g t o put my l i c e n s e on t h e l i n e f o r t h a t . But a t t h e t i m e , when the p r o c e s s i s o c c u r r i n g , y o u ' r e made t o f e e l l i k e y o u ' r e not f u n c t i o n i n g as a competent number one nu r s e , number two e d u c a t o r . F i n a l l y , r e sponses from two i n f o r m a n t s d e s c r i b e d a need t o be acknowledged f o r h a v i n g done a good j o b i n d i f f i c u l t c i r c u m s t a n c e s . Both i n f o r m a n t s f e l t t h i s r e c o g n i t i o n was l a c k i n g . At one p o i n t i n the i n t e r v i e w one i n f o r m a n t a t t e m p t e d t o use r a t i o n a l i z a t i o n t o i n d i c a t e t h a t p r o f e s s i o n a l s s h o u l d n ' t need s u p p o r t . I : ...So t h e r e ' s no s u p p o r t , t h e r e ' s no commendation t o say t h a t you d i d a good j o b . So t h e r e ' s no i n t e r n a l s u p p o r t . . . I don't b e l i e v e t h a t t h e r e would be any s u p p o r t f o r me as an i n d i v i d u a l f a c u l t y member t o say t h a t I d i d what I was supposed t o do [sounds a n g r y ] . I : ...So a g a i n i t ' s that admin, support and I guess t h a t ' s where one of the f a c t o r s f o r s t r e s s comes i n . . . y o u need t o f e e l t h a t t h e y ' r e b e h i n d you. And t h a t t h e y ' r e on y o u r s i d e . Not so much as them a g a i n s t t h e s t u d e n t s o r t of t h i n g . But t h a t t h e y u n d e r s t a n d and empathize w i t h what you a r e g o i n g t h r o u g h . I n t h e second i n t e r v i e w , t h i s i n f o r m a n t e l a b o r a t e d more on t h i s p e r c e i v e d need f o r s u p p o r t . She s a i d : I : . . t h e s t u d e n t has t h e s u p p o r t . I q u i c k l y r e a l i z e d , hey, where i s my support system! But t h e n I thought, no, you've got t o keep a h a n d l e on t h i n g s . R: Why d i d you need s u p p o r t o r f e e l you needed s u p p o r t ? I : W e l l , because i t ' s always n i c e t o have someone t o l e a n on when y o u ' r e b e i n g attacked...when y o u r p r o f e s s i o n a l a b i l i t i e s a r e q u e s t i o n e d . And they I mean they were being questioned ...I couldn't believe i t . V a r i a b l e s That I n f l u e n c e A p p r a i s a l s L a z a r u s ' s {1984b) d e f i n i t i o n of s t r e s s emphasizes the r e l a t i o n s h i p between the p e r s o n and the environment and how an i n d i v i d u a l c o g n i t i v e l y a p p r a i s e s e v e n t s . Thus, i n f o r m a n t s such as t h o s e i n t h i s s t u d y , may e x p e r i e n c e s t r e s s t o some degree but d i f f e r somewhat i n t h e i r r e a c t i o n t o and i n t e r p r e t a t i o n of c e r t a i n e v e n t s . A c c o r d i n g t o a l l i n f o r m a n t s , h a v i n g t o i s s u e a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program was a s t r e s s f u l , i n d i v i d u a l i z e d e x p e r i e n c e . C o g n i t i v e a p p r a i s a l s a r e not s t a t i c p r o c e s s e s and can be a l t e r e d by changes i n p e r s o n / s i t u a t i o n a l v a r i a b l e s w h i c h a r e i n a c o n t i n u a l s t a t e o f f l u x . The v a r i a b l e s i n t r o d u c e an element of u n c e r t a i n t y i n t o the n u r s e e d u c a t o r ' s a p p r a i s a l o f t h e s i t u a t i o n and can i n and o f themselves be a sour c e of s t r e s s . V a r i a b l e s w h i c h i n f l u e n c e the a p p r a i s a l of t h e s i t u a t i o n can be grouped under t h e c a t e g o r i e s of nurse e d u c a t o r , s t u d e n t , and environment. Nurse E d u c a t o r I n f l u e n c i n g v a r i a b l e s i n c l u d e t h e l i f e e x p e r i e n c e , commitment, v a l u e s , b e l i e f s , h e a l t h , and energy t h a t an i n d i v i d u a l n u r s e e d u c a t o r b r i n g s i n t o t h e s i t u a t i o n . These v a r i a b l e s i n f l u e n c e t h e way a nu r s e e d u c a t o r i n t e r p r e t s events and have an impact on t h e r e s o u r c e s and c o p i n g s t r a t e g i e s n u r s e e d u c a t o r s may have a v a i l a b l e t o them. L i f e e x p e r i e n c e . Four o f t h e i n f o r m a n t s i n t h i s s t u d y c o n s i d e r e d themselves t o be n o v i c e c l i n i c a l i n s t r u c t o r s w h i l e t h e o t h e r f i v e v iewed themselves as e x p e r i e n c e d . Some i n f o r m a n t s , w h i l e not n o v i c e e d u c a t o r s , were new t o t e a c h i n g i n t h e f i n a l c l i n i c a l term. These i n f o r m a n t s i d e n t i f i e d a s p e c t s o f t h e i r p erformance w h i c h t h e y f e l t r e q u i r e d f u r t h e r r e f i n e m e n t . I t became apparent d u r i n g t h e a n a l y s e s t h a t t h e i n f o r m a n t s p e r c e i v e d t h e e x p e r i e n c e o f a s s i g n i n g a f a i l i n g grade d i f f e r e n t l y when t h e y had p r e v i o u s e x p e r i e n c e i n d o i n g so. A l t h o u g h t h e y s t i l l a p p r a i s e d t h e event as s t r e s s f u l , i t seemed t o be l e s s so because of t h e c o p i n g s t r a t e g i e s d e v e l o p e d from t h e p r e v i o u s e x p e r i e n c e . N o v i c e i n f o r m a n t s tended t o seek s u p p o r t . One i n f o r m a n t r e c a l l e d what i t was l i k e f o r h e r b e i n g a n o v i c e e d u c a t o r t e a c h i n g i n the f i n a l c l i n i c a l term o f a new program. I : I was a r o o k i e t e a c h e r and my e x p e r t i s e was not measured y e t . . . . I wasn't s u r e w i t h t h e s t u d e n t s . B e i n g a r o o k i e i n s t r u c t o r made i t very, very d i f f i c u l t . N o v i c e i n f o r m a n t s d i s c l o s e d t h a t t h e y sought out o t h e r s : I : . . . . I d i d a l o t o f t a l k i n g . I t h i n k t h e f i r s t t i m e around I d i d n ' t want t o appear l i k e I wasn't s u r e what I was g o i n g t o do. And so I o n l y t a l k e d t o one p e r s o n . T h i s time around I t a l k e d t o t h e whole team. One i n f o r m a n t , a l t h o u g h not a n o v i c e e d u c a t o r , was t e a c h i n g i n the f i n a l c l i n i c a l semester f o r t h e f i r s t t i m e and r e p o r t e d r e c e i v i n g feedback about h e r documentation. * I : . . . I r e a l l y d i d n ' t have a l o t o f c l i n i c a l documentation. And I t h i n k a g a i n t h a t goes back t o t h e f a c t t h a t I was new t o t e a c h i n g t h i s l e v e l . . . . The i n f o r m a n t s emphasized th e i m p o r t a n c e of e x p e r i e n c e . They spoke of h o n i n g t h e i r s k i l l s and b u i l d i n g r e p e r t o i r e s of s k i l l s t o enhance t h e i r a b i l i t y t o t e a c h and e v a l u a t e . The f o l l o w i n g two e x c e r p t s i l l u s t r a t e t h i s c o p i n g s t r a t e g y . R: ...what h e l p s you d e a l w i t h t h e f e e l i n g s o r cope w i t h the f e e l i n g s t h a t a r i s e i n t h e s e s i t u a t i o n s t h a t you've t a l k e d about? B e i n g shocked? I : . . . b a s i c a l l y j u s t t a l k i n g w i t h o t h e r p e o p l e and what would you have done i n a s i m i l a r s i t u a t i o n and t h a t s o r t of t h i n g . And I guess j u s t l e a r n i n g t h a t b e t t e r documentation [ h e l p e d ] . And I t h i n k t h a t c e r t a i n l y r e p e a t e d e x p e r i e n c e s w i t h i n the semester I d i d [numerous] y e a r s i n [the f i n a l c l i n i c a l semester] and I t h i n k t h a t my a b i l i t y t o f o c u s i n on t h e p r o blem s t u d e n t c e r t a i n l y was honed t o a f i n e p o i n t . I : W e l l , I c o n s t a n t l y t h i n k of t h o s e s i t u a t i o n s when I'm c o n f r o n t e d w i t h a n o t h e r s t u d e n t t h a t has a s i m i l a r p r o b l e m . . . i f t hey have s i m i l a r l i t t l e p a t t e r n s t h e n . . . I ' 1 1 t r y them w i t h t h i s one and I ' l l t r y some o t h e r s . . . b u i l d i n g up y o u r r e p e r t o i r e o f s k i l l s t h a t you p u l l out t o t r y and h e l p t h i s s t u d e n t . . . . Commitment. L a z a r u s and Folkman (1984b) d e s c r i b e commitment as t h a t w h i c h i s i m p o r t a n t and has meaning t o an i n d i v i d u a l . Commitments i n f l u e n c e an i n d i v i d u a l ' s a p p r a i s a l of a s i t u a t i o n . I n d i v i d u a l s ' commitments r e f l e c t t h e i r g o a l s and i n f l u e n c e t h e c h o i c e s t h e y make. L a z a r u s and Folkman p o s t u l a t e t h a t commitments i n f l u e n c e a p p r a i s a l s i n two major ways. F i r s t , t h e g r e a t e r the commitment t h e g r e a t e r t h e p o t e n t i a l f o r an e n c o u n t e r t o be a p p r a i s e d as t h r e a t e n i n g o r c h a l l e n g i n g . Second, commitment c r e a t e s v u l n e r a b i l i t y , and v u l n e r a b i l i t y can a c t as a m o t i v a t i n g f o r c e t h a t d i r e c t s a p e r s o n toward a c o u r s e of a c t i o n t h a t can reduce t h r e a t and h e l p t o s u s t a i n c o p i n g e f f o r t s i n t h e f a c e o f s t r e s s o r s . The i n f o r m a n t s i n t h i s s t u d y were unanimous i n t h e i r commitment t o p a s s i n g o n l y t h o s e s t u d e n t s who c o u l d meet the semester o b j e c t i v e s . The i n f o r m a n t s e x p r e s s e d t h e i r f e e l i n g s of c o n c e r n and c a r i n g f o r t h e s t u d e n t who was unable t o demonstrate an a c c e p t a b l e l e v e l of performance. They spoke of f e e l i n g g u i l t y and sad f o r t h e s t u d e n t w h i l e a t t h e same time r e c o g n i z i n g t h e r e was no doubt t h a t the s t u d e n t was not f u n c t i o n i n g at t h e e x p e c t e d l e v e l . However, r e g a r d l e s s of t h e i r f e e l i n g s , n o v i c e and e x p e r i e n c e d n u r s e e d u c a t o r s f e l t r e s p o n s i b l e f o r , and committed t o , g r a d u a t i n g s t u d e n t s who had the n e c e s s a r y s k i l l s t o f u n c t i o n c o m p e t e n t l y and s a f e l y . Faced w i t h a v a r i e t y of s t r e s s o r s , the i n f o r m a n t s u t i l i z e d a number of c o p i n g s t r a t e g i e s t o a c h i e v e t h e i r g o a l . One n o v i c e i n f o r m a n t e x p r e s s e d h e r thoughts i n t h i s way : I : . . . i n i t i a l l y t o be a b l e t o t e l l a s t u d e n t t h a t t h e y ' r e not meeting t h e o b j e c t i v e s . I n i t i a l l y i t makes me f e e l somewhat g u i l t y . Somewhat sad. G u i l t y because I f e e l r e s p o n s i b l e t h a t I s h o u l d have done more f o r them. I s h o u l d have p i c k e d up on t h i s sooner. I s h o u l d have found some c r e a t i v e a l t e r n a t i v e way t o h e l p them get t o the p l a c e where t h e y needed t o be. And, then a t some p o i n t I f e e l v e r y r e l i e v e d [ l a u g h s ] . The i n f o r m a n t went on t o say: I : . . . So I f e l t a l i t t l e sad because as many- br e a k s as I f e l t I had g i v e n t h i s p e r s o n , I just couldn't give them a break f o r t h i s . . . i t was r e a l l y a b s o l u t e l y c l e a r t h a t she could not concentrate on the simplest of procedures... a b s o l u t e l y . . . i f I was t o l e t h e r go thr o u g h t h i n k i n g t h a t s h e ' l l get i t t o g e t h e r I c o u l d n ' t I c o u l d n ' t s l e e p w i t h t h e i d e a . I c o u l d n ' t l i v e w i t h t h e i d e a . . . . S i m i l a r l y , an e x p e r i e n c e d i n f o r m a n t d e s c r i b e d how she f e l t : I :...she c e r t a i n l y had t h e t h e o r y background. You c o u l d n ' t f a u l t t h i s s t u d e n t t h e o r y - w i s e a t a l l . It's just that she couldn't she was a l l thiombs i n the c l i n i c a l area..and I r e a l l y f e l t s o r r y f o r t h i s wonderful p e r s o n was g o i n g t o have t o f a i l . But the bottom l i n e was t h a t t h e r e ' s no way t h a t I c o u l d pass t h i s s t u d e n t and put h e r f o r t h as a r e p r e s e n t a t i v e o f our program out onto t h e u n s u s p e c t i n g p u b l i c as a nu r s e o r even t o t h e u n s u s p e c t i n g n u r s i n g p e o p l e t h a t she was g o i n g t o have t o work w i t h . V a l u e s and b e l i e f s . A p p r a i s a l s a r e always made w i t h i n t h e c o n t e x t of t h e encou n t e r and depend upon t h e i n f o r m a n t making a s e r i e s of r e a l i s t i c judgements about the s i t u a t i o n and i t s impact on t h e i r w e l l - b e i n g . V u l n e r a b i l i t y and one's commitments and v a l u e s go hand i n hand. The more a p e r s o n c a r e s , the more s t r o n g l y one h o l d s t o h i s / h e r v a l u e s , and the more v u l n e r a b l e he or she i s t o a p a r t i c u l a r t h r e a t (Lazarus & Folkman, 1984b). Thus, an i n d i v i d u a l ' s v a l u e s and commitments can c r e a t e a m b i g u i t y and f e e l i n g s of v u l n e r a b i l i t y t h a t r e s u l t i n s i t u a t i o n s b e i n g p e r c e i v e d as t h r e a t e n i n g . D e s c r i p t i o n s i n t h e l i t e r a t u r e d e p i c t t h e r e s p o n s i b i l i t i e s and r o l e c o n f l i c t s i n h e r e n t i n t h e nu r s e e d u c a t o r ' s r o l e (Batey, 1969; Kramer, 1970; O'Connor, 1978; W i l l i a m s o n , 1972). Numerous a u t h o r s have p o s t u l a t e d t h a t , as a r e s u l t o f t h e i r m u l t i f a c e t e d and somewhat ambiguous r o l e s , n u r s e e d u c a t o r s may e x p e r i e n c e s t r e s s , burnout and d i m i n i s h e d j o b s a t i s f a c t i o n (Fain,1987; O'Connor,1978 ; M a r r i n e r & C r a i g i e , 1977; S c h u l e r , 1975; S c h u l e r , A l d a g & B r i e f , 1977; Wood, 1971) . The e x c e r p t s below i l l u s t r a t e t h e c o m p l e x i t y o f the n u r s e e d u c a t o r r o l e , and t h e c o n f l i c t s some of t h e i n f o r m a n t s e x p e r i e n c e d . These c o n f l i c t s p r i m a r i l y r e l a t e d t o the e d u c a t o r s ' p e r c e p t i o n s of a l a c k o f a d m i n i s t r a t i v e s u pport f o r t h e i r p r o f e s s i o n a l judgement and t h e nu r s e e d u c a t o r s ' v a l u e s and commitments t o gra d u a t e o n l y competent n u r s e s . R: And how does t h a t make you f e e l ? ["to have t o be p a r t i c u l a r l y c a u t i o u s and v e r y , s t r i n g e n t i n what you do?" To make s u r e you g i v e them e v e r y o p p o r t u n i t y t o demonstrate they can make the o b j e c t i v e s " ] ? I : P e r s o n a l l y i t c a l l s i n t o q u e s t i o n my p r o f e s s i o n a l judgement. I have been h i r e d as t h e e d u c a t o r and i f I have t o go i n t o such l o n g drawn out d i s c u s s i o n s and r a t i o n a l i z e t o j u s t i f y my p r o f e s s i o n a l d e c i s i o n t h e n t h a t has an impact on me i n terms o f my a b i l i t y t o make t h i s d e c i s i o n . A n o t h e r i n f o r m a n t d e s c r i b e d b e i n g l a b e l l e d "as a t e a c h e r who f a i l s s t u d e n t s : " R: And how does t h a t make you f e e l ? You s a i d e a r l i e r about b e i n g l a b e l l e d as a t e a c h e r who f a i l s s t u d e n t s o r who works w i t h s t u d e n t s and the n makes t h e d e c i s i o n t h a t t h e s t u d e n t c a n ' t p a s s . I : W e l l , my p r o f e s s i o n a l c o n s c i e n c e i s c l e a r . I t h i n k I would be more upset i f I had l e t a s t u d e n t . 5 9 c o n t i n u e on o r g r a d u a t e who I knew was not s a f e o r was not ready t o assume t h a t r o l e . H e a l t h and energy. The way a p e r s o n copes i s a l s o d e t e r m i n e d p a r t l y by h i s / h e r r e s o u r c e s , i n c l u d i n g t h e l e v e l of h e a l t h and energy i n d i v i d u a l s have t o b r i n g t o t h e s i t u a t i o n . I n f o r m a n t s acknowledged t h a t d u r i n g t h e s e events t h e y a s s e s s e d t h i s r e s o u r c e . T h i s , i n t u r n , a s s i s t e d them i n t h e d e t e r m i n a t i o n o f w h i c h s t r a t e g i e s t o use. One i n f o r m a n t i n d i c a t e d t h a t j u s t b e i n g aware of h e r r e s o u r c e s h e l p e d h e r t o d e a l w i t h t h e s t r e s s . T h i s s e c t i o n d e s c r i b e s t h e i n f o r m a n t s ' p e r c e p t i o n s o f t h e i r h e a l t h and energy. I t i s g e n e r a l l y r e c o g n i z e d t h a t h e a l t h and energy f a c i l i t a t e c o p i n g e f f o r t s . I f one i s e n e r g i z e d and h e a l t h y , one i s b e t t e r a b l e t o cope w i t h the demands of s t r e s s f u l e v e n t s . A l l i n f o r m a n t s t a l k e d about e x p e r i e n c i n g a s i g n i f i c a n t i n c r e a s e i n w o r k l o a d w h i l e w o r k i n g w i t h t h e s t u d e n t who was h a v i n g d i f f i c u l t i e s p r o g r e s s i n g t o t h e e x p e c t e d l e v e l o f performance. One i n f o r m a n t was i n c o n s i s t e n t i n h e r v i e w as t o whether she thought h e r w o r k l o a d was e x c e s s i v e l y more but i n d i c a t e d " i t f e e l s l i k e more." Those who p e r c e i v e d an i n c r e a s e i n w o r k l o a d a t t r i b u t e d i t t o l o n g e r h o u r s , more documentation, more meetings and p l a n n i n g s e s s i o n s and a d d i t i o n a l • p r e p a r a t i o n s h o u l d t h e s t u d e n t g r i e v e the nu r s e e d u c a t o r ' s d e c i s i o n . One i n f o r m a n t d e s c r i b e d the e f f e c t on h e r of w o r k i n g l o n g e r t h a n u s u a l hours : I : . . . a t t h e v e r y end t h e r e I f e l t r e l i e f a c t u a l l y because I was exha u s t e d from the hours t h a t I had put i n t h e r e . T h i s i n f o r m a n t commented on t h e energy she put i n t o w o r k i n g w i t h t h i s s t u d e n t : I : . . . I r e a l l y d i d n ' t t h i n k t h a t i t was f a i r t o have t h i s s t u d e n t come back a t h i r d t i me i n t o t h e program r e g i s t e r e d i n t o [the f i n a l c l i n i c a l semester] and abuse t h e r e s o u r c e s of an i n s t r u c t o r . The time and energy t h a t i t took f o r me t o put i n t o t h i s one s t u d e n t was phenomenal! A n o t h e r i n f o r m a n t i n d i c a t e d t h a t : I : I was r e a l l y t i r e d and I don't think I p h y s i c a l l y was u n h e a l t h y but I c e r t a i n l y f e l t a l o t more t i r e d . More t i r e d p h y s i c a l l y . I had considerably less energy t o o , I t h i n k , t o g i v e t o the o t h e r s t u d e n t s and t o my own p e r s o n a l l i f e . And p r o b a b l y I was somewhat e d g i e r t o o . I n a d d i t i o n , one i n f o r m a n t d e s c r i b e d l o s i n g w e i g ht and e x p e r i e n c i n g s l e e p d i f f i c u l t i e s . I : . . . I l o s t w e i g h t , [and had] s l e e p l e s s n i g h t s . R: S l e e p l e s s n i g h t ? I : ...You t u r n over t h e same t h i n g s a g a i n and i s t h e r e any o t h e r way of d o i n g i t ? I t h i n l c i t has an impact when you spend that many hours. These f i n d i n g s s u ggest, t h a t the demands p l a c e d upon n u r s e e d u c a t o r s i n t h e s e c i r c u m s t a n c e s may a d v e r s e l y a f f e c t t h e i r h e a l t h . Student The second group of v a r i a b l e s w h i c h i n f l u e n c e t h e a p p r a i s a l of the s i t u a t i o n a r e termed s t u d e n t v a r i a b l e s . Student v a r i a b l e s i n c l u d e the s t u d e n t s ' i n s i g h t s r e l a t e d t o c l i n i c a l performance, t h e i r g e n e r a l e x p e c t a t i o n t h a t t h e y a r e e n t i t l e d t o r e c e i v e a p a s s i n g grade once t h e y r e a c h the f i n a l c l i n i c a l semester, and o t h e r e x t e n u a t i n g c i r c u m s t a n c e s . I n s i g h t . The e x p e r i e n c e o f a s s i g n i n g a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l c l i n i c a l semester c a r r i e d w i t h i t some degree of s t r e s s , but a s s i g n i n g a f a i l i n g grade t o a s t u d e n t who lacl^ied t h e i n s i g h t t o r e c o g n i z e t h e d e f i c i t s i n h i s / h e r performance was even more s t r e s s f u l . I n f o r m a n t s were unanimous i n t h e i r v i ews t h a t s i t u a t i o n s where s t u d e n t s l a c k e d i n s i g h t i n t o t h e i r performance would be a p p r a i s e d as s t r e s s f u l . On o c c a s i o n , i n f o r m a n t s c i t e d e x p e r i e n c e s where t h e y had more th a n one s t u d e n t i n j e o p a r d y of not meeting t h e c o u r s e o b j e c t i v e s a t the same t i m e . These s i t u a t i o n s compounded the f a c u l t y members' s t r e s s . I : . . . i t depends so much on t h e s t u d e n t and t h e i r awareness o f t h e i r p r o g r e s s o r l a c k of and how w e l l t h e y r e c e i v e i t . I f t h e y have i n s i g h t o r n o t . And from my e x p e r i e n c e I would say I had one s t u d e n t t h a t had no i n s i g h t o r very very l i t t l e . And i t was q u i t e f r u s t r a t i n g when you ' r e d e a l i n g w i t h t h a t t y p e o f s t u d e n t and y o u ' r e t r y i n g t o h o p e f u l l y have them r e c o g n i z e i t . . . . I : . . . t h a t ' s where t h e s t r e s s f o r me comes. I s when when th e y don't have t h e i n s i g h t . . . . The same i n f o r m a n t d i s c l o s e d t h a t : I : I had enough d a t a t h a t I knew t h e s t u d e n t was not s a f e . So I d i d n ' t have s t r e s s w i t h t h a t . I had s t r e s s w i t h t h e way she r e a c t e d t o i t . G e n e r a l e x p e c t a t i o n s . I n a d d i t i o n , i n f o r m a n t s g e n e r a l l y b e l i e v e d t h a t a s s i g n i n g a f a i l i n g grade i n t h e f i n a l c l i n i c a l semester r a t h e r than e a r l i e r i n t h e program u s u a l l y met w i t h more r e s i s t a n c e on t h e s t u d e n t ' s p a r t and was more d i f f i c u l t f o r f a c u l t y . T h i s was p a r t i c u l a r l y t r u e i f s i g n i f i c a n t o t h e r s a l s o had d i f f i c u l t y coming t o terms w i t h t h e d e c i s i o n . One i n f o r m a n t summed i t up t h i s way: I . . . a t l e a s t i f t h e y f a i l e a r l i e r i n .. a p r e v i o u s semester you t h i n k , okay, ( S i g h ) . They can come back a t a n o t h e r t i m e . They have a l i t t l e e x t r a t i me t o r e p e a t . But when t h e y f a i l i n the f i n a l c l i n i c a l term] [pause] i f t h e y go back t o f i v e [ p a u s e ] i t ' s j u s t not t h e same...I t h i n k because i t ' s the f i n a l semester. They're not g r a d u a t i n g w i t h t h e i r f r i e n d s . . . t h e i r f a m i l y a r e a n t i c i p a t i n g them t o g r a d u a t e . So I t h i n k t h a t ' s more d i f f i c u l t f o r t h e s t u d e n t . That makes i t more d i f f i c u l t f o r t h e i n s t r u c t o r . Because even though you c a n ' t t h i n k about t h a t , you have t o fo c u s on t h e o b j e c t i v e s . I t s t i l l has an impact. R: I know t h a t you have e x p e r i e n c e i n some of t h e low e r s e m e s t e r s . Do you t h i n k t h e r e i s a d i f f e r e n c e between f a i l i n g a s t u d e n t a t t h i s l e v e l and f a i l i n g a s t u d e n t a t a lo w e r l e v e l ? I : Yes, because a t a lower l e v e l t h e r e ' s not so much inve s t m e n t on t h e s t u d e n t ' s p a r t o r on t h e f a c u l t y ' s p a r t . As an i n s t r u c t o r you don't f e e l l i k e t h e r e ' s so much energy and time and e f f o r t gone i n t o t h e whole s c e n a r i o . And so i t i s e a s i e r I t h i n k t o say t o a s t u d e n t t h e n . F o r some r e a s o n t h e s t u d e n t s t e n d t o have, I won't say, more i n s i g h t but t h e y a r e more a c c e p t i n g . I t may be t h a t t h e y see you i n a more a u t h o r i t a r i a n r o l e i n t h o s e l o w e r semesters but t h e y seem t o t a k e what you say as something c o n s t r u c t i v e and not something t h a t i s a p e r s o n a l a t t a c k . I : W e l l , i n my e x p e r i e n c e I t h i n k i t i s more d i f f i c u l t [ t o a s s i g n a f a i l i n g grade t o s t u d e n t s i n t h e f i n a l c l i n i c a l semester] t h a n i t i s w i t h s t u d e n t s i n lower s e m e s t e r s . . . i t i s much more d i f f i c u l t . I t h i n k a l s o we have t o f a c e c e r t a i n q u e s t i o n s from o t h e r i n s t r u c t o r s because I t h i n k some of them have a v e s t e d i n t e r e s t . They have known the s t u d e n t s . Maybe th e y d i d f i n e i n t h e i r semester but they a r e not f i n e i n [the f i n a l c l i n i c a l semester] now because i t i s v e r y d i f f e r e n t . They a r e now h a v i n g t o p u l l a l l t h e i r knowledge t o g e t h e r . T h i s i n f o r m a n t went on t o i d e n t i f y o t h e r " p r e s s u r e s " she e x p e r i e n c e d . I : . . . i f they have done well o r a t l e a s t met t h e o b j e c t i v e s from p a s t semesters,...[pause] why now? I t h i n k t h e r e i s a l s o . . . t h e pressure, the g r a d p i n s , t h e bake s a l e s , t h e [laugh] and s t u d e n t s g i v e you t h a t . . . l i k e I have bought my p i n . I , have p a r t i c i p a t e d i n r a i s i n g money f o r g r a d u a t i o n and what a r e you s a y i n g ? I t h i n k sometimes, because they have more i n v e s t e d t h e i r i n s i g h t i s not v e r y good. Many of them have a l r e a d y made p l a n s where t h e y a r e g o i n g t o go work.... E x t e n u a t i n g c i r c u m s t a n c e s . F u r t h e r compounding the n u r s e e d u c a t o r s ' a p p r a i s a l s of events were a number of e x t r a n e o u s v a r i a b l e s w h i c h added t o t h e uniqueness of t h e s i t u a t i o n . These i n c l u d e d s t u d e n t i l l n e s s , f i n a n c i a l problems, and f a m i l y s t r e s s e s . One o r more of t h e s e v a r i a b l e s may be p r e s e n t i n a g i v e n s i t u a t i o n . The e x c e r p t s below i d e n t i f y some of t h e s e v a r i a b l e s and d e s c r i b e t h e i n f o r m a n t s ' views on t h e impact of t h e v a r i a b l e s on t h e e v a l u a t i o n p r o c e s s . I : ... you see how t h e y r e a l l y . . . s t u d e n t s a r e under a l o t of d u r e s s . F i n a n c i a l , f a m i l y s t r e s s e s . They r e a l l y put themselves out on t h e end o f t h e rope. And so they l o s e s i g h t . And a l l t h e y want t o do i s r e a c h t h a t g o a l a t no m a t t e r what c o s t . O f t e n i n t a l k i n g w i t h n u r s e e d u c a t o r s i n p r e v i o u s semesters i n s t r u c t o r s c o u l d i d e n t i f y e x t e n u a t i n g c i r c u m s t a n c e s w h i c h p r e v e n t e d the s t u d e n t from f a i l i n g i n an e a r l i e r . s e m e s t e r . The f o l l o w i n g e x c e r p t i d e n t i f i e s some of t h o s e e x t e n u a t i n g f a c t o r s . I : [ I n t a l k i n g w i t h a n o t h e r f a c u l t y member} ...and then t h e y ' l l say she was d o i n g t h i s and a c t u a l l y t h a t sometimes i s q u i t e h e l p f u l because you can say why t h e h e l l d i d n ' t you do something about i t i n semester f o u r . . . t h e n they w i l l t e l l you t h a t f o r t h i s , t h i s , o r t h i s , r e a s o n e i t h e r t h e s t u d e n t had a l o t o f i l l n e s s o r the s t u d e n t used absentee time o r a change o f i n s t r u c t o r or something t o p a c i f y o r t o make i t not seem t o s h i f t t h e blame from t h e s t u d e n t ' s b e h a v i o u r t o w h a t e v e r . . . . . R: So, f o r whatever r e a s o n t h e r e was some e x t e n u a t i n g c i r c u m s t a n c e s t h e s t u d e n t d i d n ' t f a i l a t t h a t p a r t i c u l a r p o i n t ? I : Yes. R: And c o n t i n u e d on? I : . . . t h a t you t h i n k p r e v i o u s semester i n s t r u c t o r s ] should have f a i l e d them but then you can u n d e r s t a n d why t h e y were u n a b l e t o . Environment D u r i n g the i n t e r v i e w s , i n f o r m a n t s i d e n t i f i e d a v a r i e t y o f e n v i r o n m e n t a l v a r i a b l e s w h i c h i n f l u e n c e d t h e i r a p p r a i s a l of t h e s i t u a t i o n and tended t o i n t r o d u c e an element of u n c e r t a i n t y i n t o the d e c i s i o n - making p r o c e s s . These e x t e r n a l s t r e s s o r s w h i c h c o n t r i b u t e d t o t h e uniqueness of each s i t u a t i o n c o u l d be grouped i n t o two c a t e g o r i e s : t h e c l i n i c a l agency and the e d u c a t i o n a l i n s t i t u t i o n . C l i n i c a l agency. I n f o r m a n t s spoke about th e s u i t a b i l i t y o f the c l i n i c a l agency i n terms of b e i n g a b l e t o p r o v i d e a p p r o p r i a t e t y p e s of c l i n i c a l e x p e r i e n c e s , t h e a b i l i t y and w i l l i n g n e s s of agency s t a f f t o work w i t h the s t u d e n t and i n s t r u c t o r , as w e l l as i n t e r n a l agency problems w h i c h may a d v e r s e l y a f f e c t t h e s t u d e n t s ' l e a r n i n g environment. R: ...Can you t h i n k about what e l s e makes t h i s s i t u a t i o n p a r t i c u l a r l y d i f f i c u l t ? . 6 8 I : W e l l , you can t h i n k i n terms o f t h e agency i t s e l f . I f you l o o k a t t h e p a r t i c u l a r u n i t . What t y p e of u n i t i s i t ? And i f you have a weak s t u d e n t o r a f a i l i n g s t u d e n t who's on an u n s t a b l e f l o o r t h a t ' s v e r y busy and has cha n g i n g p a t i e n t s . . . . That poses p a r t i c u l a r problems because you have t o be on y o u r t o e s . And make s u r e t h a t y o u ' r e t h e r e t o ensure t h a t t h e s t u d e n t i s s a f e . . . . The s t a f f . What q u a l i f i c a t i o n s do the s t a f f have i n terms of t h e l e n g t h of e x p e r i e n c e ? Are th e y new t o t h a t h o s p i t a l ? Are the y new t o b e i n g a s t u d e n t guide? Are they new t o [ e d u c a t i o n a l agency's name] program? Have they been a p r e c e p t o r f o r a n o t h e r program? You don't r e a l l y get an o p p o r t u n i t y to look a t the p a r t i c u l a r s t u d e n t g u i d e s . I n t h i s l a s t s i t u a t i o n t h e y were j u s t a s s i g n e d . I don't know t h e h o s p i t a l , I don't know the s t a f f , so I'm coming i n c o l d . I don't know my s t u d e n t s o t h e r t h a n what I've r e a d i n t h e i r f i l e s . So I'm coming i n c o l d . I : So I have t o f i n d out as we go a l o n g i n the r o t a t i o n what the e x p e r i e n c e i s of t h e g u i d e s . So t h a t i s a problem. I f t h e r e ' s any i n t e r n a l problems on t h e u n i t . L i k e one of the f l o o r s t h e r e i s some problems r e l a t e d t o u s i n g the s t u d e n t s as w o r k l o a d . A n o t h e r i n f o r m a n t commented: I : . . . I f I've got f a i t h i n t h e s t u d e n t g u i d e I s l e e p b e t t e r . E d u c a t i o n a l i n s t i t u t i o n . W i t h i n the e d u c a t i o n a l i n s t i t u t i o n , p a r t i c u l a r p o l i c i e s , p r i o r i t i e s , and i n i t i a t i v e s were p i n p o i n t e d as v a r i a b l e s w h i c h might i n f l u e n c e t h e i n f o r m a n t ' s a p p r a i s a l . A l s o i d e n t i f i e d were t h e adequacy of t h e r e s o u r c e s a v a i l a b l e t o t h e nur s e e d u c a t o r w h i c h might r e s t r i c t t he i n f o r m a n t ' s o p t i o n s and/or s t r a t e g i e s . F u rthermore, concerns r e g a r d i n g j o b s e c u r i t y were a l s o e x p r e s s e d . I n t h i s next n a r r a t i v e , t h e r e s e a r c h e r asked t h e i n f o r m a n t about how she f e l t when she had l a i d out h e r p l a n and r e a l l y t r i e d h a r d t o work w i t h the s t u d e n t and n o t h i n g was happening. Her response r e f l e c t e d concerns about t h e program's a d m i s s i o n c r i t e r i a . I : W e l l t h e y ' r e not ready o r t h e y ' r e out of t h e i r l e a g u e . L i k e t h e s t u d e n t s h o u l d n ' t be h e r e , she s h o u l d n ' t have been a l l o w e d t o come i n t o t h e program. Two o t h e r i n f o r m a n t s r e c a l l e d b e i n g s e n s i t i z e d t o c i r c u m s t a n c e s t h a t a r o s e because t h e i r programs were new. The i n f o r m a n t s i m p l i e d t h e y f e l t p r e s s u r e under the s c r u t i n y t h a t came w i t h t h e new programs. I : T h i s was [the program] very very new t o the c o l l e g e and c e r t a i n l y a t t h a t t i m e , my c o l l e a g u e s , I mean t h i s was t h e i r f a v o r i t e program...we had a l l worked on t h e c u r r i c u l u m and why were they not p a s s i n g ? I : ...and I t h i n k i t was because of the type of program. I t was d i f f e r e n t from a r e g u l a r c o l l e g e program i n t h a t i t was funded, t h e f i r s t p i l o t . p r o j e c t t h a t was funded by.... Other i n f o r m a n t s responded i n t h i s way: R: So what i f a n y t h i n g i s t h e impact of you a s s i g n i n g a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l c l i n i c a l semester? I : I t h i n k we have an i n t e r n a l problem i n terms o f how f a r we l e t a s t u d e n t go b e f o r e t h e y ' r e a c t u a l l y f a i l e d . And I t h i n k t h i s goes back t o the i s s u e of r e t e n t i o n and r e m e d i a t i o n . P a r t i c u l a r l y f o r a s t u d e n t who i t ' s t h e i r l a s t chance. They don't have a n o t h e r o p p o r t u n i t y t o corne back i n t o the program so y o u ' r e p a r t i c u l a r l y cautious and v e r y s t r i n g e n t i n what you do t o make su r e you g i v e them every opportunity to demonstrate t h e y can make t h e o b j e c t i v e s . T h i s i n f o r m a n t went on t o say: I : ...no p r a c t i c u m s t u d e n t s were d e s i g n a t e d as • b e i n g e l i g i b l e f o r r e m e d i a t i o n . . . so t h a t c e r t a i n l y i mpacts on y o u r d e c i s i o n . Then, when y o u ' r e making up y o u r l e a r n i n g p l a n and you have t o r e a l i z e t h a t you have to make sure t h a t t h e time you spend w i t h t h a t f a i l i n g s t u d e n t i s adequate and a l s o the time you spend w i t h y o u r good s t u d e n t s i s adequate...because you're not going to be receiving any help, any c l i n i c a l h e l p , t h e r e f o r e t h a t p u t s i n t o c o n t e x t what you can a c h i e v e . What k i n d of l e a r n i n g s t r a t e g i e s can I use t h e n i f I'm on my own? I : ...however I have t o say t h a t one of the f a c t o r s t h a t p r o b a b l y impinged a g r e a t d e a l on t h a t d e c i s i o n was a b u d g e t a r y one. And t h a t i s a n o t h e r i n t e r e s t i n g a s p e c t i n terms o f once you i d e n t i f y problems how much r e m e d i a t i o n can you o f f e r w i t h i n t h e r e s o u r c e s t h a t you p e r s o n a l l y R: And how does t h a t make you f e e l i f t h e r e s o u r c e s l i m i t y o u r a b i l i t y t o p r o v i d e a p p r o p r i a t e r e m e d i a t i o n ? I : W e l l , one of the t h i n g s i t ' s done f o r me i s t h a t I know t h a t many tim e s I have extended m y s e l f by f a r above and beyond t h e e x p e c t a t i o n s of my r o l e and as w e l l above and beyond what my c o l l e a g u e s a r e p r e p a r e d t o do. R i g h t l y o r wr o n g l y , I have done t h a t . But I have done t h a t f o r the b e n e f i t of t h e s t u d e n t and i n many i n s t a n c e s I have t o say i t has been b e n e f i c i a l f o r the s t u d e n t . Don't know t h a t i t ' s been b e n e f i c i a l f o r me. I n a d d i t i o n , problems r e l a t e d t o l i m i t e d r e s o u r c e s were compounded by time l i m i t s i n w h i c h t h e d e c i s i o n had t o be made. I : . . . a t t h e time I f e l t v e r y l i m i t e d i n the k i n d o f r e s o u r c e s I had. And i t seemed a l s o [ s p e a k i n g q u i c k l y ] t h a t t h i n g s were moving q u i c k l y . More t h a n one i n f o r m a n t commented about the r e - e n t r y o p p o r t u n i t i e s a v a i l a b l e t o s t u d e n t s . I : I f e l t p a r t i c u l a r l y bad because I knew t h a t t h i s would be the l a s t . She wouldn't have a n o t h e r chance t o r e - e n t e r . And so i t made i t a l l t h e more d i f f i c u l t . I t wasn't l i k e I c o u l d o f f e r h e r and say w e l l now come back and r e p e a t i t . . . I n c o n t r a s t , a n o t h e r i n f o r m a n t saw t h e r e e n t r y p o l i c y as b e i n g too l a x thus c r e a t i n g a n o t h e r s o u r c e of f r u s t r a t i o n f o r the nu r s e e d u c a t o r . I : W e l l , i t ' s a v e r y l a x r e - e n t r y p o l i c y . The way i t ' s supposed t o work i s they a r e supposed t o have 32 months t o complete t h e program. That's g i v i n g them one semester o f f , a l l o w i n g f o r s i c k n e s s o r whatnot and they w i l l extend i t . They say one semester, so an e x t r a f o u r months i n very _ extenuating circumstances. Yet th e y I've seen them extend i t and extend i t beyond I t h i n k any p o i n t t h a t t h e y ' r e d o i n g t h e s t u d e n t any good. R: So you don't have one o r two c l i n i c a l f a i l u r e s o r academic f a i l u r e s and the n they c a n ' t r e - e n t e r ? I : W e l l , I t h i n k we do have t h a t but i t ' s not adhered t o . And that's the f r u s t r a t i n g part. Because I t h i n k i f you put a student through a semester three times t h e n they w i l l e v e n t u a l l y get i t . That doesn't mean t h e y ' r e a competent n u r s e but i t ' s j u s t t h a t you wouldn't have enough data t o f a i l them t h e t h i r d t i me t h r o u g h . I n t h i s next e x c e r p t a n o t h e r i n f o r m a n t d e s c r i b e d how the p o l i c y i n f l u e n c e d h e r approach. I : Because o f the unique s i t u a t i o n o f t h i s s t u d e n t [the i n f o r m a n t i n d i c a t e d she spent a l o t o f time t a l k i n g w i t h o t h e r p e o p l e , p l a n n i n g h e r a p p r o a c h ] . I t h i n k t h e f a c t t h a t she had spent so much time i n our program and she was r e p e a t i n g t h e semester and she was a t the l i m i t s of h e r 32 months because she had been extended t o f i n i s h [the f i n a l c l i n i c a l s e m e s t e r ] . These e x c e r p t s i n d i c a t e t h a t a d m i n i s t r a t o r s need t o be c o n s i s t e n t i n the i m p l e m e n t a t i o n of e d u c a t i o n a l p o l i c i e s . P o l i c i e s need t o be d e s i g n e d t o u t i l i z e i n s t r u c t o r r e s o u r c e s o p t i m a l l y . I n t h i s way, nu r s e e d u c a t o r s can be a s s u r e d t h a t they a r e w o r k i n g t o a c h i e v e a common g o a l ; t h a t o f g r a d u a t i n g competent and s a f e n u r s e s . Coping Two f i e l d s o f s c i e n t i f i c i n q u i r y have e x t e n s i v e l y examined t h e concept o f c o p i n g : a n i m a l p h y s i o l o g y and p s y c h o a n a l y t i c p s y c h o l o g y (Lazarus & Folkman, 1984b). The a n i m a l model f o c u s e d on t h e concept o f d r i v e w i t h t h e emphasis p r i m a r i l y on a v o i d a n c e and escape b e h a v i o u r s . T h i s model of c o p i n g was s i m p l i s t i c and l a c k e d a c o g n i t i v e component. The p s y c h o a n a l y t i c approach r e c o g n i z e d t h e s i g n i f i c a n c e o f c o g n i t i o n but tended t o downplay th e importance o f b e h a v i o u r . H i e r a r c h i c a l p a t t e r n s o f c o p i n g were i d e n t i f i e d . These systems tended t o d e s c r i b e s t y l e s and t r a i t s used by i n d i v i d u a l s t o adapt t o s i t u a t i o n s and thus reduce s t r e s s . Coping was not c o n c e i v e d as a dynamic, ch a n g i n g p r o c e s s . T h i s s t u d y used L a z a r u s and Folkman's (1984b) d e f i n i t i o n of c o p i n g . These r e s e a r c h e r s v i e w c o p i n g as a c o n t e x t - s p e c i f i c , dynamic, c o g n i t i v e and b e h a v i o r a l p r o c e s s . They d e f i n e c o p i n g as an i n d i v i d u a l ' s " c o n s t a n t l y changing c o g n i t i v e and b e h a v i o r a l e f f o r t s t o manage s p e c i f i c e x t e r n a l and/or i n t e r n a l demands t h a t a r e a p p r a i s e d as t a x i n g o r e x c e e d i n g the r e s o u r c e s of t h e p e r s o n " (Lazarus & Folkman, 1984b, p.141). They b e l i e v e t h a t e f f e c t i v e c o p i n g depends on t h e r e l a t i o n s h i p between th e demands of t h e s i t u a t i o n and t h e p e r s o n ' s r e s o u r c e s . I n o r d e r f o r one t o cope e f f e c t i v e l y , c o p i n g e f f o r t s must not be i n c o n f l i c t w i t h an i n d i v i d u a l ' s v a l u e s , commitments, and b e l i e f s ( L azarus & Folkman, 1984b). U n l i k e o t h e r models, t h i s one t a k e s i n t o account t h a t many s o u r c e s of s t r e s s cannot be e f f e c t i v e l y managed. R e g a r d l e s s o f outcome, e f f e c t i v e c o p i n g i n t h e s e i n s t a n c e s t h e n i s d e f i n e d as " a n y t h i n g a p e r s o n does o r t h i n k s , r e g a r d l e s s of how w e l l o r b a d l y i t works" (Lazarus & Folkman, 1984b, p.142), w h i c h " a l l o w s t h e p e r s o n t o t o l e r a t e , m i n i m i z e , a c c e p t , o r i g n o r e what cannot be mastered" (Lazarus & Folkman, 1984b, p. 140) . Coping i s d e t e r m i n e d by c o g n i t i v e a p p r a i s a l . I n d i v i d u a l s use p r o b l e m - f o c u s e d and e m o t i o n - f o c u s e d s t r a t e g i e s . O f t e n t h e s e s t r a t e g i e s a r e u t i l i z e d c o n c u r r e n t l y . The p r o b l e m - f o c u s e d p r o c e s s e s used by i n f o r m a n t s i n t h i s s t u d y can be c l a s s e d i n t o two b r o a d c a t e g o r i e s : 1) i n f o r m a t i o n s e e k i n g ; and 2) d i r e c t a c t i o n t o a l t e r one's approach. P r o b l e m - f o c u s e d S t r a t e g i e s I n f o r m a t i o n s e e k i n g . A l l i n f o r m a n t s emphasized t h e i m p o r t a n c e of t a l k i n g w i t h o t h e r s . T h i s was viewed as an easy and e f f e c t i v e c o p i n g s t r a t e g y . By t a l k i n g , t h e y sought out i n f o r m a t i o n , v a l i d a t e d t h e i r a c t i o n s . v e n t e d t h e i r f r u s t r a t i o n s and, a t t h e same tim e , o f t e n r e c e i v e d some e m o t i o n a l s u p p o r t . The n a r r a t i v e s below summarize t h e i n f o r m a n t s e x p e r i e n c e s : I : [I] d i s c u s s e d i t w i t h the o t h e r semester i n s t r u c t o r . We spent l o t s of hours on t h e phone because she was t e a c h i n g at[name o f agency] a t t h e ti m e . I spent a l o t of time t a l k i n g i t over w i t h t h e department chairman and w i t h the s t u d e n t a f f a i r s c o o r d i n a t o r . . . . And f i n a l l y we d e c i d e d t h a t we needed t o go a c o n t r a c t r o u t e w i t h t h i s s t u d e n t and I s e t up a very s p e c i f i c contract. I n t h e p r e v i o u s t r a n s c r i p t , the i n f o r m a n t sought d i r e c t i o n , took d i r e c t a c t i o n and a l t e r e d h e r approach because "of t h e unique s i t u a t i o n o f t h e s t u d e n t . " Another i n f o r m a n t d i s c l o s e d : I:...But i t was very, very, f r u s t r a t i n g . I remember g o i n g home e v e r y n i g h t not knowing what t o do. R: And how d i d you d e a l w i t h t h a t when you d i d n ' t know what t o do? I : . . . I had l o t s of f r i e n d s but one i n p a r t i c u l a r t h a t who had a c t u a l l y been my i n s t r u c t o r as w e l l i n t h e di p l o m a program and h e r big thing was • , . 78 documenting. And j u s t documenting r e a l l y - - a c c u r a t e l y what went on and what t h e s c e n a r i o s were. And making sure t h a t I had a r u n n i n g t a b . . . so i n s t e a d o f j u s t documenting and not s a y i n g a n y t h i n g t o h e r , s a y i n g i t t o h e r and a s k i n g h e r t o s i g n t h a t she had r e a d what I had w r i t t e n so t h a t she c o u l d n ' t come back l a t e r and say t h a t she d i d n ' t have a c l u e what was g o i n g on. Anot h e r i n f o r m a n t i n d i c a t e d t h a t : I : I t was v e r y h e l p f u l j u s t t o t a l k t o t h e o t h e r p e o p l e . . I d i d not o n l y j u s t go t o t h e p e o p l e t h a t I r e s p e c t e d because t h a t ' s who I went t o f i r s t . So t h a t I m y s e l f c o u l d get some feedback from them f i r s t so t h a t I wouldn't f e e l so i n e f f e c t i v e as an i n s t r u c t o r i n t h e l a s t c l i n i c a l semester. So they c o u l d g i v e me some feedback and I c o u l d say. Okay maybe I'm on t h e r i g h t t r a c k h e r e . Maybe...I am d o i n g my j o b . . . . And th e n I went t o p e o p l e t h a t I r e s p e c t but I don't know so w e l l who have a . d i f f e r e n t p h i l o s o p h y o r d i f f e r e n t approach t o s t u d e n t s and have a d i f f e r e n t r e p u t a t i o n . . . w i t h t h e s t u d e n t s . . . b u t t h e message kept coming t h r o u g h d e s p i t e who I t a l k e d t o t h a t t h e r e ' s r e a l l y just no way t h a t t h i s p e r s o n can go t h r o u g h . I n h e r e n t i n t h i s q u o t a t i o n i s an element of s e e k i n g e m o t i o n a l s u p p o r t . By r e c e i v i n g v a l i d a t i o n f o r h e r d e c i s i o n from m u l t i p l e f a c u l t y members, t h i s n o v i c e e d u c a t o r o b t a i n e d c o n f i r m a t i o n t h a t she was i n d e e d "doing h e r j o b " and was "on t h e r i g h t t r a c k . " I n c o n t r a s t , an e x p e r i e n c e d e d u c a t o r sought out s p e c i f i c c o l l e a g u e s who were f a m i l i a r w i t h t h e e d u c a t i o n a l l e v e l of t h e s t u d e n t and had had s i m i l a r t y p e s o f e x p e r i e n c e s : R: What h e l p s you cope w i t h the f e e l i n g s t h a t a r i s e i n t h e s e s i t u a t i o n s ? I : [Long pause] W e l l , I guess th e s u p p o r t from c o l l e a g u e s . But you have to seek out s p e c i f i c c o l l e a g u e s who w i l l g i v e you s u p p o r t . I f I wanted su p p o r t I would go to individuals and say t h i s i s t h e s i t u a t i o n . T h i s i s the s t u d e n t ' s b e h a v i o u r s . T h i s i s what I'm d o i n g . Can you g i v e me some s u g g e s t i o n s ? So very s p e c i f i c people would be i d e n t i f i e d t o o f f e r s u p p o r t . I wouldn't expect o r want the whole f a c u l t y t o g i v e me s u p p o r t . I t would be s p e c i f i c p e o p l e whom I respect and know that they've been i n a s i m i l a r s i t u a t i o n and t h e r e f o r e can h e l p me o u t . They can comment on i t . C l e a r l y , t h i s q u o t a t i o n i n d i c a t e s t h a t t h e e x p e r i e n c e d n u r s e e d u c a t o r sought out s p e c i f i c r e s o u r c e s . I n t h i s case, they were i n d i v i d u a l s who had • e x p e r i e n c e a t t h e f i n a l c l i n i c a l semester and thus might be a b l e t o p r o v i d e h e r w i t h s p e c i f i c i n f o r m a t i o n . T h i s i n f o r m a n t used the term s u p p o r t i n r e f e r r i n g t o a c q u i r i n g s u g g e s t i o n s and feedback. T h i s e x p e r i e n c e d i n f o r m a n t d i d not appear t o r e q u i r e v a l i d a t i o n o r r e a s s u r a n c e t h a t she was d o i n g a good j o b . D i r e c t a c t i o n t o a l t e r one's approach. I n f o r m a n t s o f t e n a l t e r e d t h e i r approach t o c l i n i c a l e v a l u a t i o n on r e c e i v i n g s u g g e s t i o n s and feedback from o t h e r s . P r i o r e x p e r i e n c e w i t h h a v i n g t o i s s u e a f a i l i n g grade may i n i t s e l f be a m o t i v a t o r t o a l t e r one's approach. One i n f o r m a n t r e p o r t e d t h a t : I : The i n s t r u c t o r t h a t I was w o r k i n g w i t h t h e r e had t a u g h t [the f i n a l c l i n i c a l semester] a number of t i m e s and h e l p e d me a l o t a c t u a l l y i n how I • c o u l d b e t t e r f o c u s my time when I went t o t h e c l i n i c a l a r e a . I n a second i n t e r v i e w , t h e r e s e a r c h e r v a l i d a t e d t h a t an i n f o r m a n t had, i n f a c t , i n d i c a t e d t h a t h e r p r a c t i c e had changed because she p e r c e i v e d i n c r e a s e d r i s k . R:... [you a l s o s a i d t h a t ] concerns about i n c r e a s e d r i s k r e s u l t e d i n [you] p u t t i n g i n t o p r a c t i c e ways t o be v e r y t h r o u g h and c o n s c i e n t i o u s about s t u d e n t / i n s t r u c t o r and ward r e s p o n s i b i l i t i e s . I : R i g h t . R: So you a c t u a l l y i n c r e a s e d y o u r s u r v e i l l a n c e , I t h i n k t h a t was one o f t h e t h i n g s you s a i d ? I : Yes. R: Your m o n i t o r i n g o f t h e s t u d e n t because you were w o r r i e d about th e l e g a l i t i e s w i t h the c a r e t h a t s u r r o unded t h i s ? I : Yes. A n o t h e r i n f o r m a n t d i s c l o s e d t h a t : I : So t h o s e two l e f t me l i k e wow, [ s i t t i n g back i n c h a i r ] . You r e a l l y have t o get a system down and t h a t ' s a c t u a l l y what happened. I got a l o t more q u i c k o f f t h e mark about l e a r n i n g p l a n s as soon as I thought t h e r e was some u n e a s i n e s s . I guess i t ' s t h e way i n w h i c h you use t h e t o o l . I use i t as y o u ' r e d o i n g y o u ' r e t r y i n g r e a l l y h a r d . Here's a p l a n so t h a t you can be s u c c e s s f u l . And I t r y t o put i t i n t h a t l i g h t . But I a l s o do i t t o c o v e r my b u t t [ v o i c e low, as i f not w a n t i n g t o be h e a r d ] . T h i s n a r r a t i v e d e s c r i b e s a s i m i l a r v i e w p o i n t : I : ...So y o u ' r e a l i t t l e more s t r i n g e n t w i t h y o u r boolckeeping. You can sometimes sense when you a r e g o i n g t o have a d i f f i c u l t s t u d e n t . Someone who's g o i n g t o a p p e a l o r someone who's g o i n g t o f i g h t . Someone who doesn't have any i n s i g h t and ca n ' t ^ r e c o g n i z e t h a t t h e y ' r e not ready t o g r a d u a t e . They could not work as a graduate nurse with t h e i r current a b i l i t i e s . E m o t i o n - f o c u s e d S t r a t e g i e s I n f o r m a n t s used a number o f e m o t i o n - f o c u s e d s t r a t e g i e s d i r e c t e d toward l e s s e n i n g t h e i r p e r c e i v e d e m o t i o n a l d i s t r e s s . These i n c l u d e d : a) s e e k i n g e m o t i o n a l s u p p o r t ; b) v e n t i n g of anger; c) engaging i n p h y s i c a l a c t i v i t i e s ; d) r a t i o n a l i z a t i o n ; and e) d i s t a n c i n g . S e e k i n g e m o t i o n a l s u p p o r t . I n the next n a r r a t i v e , one i n f o r m a n t d i s c l o s e d how t a l k i n g h e l p e d h e r t o cope t h r o u g h t h e d e c i s i o n - m a k i n g p r o c e s s and a subsequent a p p e a l . I : I was coping through t h e d e c i s i o n and the a p p e a l and t h o s e k i n d s o f t h i n g s . And what was I d o i n g t o cope? T a l k , and t a l k , and t a l k . Some i n f o r m a n t s sought support from s i g n i f i c a n t o t h e r s : t h e i r husbands, f a m i l i e s , f r i e n d s , and n u r s i n g c o l l e a g u e s . The f o l l o w i n g n a r r a t i v e d e p i c t s one i n f o r m a n t ' s e x p e r i e n c e : I : So I d i d t a l k t o a l o t of p e o p l e . R: Any p e o p l e t h a t were not n u r s i n g - r e l a t e d p e o p l e n e c e s s a r i l y ? I : T r u t h f u l l y ? My b a b y s i t t e r [ l a u g h s ] . My b a b y s i t t e r i s my c o n f i d a n t . . . R: So a s i g n i f i c a n t o t h e r then? I : A s i g n i f i c a n t o t h e r . Yes, v e r y much so. And I speak t o h e r about i t not because I'm t r y i n g t o s e n s a t i o n a l i z e the s i t u a t i o n but because she can see how s t a b l e I am. She can see a p a r t o f me t h a t t h e y don't e v e r get t o see a t s c h o o l . So she can see j u s t how s t a b l e I am i n my own personal l i f e and can g i v e me feedback on whether I seem i r r a t i o n a l about t h i s s i t u a t i o n o r n o t . However, not a l l i n f o r m a n t s sought s u p p o r t o r feedback from s i g n i f i c a n t o t h e r s . A number o f i n f o r m a n t s r e a l i z e d t h a t f a m i l y members were o f t e n t o o removed from t h e c o n t e x t o f c l i n i c a l p r a c t i c e and the p r o f e s s i o n a l a s p e c t s o f p r a c t i c e t o be a b l e t o p r o v i d e e f f e c t i v e s u p p o r t . I n t h e s e c a s e s , t h e i n f o r m a n t s l o o k e d t o o t h e r c o l l e a g u e s f o r su p p o r t and a d v i c e . F o r example : I : . . . W e l l , I am m a r r i e d and I have a f a m i l y . P r o b a b l y my husband does know when I'm i n t h e t h r o e s o f a n x i e t y over a s t u d e n t , o r h a v i n g a problem w i t h a s t u d e n t , o r i f I'm h a v i n g a semester t h a t ' s not g o i n g w e l l . But he's t o t a l l y removed from t h e m e d i c a l o r p a r a m e d i c a l p r o f e s s i o n p e r i o d . . . I t h i n k as f a r as he's t h e r e f o r me and r e c o g n i z e s t h a t maybe I'm h a v i n g a d i f f i c u l t t i me i n t h e c l i n i c a l a r e a , and i f I'm p a r t i c u l a r l y busy he c e r t a i n l y has st e p p e d i n and has t a k e n o v e r some o f t h e f a m i l y r e s p o n s i b i l i t i e s , and....; R: So s u p p o r t i v e i n a d i f f e r e n t way? I : Yes. Yes, s u p p o r t i v e , not s u p p o r t i v e of me making the decision because he c e r t a i n l y c a n ' t h e l p me make t h e d e c i s i o n . That has t o come from me and i f I'm g o i n g t o get h e l p making t h a t k i n d o f d e c i s i o n I t h i n k i t has t o be from my c o l l e a g u e s more th a n p e o p l e e x t e r n a l t o the n u r s i n g program. V e n t i n g o f anger. Some anger i s caused by f r u s t r a t i o n . E x p r e s s i n g one's f r u s t r a t i o n s can reduce s t r e s s (Levy, Dignan & S h i r r e f f s , 1987). One i n f o r m a n t d i s c l o s e d t h a t she used h e r f a m i l y t o h e l p h e r cope w i t h some of the f e e l i n g s t h a t a r o s e out of t h e s i t u a t i o n . I : . . . I must say I do use [laughs] my f a m i l y o r my husband q u i t e a b i t f o r t h a t and I t h i n k i t ' s good because he's t h a t one s t e p removed and he can p r e s e n t I t h i n k more of t h e s t u d e n t ' s s i d e of t h e s t o r y . Because he's not i n t h e e v a l u a t o r r o l e and h asn't been i n t h a t r o l e as my p e e r s have been. And y e t when I'm b e i n g e m o t i o n a l o r b e i n g angry at t h i s s t u d e n t s a y i n g why won't t h i s s t u d e n t do t h i s ? I f e l t l i k e wringing her neck or whatever. I t ' s okay t o v e n t i l a t e t h a t and say t h a t , e x p r e s s y o u r emotions i n t h o s e terms t o him whereas you c o u l d n ' t o r I don't f e e l as c o m f o r t a b l e d o i n g t o a c o l l e a g u e . S i m i l a r l y , a n o t h e r i n f o r m a n t e x p r e s s e d t h i s v i e w : I : ...So I have t o say t h a t my f a m i l y members were p r o b a b l y they p r o v i d e d t h e most su p p o r t a t t h a t time f o r me and I would come home and a i r my [pause] perhaps f r u s t r a t i o n about not b e i n g a b l e t o ma]<;e enough p r o g r e s s w i t h i n the time l e f t . P h y s i c a l a c t i v i t y . Engaging i n p h y s i c a l a c t i v i t i e s t o get one's mind o f f a problem can - e f f e c t i v e l y reduce s t r e s s . E x e r c i s e seems t o d i s c h a r g e t h e t e n s i o n s we e x p e r i e n c e when we a r e under s t r e s s ( C o r b i n & L i n d s a y , 1985). I n t h i s s t u d y , a number of i n f o r m a n t s engaged i n p h y s i c a l a c t i v i t i e s t o reduce the s t r e s s they e x p e r i e n c e d . Thus, p h y s i c a l a c t i v i t i e s can be d e s c r i b e d as c o p i n g s t r a t e g i e s . I : E x e r c i s e . E x e r c i s e . R: E x e r c i s e ? I : Oh. I'm an e x e r c i s e f i e n d . I thinly; t h a t ' s so c r i t i c a l . When s t r e s s e d r e g a r d l e s s of what i t i s . E s p e c i a l l y worJcing w i t h s t u d e n t s . You need t o get away and so t o spealc blow out t h e c a r b o n . Get out t h e r e and wor]<: i t o u t . So t h a t you can come back r e f r e s h e d and l o o k a t i t from maybe a d i f f e r e n t a n g l e . Not t h a t e x e r c i s e i s g o i n g t o h e l p you do t h a t . But I f i n d i t r e a l l y h e l p f u l d e a l i n g w i t h s t r e s s . And i f you can b r i n g y o u r s t r e s s l e v e l down then, you can l o o k a t t h i n g s maybe from a d i f f e r e n t a n g l e . R a t i o n a l i z a t i o n . E m o t i o n - f o c u s e d c o p i n g p r o c e s s e s can be used t o m a i n t a i n hope and opt i m i s m . I n t h i s s t u d y , r a t i o n a l i z a t i o n was sometimes used i n t h i s manner. When some i n f o r m a n t s r a t i o n a l i z e d , t h e y r e f l e c t e d back on t h e e n c o u n t e r s and i d e n t i f i e d some p o s i t i v e outcomes. One i n f o r m a n t d i s c l o s e d : I : . . . I ' d never r e a l l y e n c o u n t e r e d t o t h i s degree [the magnitude of problems] w i t h o t h e r s t u d e n t s . . . so i t was good f o r me. D i s t a n c i n g . D i s t a n c i n g r e f e r s t o mechanisms by wh i c h t h e i n f o r m a n t s a t t e m p t e d t o s h i e l d themselves from p e r c e i v e d t h r e a t . I n f o r m a n t s made st a t e m e n t s l i k e " I s i t w o r t h i t ? " and " W e l l , can I not work f o r a whole semester?" One i n f o r m a n t d i s c l o s e d t h a t she used p r a y e r e f f e c t i v e l y t o keep h e r emotions i n check w h i l e a s t u d e n t v e n t e d h e r anger. I : . . I use p r a y e r and t h a t ' s one t h i n g t h a t r e a l l y h e l p e d me get h o l d because I l i t e r a l l y was j u s t p r a y i n g w h i l s t t h i s woman, I had t o g i v e h e r the o p p o r t u n i t y t o blow o f f steam...I was l i t e r a l l y s a y i n g l i t t l e p r a y e r s as she was b u i l d i n g t o a c r e s c e n d o w i t h some of t h e s e comments... Anot h e r i n f o r m a n t d i s c l o s e d t h a t : I : ... I was t h i n k i n g I am never going to teach i n t h i s semester again. R: Because of y o u r w i s h o r because you wouldn't be p l a c e d ? I : No! My w i s h . . I was a sessional i n s t r u c t o r . . So, I mean t o say here I was t h i n k i n g . W e l l , can I not work f o r a whole semester and have no money? Yes I c o u l d b u t , I mean on t h e o t h e r hand I d i d l i k e t e a c h i n g . . . a n d I was t h i n k i n g I want t o get a p o s i t i o n t h e r e [deep b r e a t h ] and t o get i t I have t o do t h a t [work.] I : W e l l I guess you think i s i t worth i t ? [ l a u g h s ] . There's a l o t o f o t h e r j o b s I c o u l d be d o i n g t h a t don't have t h i s amount of s t r e s s i n v o l v e d i n i t . And you t h i n k w e l l am I i n t h e r i g h t [ laughs] i t makes you second guess whether y o u ' r e you s h o u l d be i n t h i s l i n e of work. These q u o t a t i o n s p r o v i d e s u p p o r t f o r C a r p e n i t o ' s o b s e r v a t i o n s (1983) t h a t nurse e d u c a t o r s may d i s t a n c e themselves b o t h p h y s i c a l l y and e m o t i o n a l l y i n response t o s t u d e n t anger and h o s t i l i t y . L i k e w i s e , t h e s e n a r r a t i v e s g i v e a d d i t i o n a l support f o r t h e p o s i t i o n s of O'Connor (1978) and Symanski (1991) . They p o s t u l a t e t h a t t h e m u l t i p l e s t r e s s e s i n h e r e n t i n d e a l i n g w i t h . f a i l i n g s t u d e n t s may a c t u a l l y r e s u l t i n a l o s s of n u r s e e d u c a t o r s from c l i n i c a l t e a c h i n g . Immediate and Long-term E f f e c t s The outcomes of h a v i n g t o a s s i g n a f a i l i n g grade t o a s t u d e n t i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program were v a r i e d . Each s i t u a t i o n was i n d i v i d u a l i z e d , i n f l u e n c e d by t h e v a r i a b l e s w h i c h were unique t o t h a t p a r t i c u l a r s i t u a t i o n . I n f o r m a n t s used a v a r i e t y o f c o p i n g s t r a t e g i e s t o i n f l u e n c e the outcome. F e e l i n g s of s t r e s s and u n c e r t a i n t y were always p r e s e n t and, i n c e r t a i n c i r c u m s t a n c e s , i n f o r m a n t s f e l t i s o l a t e d . The e x p e r i e n c e l e f t a l a s t i n g i m p r e s s i o n w i t h t h e n u r s e e d u c a t o r . Nurse e d u c a t o r s c o u l d v i v i d l y r e c a l l c i r c u m s t a n c e s and e v e nts w h i c h o c c u r r e d d u r i n g t h i s p e r i o d of t i m e . The f o l l o w i n g n a r r a t i v e s d e s c r i b e the i n f o r m a n t s ' p e r c e p t i o n s o f how they had been a f f e c t e d . Immediate E f f e c t s The m a j o r i t y of i n f o r m a n t s d e s c r i b e d f e e l i n g r e l i e f . I : . . . I a c t u a l l y f e l t r e l i e f . W i t h a l l of them I f e l t r e l i e f because of p a t i e n t s a f e t y . . . i t ' s l i k e i t a l l t h r e e were, e s p e c i a l l y t h e f i r s t and t h i r d were p a t i e n t s a f e t y c o n c e r n s , ... [I] j u s t thought, thank God. R: And when i t ' s over? When you've a s s i g n e d the f a i l i n g grade, gone t h r o u g h g r i e v a n c e i f t h a t ' s what's r e q u i r e d and i t ' s over? I : I t ' s l i k e a weight has been l i f t e d o f f y o u r s h o u l d e r s . I : ...So i n t h e whole s c e n a r i o i t made i t e a s i e r f o r me t o d e a l w i t h the o t h e r two s t u d e n t s who • were weak c l i n i c a l l y and had a l o t of d i f f i c u l t i e s making d e c i s i o n s under p r e s s u r e . So i t made i t a l o t e a s i e r . One was so c l o s e t o f a i l i n g as w e l l and I had t o spend a l o t o f time w i t h him. So I was r e l i e v e d because I f e l t l i k e I had some t o o l s . Some s u c c e s s . Some e x p e r i e n c e t o draw from. I : ...those two e x p e r i e n c e s , t h o s e i n i t i a l e x p e r i e n c e s have r e a l l y put me on guard. In t he second i n t e r v i e w , when t h i s i n f o r m a n t was asked t o d e s c r i b e what she meant by b e i n g on guard she r e p l i e d : I : Okay. On guard. I t h i n k i t ' s as soon as t h e emotions s t a r t t o come out and you have t o i n i t i a t e a l e a r n i n g p l a n o r something l i k e t h a t t o be r e a l l y aware of what's g o i n g on and t o i n v o l v e o t h e r p e o p l e . Whereas n o r m a l l y i n t h e p a s t I wouldn't have. Now, I ' l l be much more ready. I:...you r e a l l y had t o get a system down and t h a t ' s a c t u a l l y what happened. I got a l o t more q u i c k o f f t h e mark about g e t t i n g l e a r n i n g p l a n s as soon as I thought t h e r e was some u n e a s i n e s s . . . . I : . . . I d e f i n i t e l y m o d i f i e d my approach w i t h t h e second one.... Long Term E f f e c t s I n t h e l o n g term , n u r s e e d u c a t o r s were q u i t e s i g n i f i c a n t l y a f f e c t e d by the e x p e r i e n c e of f a i l i n g a s t u d e n t . I : ( t h e e x p e r i e n c e ) ... I guess when I t h i n k about how c l e a r l y I can r e c a l l g i v e n t h e span of y e a r s t h a t have t r a n s p i r e d from t h a t t i m e . I t must have a f f e c t e d me q u i t e s i g n i f i c a n t l y . I do r e f l e c t on i t anytime anyone e l s e s h a r e s t h e i r e x p e r i e n c e about d o i n g a s i m i l a r t h i n g . • I : . . . W e l l , I c o n s t a n t l y t h i n k of t h o s e s i t u a t i o n s when I'm c o n f r o n t e d w i t h a n o t h e r s t u d e n t t h a t has a s i m i l a r problem. I : ...when she d i d come back i n t o the program and do so w e l l . That r e a l l y , I t h i n k , made me f e e l more c o n f i d e n t i n f a i l i n g s t u d e n t s . R: That t h e r e were some p o s i t i v e s t h e r e ? I : That t h e r e was p o s i t i v e a s p e c t s , t h a t maybe my judgements weren't a l l bad. Because I t h i n k o f t e n when you a r e f a i l i n g t h i s s t u d e n t i n the f i n a l semester you do f e e l t h a t h e r e ' s t h i s s t u d e n t . . she can see t h e f i n i s h l i n e , and y o u ' r e s a y i n g no, t h a t y o u ' r e g o i n g t o t r i p them up one hundred y a r d s s h o r t of t h e i r g o a l . Summing Up The predominant o v e r r i d i n g theme w h i c h emerged from t h e d a t a was s t r e s s . Two o t h e r i n t e r r e l a t e d themes embedded i n t h e i n f o r m a n t s ' d e s c r i p t i o n s of t h e i r e x p e r i e n c e s were u n c e r t a i n t y and i s o l a t i o n . Nurse e d u c a t o r s o f t e n f e l t u n s u p p o r t e d i n t h e i r r o l e . These themes a r e i n t e r r e l a t e d and i n themselves can be i d e n t i f i e d as s t r e s s o r s . The n u r s e e d u c a t o r s ' p e r c e p t i o n s of t h e i r e x p e r i e n c e s were i n f l u e n c e d by t h e i r s u b j e c t i v e a p p r a i s a l of t h e v a r i a b l e s p r e s e n t i n each s i t u a t i o n and t h e degree of harm, t h r e a t , o r c h a l l e n g e they p e r c e i v e d . V a r i a b l e s i n c l u d e d such c h a r a c t e r i s t i c s as th e l i f e e x p e r i e n c e , commitment, v a l u e s , b e l i e f s , and h e a l t h and energy of t h e nu r s e e d u c a t o r . A d d i t i o n a l f a c t o r s o f t e n i d e n t i f i e d as e x t e r n a l s t r e s s o r s can be b r o a d l y c l a s s i f i e d i n t o s t u d e n t v a r i a b l e s and e n v i r o n m e n t a l v a r i a b l e s . By a s s e s s i n g s t u d e n t and e n v i r o n m e n t a l v a r i a b l e s , t h e n u r s e e d u c a t o r s d e t e r m i n e d whether t h e e x p e r i e n c e s and t h e i r consequences were i r r e l e v a n t , p o s i t i v e , o r s t r e s s f u l . Once a c o g n i t i v e a p p r a i s a l was made and t h e degree o f t h r e a t d e t e r m i n e d , the e d u c a t o r s made judgements as t o what might o r c o u l d be done. I n d o i n g t h i s , t he i n f o r m a n t s examined t h e i r c o p i n g r e s o u r c e s and t h e s t r a t e g i e s a v a i l a b l e t o them. T h i s i n c l u d e d an assessment o f t h e s i t u a t i o n a l s u p p o r t a v a i l a b l e t o them from p e e r s and a d m i n i s t r a t o r s . I n o r d e r t o d e a l w i t h t h e i r s t r e s s f u l e x p e r i e n c e s , t h e n u r s e e d u c a t o r s used a v a r i e t y o f c o p i n g s t r a t e g i e s . These c o n s i s t e d of p r o b l e m - f o c u s e d and e m o t i o n - f o c u s e d a c t i o n s d i r e c t e d toward problem- s o l v i n g , a l o n g w i t h e f f o r t s t o c o n t r o l t h e e m o t i o n a l r e a c t i o n s a r i s i n g from the s i t u a t i o n . P r o b l e m - f o c u s e d c o p i n g s t r a t e g i e s i n c l u d e d i n f o r m a t i o n s e e k i n g and t h e t a k i n g o f d i r e c t a c t i o n t o a l t e r one's approach. E m o t i o n - f o c u s e d responses i n c l u d e d s e e k i n g e m o t i o n a l s u p p o r t , v e n t i n g of anger, p h y s i c a l a c t i v i t y , r a t i o n a l i z a t i o n , and d i s t a n c i n g . I n a d d i t i o n , i n f o r m a n t s i d e n t i f i e d immediate and l o n g - t e r m e f f e c t s of l i v i n g t h r o u g h t h e i r e x p e r i e n c e s . Many o f the e f f e c t s t h e y i d e n t i f i e d had p o s i t i v e a s p e c t s such as f e e l i n g a sense of r e l i e f as w e l l as c o n f i d e n c e i n t h e i r a b i l i t y t o h a n d l e s i m i l a r s i t u a t i o n s i n the f u t u r e . Immediate e f f e c t s d e s c r i b e d - by i n f o r m a n t s i n c l u d e d b e i n g more on guard i n s i t u a t i o n s w h i c h might r e q u i r e e a r l y i n t e r v e n t i o n , as w e l l as m o d i f y i n g and r e f i n i n g t h e i r approaches t o c l i n i c a l e v a l u a t i o n . I n t h e l o n g term, f a c u l t y members were q u i t e s i g n i f i c a n t l y a f f e c t e d by t h e i r e x p e r i e n c e s . These s i t u a t i o n s p r o v i d e d an e x p e r i e n t i a l base f o r t h e nu r s e e d u c a t o r o r f o r h e r c o l l e a g u e s who were w o r k i n g w i t h o t h e r s t u d e n t s h a v i n g s i m i l a r problems. A number of i n f o r m a n t s d e s c r i b e d t h e e x p e r i e n c e as c o n f i d e n c e - b u i l d i n g . The e x p e r i e n c e s e r v e d t o r e i n f o r c e t h a t " t h e i r judgements weren't a l l bad." Some i n f o r m a n t s d e s c r i b e d f e e l i n g more c o n f i d e n t i n t h e i r a b i l i t i e s t o work w i t h s t u d e n t s who were not a b l e t o meet the semester o b j e c t i v e s w h i l e o t h e r s e x p r e s s e d a d e s i r e t o d i s t a n c e themselves from th e s i t u a t i o n by never t e a c h i n g i n t h a t p a r t i c u l a r semester a g a i n o r l e a v i n g t e a c h i n g a l t o g e t h e r . The f o l l o w i n g framework ( F i g u r e 1) g r a p h i c a l l y r e p r e s e n t s n u r s e e d u c a t o r s ' e x p e r i e n c e s w i t h a s s i g n i n g a f a i l i n g grade. VARIABLES INFLUENCING APPRAISAL Nurse Educator 1. Life Expartenco 2. Commitment 3. Values and Beliefs 4. Health A Energy \ SUPPORT / \ / \ 7 \ / A / \ / \ < ^ Cognitive A Appraisal student 1. Insight 2. Expectations 3. Extenuating Circumstances Environment 1. Clinical Agency 2. Educational Institution Throat ^ O R ^ "Challenge ^ COPING S T R E S S Figure 1. Adaptation of Lazarus's Framework to Depict Nurse Educators' Experiences with Assigning a F a i l i n g Grade. Coping Strategies Problem-focused 1. Information Seeking 2. Direct Action to Alter One's Approach Emotion-focused 1. Seeking Emotional Support 2. Venting of Anger 3. Engaging In Physical Activities 4. Rationalization 5. Distancing / IMMEDIATE EFFECTS \ LONG-TERM EFFECTS CHAPTER FIVE Sliinmary, C o n c l u s i o n s , and I m p l i c a t i o n s Summary The purpose of t h i s s t u d y was t o e x p l o r e the impact on n u r s e e d u c a t o r s of a s s i g n i n g a f a i l i n g grade t o s t u d e n t s e n r o l e d i n the f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program. U s i n g p h e n o m e n o l o g i c a l methodology, and L a z a r u s ' s p r o c e s s - o r i e n t e d t h e o r e t i c a l framework, n i n e i n f o r m a n t s c u r r e n t l y employed i n B r i t i s h Columbia Lower M a i n l a n d d i p l o m a n u r s i n g programs were i n t e r v i e w e d and a u d i o - t a p e d . From the i n f o r m a n t s ' a c c o u n t s d a t a a n a l y s i s sought t o i d e n t i f y t h e forms and t y p e s o f phenomena and t o d e s c r i b e t h e essence of t h e e x p e r i e n c e . The e d u c a t i o n a l p r e p a r a t i o n o f t h e i n f o r m a n t s was d i v e r s e . They were a l l female and had one t o o v e r t e n y e a r s o f t e a c h i n g e x p e r i e n c e . Three i n f o r m a n t s had i s s u e d f a i l i n g grades t o o n l y one s t u d e n t w h i l e two had a s s i g n e d f a i l i n g grades t o more than s i x s t u d e n t s . The f i n d i n g s o f the s t u d y i l l u s t r a t e t h a t a s s i g n i n g a f a i l i n g grade t o a n u r s i n g s t u d e n t i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program was a s t r e s s f u l event f o r n urse e d u c a t o r s . The prominent o v e r r i d i n g concept w h i c h emerged from the d a t a was s t r e s s . S t r e s s was d e f i n e d as t h e " r e l a t i o n s h i p between the p e r s o n and t h e environment t h a t i s a p p r a i s e d by the p e r s o n as t a x i n g o r e x c e e d i n g h i s o r h e r r e s o u r c e s and e n d a n g e r i n g h i s o r h e r w e l l - b e i n g " (Lazarus & Folkman, 1984b, p. 19). W h i l e t h e s o u r c e s o f s t r e s s v a r i e d , b o t h n o v i c e and e x p e r i e n c e d e d u c a t o r s d e s c r i b e d f e e l i n g some degree of s t r e s s . Two o t h e r i n t e r r e l a t e d themes, u n c e r t a i n t y and i s o l a t i o n , were a l s o embedded i n t h e i n f o r m a n t s ' d e s c r i p t i o n s of t h e i r e x p e r i e n c e . U n c e r t a i n t y was c o n c e p t u a l i z e d as the s e l f - d o u b t e x p e r i e n c e d by n u r s e e d u c a t o r s as t o whether t h e y were d o i n g the r i g h t t h i n g . I s o l a t i o n d e s c r i b e d t h e p e r c e p t i o n s t h e n u r s e e d u c a t o r s e x p r e s s e d about u l t i m a t e l y b e i n g s o l e l y r e s p o n s i b l e f o r t h e i r d e c i s i o n s . O f t e n they i n d i c a t e d t h e y f e l t a l a c k of s u p p o r t from c o l l e a g u e s and a d m i n i s t r a t o r s . I n a d d i t i o n , i n f o r m a n t s d e s c r i b e d a t t i m e s f e e l i n g p h y s i c a l l y i s o l a t e d i n t h e c l i n i c a l s e t t i n g , and d i s t a n c e d from c o l l e a g u e s who c o u l d a c t as a s o u r c e of s u p p o r t . These two themes were i n t e r r e l a t e d i n the i n f o r m a n t s ' a c c o u n t s and were, i n t h e m s e l v e s , s t r e s s o r s . The uniqueness and c o m p l e x i t y of each s i t u a t i o n was i n f l u e n c e d by m u l t i p l e v a r i a b l e s and t h e i n t e r r e l a t i o n s h i p among them. The v a r i a b l e s i n f l u e n c e d t h e way t h e n u r s e e d u c a t o r a p p r a i s e d e v e n t s . U n c e r t a i n t y as t o the m u l t i p l e ways t h a t v a r i a b l e s c o u l d be i n t e r p r e t e d l e d t o a m b i g u i t y and thus c o n t r i b u t e d t o n u r s e e d u c a t o r s a p p r a i s i n g t h e s i t u a t i o n as t h r e a t e n i n g o r s t r e s s f u l . Based on t h e i r a p p r a i s a l o f t h e v a r i a b l e s , the i n f o r m a n t s examined t h e i r r e s o u r c e s and made judgements as t o what might o r c o u l d be done. The e d u c a t o r s used a v a r i e t y of c o p i n g s t r a t e g i e s c o n s i s t i n g of a c t i o n s d i r e c t e d toward p r o b l e m - s o l v i n g a l o n g w i t h e f f o r t s t o c o n t r o l t h e e m o t i o n a l r e a c t i o n s a r i s i n g from th e s i t u a t i o n . These i n c l u d e d i n f o r m a t i o n s e e k i n g , d i r e c t a c t i o n t o a l t e r one's approach, s e e k i n g e m o t i o n a l s u p p o r t , v e n t i n g of anger, p h y s i c a l a c t i v i t y , r a t i o n a l i z a t i o n , and d i s t a n c i n g . I n a d d i t i o n , e d u c a t o r s i d e n t i f i e d immediate and l o n g - t e r m e f f e c t s of l i v i n g t h r o u g h t h e i r e x p e r i e n c e . Many of t h e e f f e c t s t h e y i d e n t i f i e d had p o s i t i v e a s p e c t s . Immediate e f f e c t s d e s c r i b e d by i n f o r m a n t s i n c l u d e d b e i n g more on guard, as w e l l as m o d i f y i n g and r e f i n i n g t h e i r approach t o c l i n i c a l e v a l u a t i o n . The l o n g - t e r m outcomes i n d i c a t e d t h a t f a c u l t y members were ' q u i t e s i g n i f i c a n t l y a f f e c t e d by t h e i r e x p e r i e n c e s . These s i t u a t i o n s s e r v e d as a p o i n t o f r e f e r e n c e f o r nur s e e d u c a t o r s when f a c e d w i t h o t h e r s t u d e n t s h a v i n g s i m i l a r problems. A number of i n f o r m a n t s d e s c r i b e d t h e e x p e r i e n c e as c o n f i d e n c e - b u i l d i n g , s e r v i n g t o r e i n f o r c e t h a t " t h e i r judgements weren't a l l bad." Some i n f o r m a n t s d e s c r i b e d f e e l i n g more c o n f i d e n t i n t h e i r a b i l i t i e s t o work w i t h s t u d e n t s who were h a v i n g d i f f i c u l t i e s m e e t i n g the semester o b j e c t i v e s and i n u l t i m a t e l y h a v i n g t o a s s i g n a f a i l i n g grade. However, not a l l i n f o r m a n t s f e l t t h i s way. One i n f o r m a n t r e c a l l e d not e v e r w a n t i n g t o t e a c h i n t h e f i n a l semester a g a i n , w h i l e a n o t h e r i n f o r m a n t d i s c l o s e d t h o u g h t s of l o o k i n g f o r o t h e r j o b p r o s p e c t s w i t h l e s s s t r e s s and more j o b s a t i s f a c t i o n . C o n c l u s i o n s Three major c o n c l u s i o n s can be i d e n t i f i e d from t h e f i n d i n g s . F i r s t , a s s i g n i n g a f a i l i n g grade t o a s t u d e n t i s a s t r e s s f u l e v e nt. Second, nurse e d u c a t o r s e x p r e s s e d a need f o r e m o t i o n a l s u p p o r t from t h e i r p e e r s . T h i r d , program a d m i n i s t r a t o r s c o u l d and s h o u l d be s u p p o r t i v e t o n u r s e e d u c a t o r s i n two a r e a s : acknowledgement of the s i t u a t i o n and r e a s s u r a n c e and c o n s i s t e n t a d m i n i s t r a t i o n of e d u c a t i o n a l p o l i c i e s . I m p l i c a t i o n s f o r N u r s i n g N u r s i n g E d u c a t i o n Graduate programs p r e p a r i n g nurse e d u c a t o r s may b e n e f i t from the f i n d i n g s of t h i s s t u d y w h i c h enhance the u n d e r s t a n d i n g of s t r e s s and i t s impact on t h e n u r s e e d u c a t o r and n u r s i n g e d u c a t i o n as a whole. T h i s i n t u r n may p r o v i d e t h e b a s i s f o r the development of c u r r i c u l u m c o n t e n t r e l a t e d t o the t e a c h i n g / e v a l u a t i o n p r o c e s s . Thus, a c t i o n s can be d i r e c t e d toward m i n i m i z i n g the s t r e s s n u r s e e d u c a t o r s e x p e r i e n c e and d e c r e a s i n g t h e p o t e n t i a l o f t h e i r l e a v i n g c l i n i c a l t e a c h i n g f o r l e s s s t r e s s f u l and s e e m i n g l y more r e w a r d i n g p o s i t i o n s . F u r thermore, a d m i n i s t r a t o r s of n u r s i n g e d u c a t i o n programs need t o examine th e e f f e c t s of p o l i c i e s and program i n i t i a t i v e s and t h e i r i m p l e m e n t a t i o n on f a c u l t y , and how t h e s e may u l t i m a t e l y have an impact on t h e q u a l i t y of t h e g r a d u a t e . Resources s h o u l d be made a v a i l a b l e t o p r o v i d e n u r s e e d u c a t o r s w i t h adequate su p p o r t and a s s i s t a n c e t o d e a l w i t h the i n c r e a s e d w o r k l o a d e x p e r i e n c e d when w o r k i n g w i t h f a i l i n g s t u d e n t s . D e b r i e f i n g o p p o r t u n i t i e s s h o u l d be p r o v i d e d . E d u c a t i o n a l a d m i n i s t r a t o r s need t o acknowledge t h a t t h e y r e c o g n i z e t h e s t r e s s e s i n h e r e n t i n t h e s i t u a t i o n and a p p r e c i a t e t h e c o n s i d e r a b l e e f f o r t t h a t f a c u l t y members expend d u r i n g t h e p r o c e s s . • E d u c a t i o n a l a d m i n i s t r a t o r s of n u r s i n g programs may w i s h t o e x p l o r e t h e p o t e n t i a l b e n e f i t f a c u l t y mentors may p r o v i d e , p a r t i c u l a r l y t o n o v i c e f a c u l t y members. These mentors may be a b l e t o p r o v i d e t h e much needed s u p p o r t , v a l i d a t i o n , and feedback many n u r s i n g f a c u l t y seem t o l a c k when w o r k i n g w i t h f a i l i n g s t u d e n t s . N u r s i n g R e s e a r c h , There i s a need f o r f u r t h e r r e s e a r c h i n t h i s a r e a . U s i n g a p h e n o m e n o l o g i c a l p e r s p e c t i v e , i t may be u s e f u l t o examine whether n u r s e e d u c a t o r s i n b a c c a l a u r e a t e programs share s i m i l a r o r c o n t r a s t i n g p e r c e p t i o n s of t h e i r e x p e r i e n c e . A d d i t i o n a l i n s i g h t s might be g a i n e d by e xamining t h e r e l a t i o n s h i p o f the v a r i a b l e s and the e f f e c t i v e n e s s o f c o p i n g r e s p o n s e s , and t h e n u r s e e d u c a t o r ' s e x p e r i e n c e l e v e l . I n a d d i t i o n , t h e concept of s t r e s s and t h e i n t e r r e l a t i o n s h i p s o f u n c e r t a i n t y and i s o l a t i o n w a r r a n t f u r t h e r i n - d e p t h a n a l y s i s . L a s t l y , r e s e a r c h i s needed t o c o n f i r m whether o r not n u r s e e d u c a t o r s do, i n f a c t , l e a v e c l i n i c a l t e a c h i n g because of t h e s e e x p e r i e n c e s and, i f so, what i s the impact on n u r s i n g e d u c a t i o n . T h i s t h e s i s has p r o v i d e d a p h e n o m e n o l o g i c a l d e s c r i p t i o n of the p e r c e p t i o n s and f e e l i n g s e x p e r i e n c e d by n u r s e e d u c a t o r s who a s s i g n f a i l i n g grades t o : s t u d e n t s e n r o l e d i n t h e f i n a l c l i n i c a l semester of a d i p l o m a n u r s i n g program. The f i n d i n g s have a t t e m p t e d t o e n c a p s u l a t e the essence of t h e e x p e r i e n c e as v i e w e d t h r o u g h t h e eyes of t h e i n f o r m a n t s . R e f e r e n c e s Anderson, D. M., & Saxon, J . (1968) . Performance e v a l u a t i o n of n u r s i n g s t u d e n t s . N u r s i n g O u t l o o k , 16 (5 ) , 56-58. Batey, M. V. (1969). The two n o r m a t i v e w o r l d s of t h e u n i v e r s i t y n u r s i n g f a c u l t y . N u r s i n g Forum, 8, ( 1 ) , . 5-17. Brozenec, S., M a r s h a l l , J . R., Thomas, C , & Walsh, M. (1987). E v a l u a t i n g b o r d e r l i n e s t u d e n t s . J o u r n a l o f N u r s i n g E d u c a t i o n , 26, ( 1 ) , 42-44. C a r p e n i t o , L. J . (1983). The f a i l i n g o r u n s a t i s f a c t o r y s t u d e n t . Nurse E d u c a t o r , 8 ( 4 ) , 32-33. C o r b i n , C , & L i n d s a y , R. (1985) . Concepts o f p h y s i c a l f i t n e s s . Iowa : Brown. D i c k , M. J . (1986). Burnout i n n u r s i n g f a c u l t y : R e l a t i o n s h i p s w i t h management s t y l e , collégial su p p o r t , and w o r k l o a d . J o u r n a l of P r o f e s s i o n a l N u r s i n g , 2 ( 4 ) , 252-260. F a i n , J . A. (1987) . P e r c e i v e d r o l e c o n f l i c t , r o l e a m b i g u i t y , and j o b s a t i s f a c t i o n among nu r s e e d u c a t o r s . J o u r n a l of N u r s i n g E d u c a t i o n , 26, ( 6 ) , 233-238. F i e l d , P. A., Sc Morse, J . M. (1985). N u r s i n g r e s e a r c h : The a p p l i c a t i o n of q u a l i t a t i v e approaches. R o c k v i l l e , MD.: Aspen. Fong, C. M. (1990) . R o l e o v e r l o a d , s o c i a l s u p p port, and burnout among n u r s i n g e d u c a t o r s . J o u r n a l o f N u r s i n g E d u c a t i o n , 29, ( 3 ) , 102-108. G o c l o w s k i , J . (1985) . L e g a l i m p l i c a t i o n s of academic d i s m i s s a l and e d u c a t i o n a l m a l p r a c t i c e f o r n u r s i n g f a c u l t y . J o u r n a l of N u r s i n g E d u c a t i o n , 24, ( 3 ) , 104-108. Goldenberg, D., & W a d d e l l , J . (1990). O c c u p a t i o n a l s t r e s s and c o p i n g s t r a t e g i e s among female b a c c a l a u r e a t e n u r s i n g f a c u l t y . J o u r n a l o f Advanced N u r s i n g , 15, 531-543. Helms, L. B., & W e i l e r , K. (1991). S u i n g programs of n u r s i n g e d u c a t i o n . N u r s i n g O u t l o o k , 39, ( 4 ) , 156-161. K e l l y , R. L. (1973). E v a l u a t i o n i s more th a n measurement. American J o u r n a l of N u r s i n g , 73, ( 1 ) , 114-116. Kramer, M. (1966) . Some e f f e c t s o f exposure t o employing s u c c e s s i n h o s p i t a l n u r s i n g . N u r s i n g Research, 19, ( 5 ) , 428-434. Lankshear, A. (1990). F a i l u r e t o f a i l : The t e a c h e r ' s dilemma. N u r s i n g S t a n d a r d , 4, (20), 35-37. L a z a r u s , R. S. (1966). P h y s i o l o g i c a l s t r e s s and t h e c o p i n g p r o c e s s . New York: M c G r a w - H i l l . L a z a r u s , R. S., & Folkman, S. (1984a). Coping and a d a p t a t i o n . I n W.D. G e n t r y (Ed.), The handbook of b e h a v i o r a l m e d i c i n e (pp.282-325). New York: G u i l f o r d . L a z a r u s , R. S., & Folkman, S. (1984b). S t r e s s , a p p r a i s a l , and c o p i n g . New York: S p r i n g e r P u b l i s h i n g . L a z a r u s R. S., & Folkman, S. (1991). The concept o f c o p i n g . I n A. Monat & R. L a z a r u s ( E d s . ) , S t r e s s and c o p i n g : An a n t h o l o g y (pp. 189-227). New York: Columbia U n i v e r s i t y P r e s s . L a z a r u s , R., & L a u n i e r , F. (1978). S t r e s s - r e l a t e d t r a n s a c t i o n s between p e r s o n and environment. I n L. P e r v i n & M. Lewis ( E d s . ) , P e r s p e c t i v e s i n i n t e r n a t i o n a l p s y c h o l o g y (pp. 2 87-327). New York: Plenum P u b l i s h i n g . L e i n i n g e r , M. M. (1985). Ethnography and e t h n o n u r s i n g : Models and modes of q u a l i t a t i v e d a t a a n a l y s i s . I n M. M. L e i n i n g e r (Ed.), Q u a l i t a t i v e r e s e a r c h methods i n n u r s i n g , (pp.33-69). New York: Grune & S t r a t t o n I n c . L e n h a r t , R. C. (1980). F a c u l t y burnout--and some reasons why. (EDITORIAL) N u r s i n g O u t l o o k , 28 ( 7 ) , 424-425. L e s s n e r , M. W. (1990). A v o i d i n g s t u d e n t - f a c u l t y l i t i g a t i o n . Nurse E d u c a t o r , 15 ( 6 ) , 29-32. Levy, M. R., Dignan, M., & S h i r r e f f s , J . H. (1987). L i f e and h e a l t h . New York: Random House. M a r r i n e r , A., & C r a i g i e , D. (1977). Job s a t i s f a c t i o n and m o b i l i t y of n u r s i n g e d u c a t o r s . N u r s i n g Research, 26, ( 5 ) , 349-360. M u n h a l l , P. L., & O i l e r , C. J . (1986). N u r s i n g r e s e a r c h : A q u a l i t a t i v e p e r s p e c t i v e . C o n n e c t i c u t : A p p l e t o n - C e n t u r y - C r o f t s . O'Connor, A. B. (1978). Sources of c o n f l i c t f o r f a c u l t y members. J o u r n a l of N u r s i n g E d u c a t i o n , 17, (5) , 35-38. Orchard, C. (1992). F a c t o r s t h a t i n t e r f e r e w i t h c l i n i c a l judgement o f s t u d e n t s ' performance. J o u r n a l of N u r s i n g E d u c a t i o n , 31, ( 7 ) , 309-313. P o l l o k , C. S., P o t e e t , G. W. (1983). D i m i n i s h i n g . f a c u l t y l i a b i l i t y . Nurse E d u c a t o r , 8. ( 1 ) , 31-34 Ray, G. J . (1984). Burnout; p o t e n t i a l p r o blem f o r n u r s i n g f a c u l t y . N u r s i n g and H e a l t h Care, 5, ( 4 ) , 218-221. S c h u l e r , R. S. (1975). R o l e p e r c e p t i o n s , s a t i s f a c t i o n , and performance; a p a r t i a l r e c o n c i l i a t i o n . J o u r n a l of A p p l i e d P s y c h o l o g y , 60, ( 6 ) , 683-687. S c h u l e r , R. S., A l d a g , R. J . , & B r i e f , A. B. (1977). R o l e c o n f l i c t and a m b i g u i t y ; a s c a l e a n a l y s i s . O r g a n i z a t i o n a l B e h a v i o r and Human Performance, 20, 111-128. S p i e g e l b e r g , H. (1960). The ph e n o m e n o l o g i c a l movement: A h i s t o r i c a l i n t r o d u c t i o n : V o l . 2. The Hague: M a r t i n u s N i j h o f f . Spink, L. M. (1983). Due p r o c e s s i n academic d i s m i s s a l s . J o u r n a l of N u r s i n g E d u c a t i o n , 22, ( 7 ) , 305-306. Symanski, M. E. (1991). Reducing t h e e f f e c t o f f a c u l t y d e m o r a l i z a t i o n when f a i l i n g s t u d e n t s . Nurse E d u c a t o r , 16, ( 3 ) , 18-22. T u r k e t t , S. (1987). L e t ' s t a k e the " i " out o f f a i l u r e . J o u r n a l o f N u r s i n g E d u c a t i o n , 26, ( 6 ) , 246-247. Welborn, P., & Thompson, D. (1982). S t r a t e g i e s f o r d e a l i n g w i t h s t u d e n t s whose c l i n i c a l perfomance i s u n s a t i s f a c t o r y . J o u r n a l o f N u r s i n g E d u c a t i o n , 21, (5 ) , 26-30. W i l l i a m s o n , J . A. (1972). The c o n f l i c t - p r o d u c i n g r o l e of t h e p r o f e s s i o n a l s o c i a l i z e d n u r s e - f a c u l t y member. N u r s i n g Forum, 11, ( 4 ) , 357-366. Wood, V. (1971). The b o r d e r l i n e s t u d e n t n u r s e . N u r s i n g Papers, 15, (26), 15-26. Appendix A E x p l a n a t o r y L e t t e r f o r Agency Consent T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A School of Nursing T. 206-2211 Wesbrook Mall Vancouver, B.C. Canada V6T 2B5 Fax: (604) 822-7466 Dear My name i s Susan Greathouse. I am a nurse educator currently enroled i n graduate studies i n nursing at the University of B r i t i s h Coltimbia. My master's thesis e n t i t l e d The Impact of Assigning a F a i l i n g Grade to a Student i n the F i n a l C l i n i c a l Semester i s directed toward describing t h i s experience from the perspective of college nurse educators. It has been my observation that f a i l u r e to complete the f i n a l c l i n i c a l semester of a nursing program often results i n student responses d i f f e r e n t from and more exaggerated than c l i n i c a l f a i l u r e s i n e a r l i e r semesters. These situations which are often coupled with highly emotionally charged student responses, may have a major and l a s t i n g impact on nurse educators. The lack of researched-based data on th i s topic has lead to the development of th i s study. Being aware of the feelings and reactions that may res u l t from such situations may as s i s t nurse educators to cope with t h i s aspect of c l i n i c a l evaluation more e f f e c t i v e l y . My purpose i n writing to you i s two f o l d : (1) to request consent from you to discuss the study with interested faculty members and (2) to request an opportunity to meet with your instructors to explain the study. I welcome the opportunity to meet and present itry proposal and respond to any questions you or your faculty may have. It i s my intention to interview nurse educators who have assigned a f a i l i n g grade to at least one nursing student i n the f i n a l c l i n i c a l semester. Faculty who agree to p a r t i c i p a t e i n th i s study would require a series of two or perhaps three one- hour unstructured audio-taped interviews. In addition, each pa r t i c i p a n t w i l l be asked to answer a few demographic questions. A l l information obtained i s co n f i d e n t i a l . The name of the agency, student(s) or faculty member w i l l not be revealed. An abstract w i l l be available to you and to any interested faculty member on request once the study i s complete. For purposes of the University of B r i t i s h Columbia e t h i c a l review committee, written evidence of agency consent i s required for approval of the study. Please fi n d enclosed the agency consent form. Please contact me to arrange an appointment. My home phone number i s Thank you for your cooperation. Sincerely Susan E. Greathouse, RN, BN Thesis chair: Dr. Marilyn D. Willman I l l A ppendix B Agency Consent Form I, the undersigned, give permission to Susan Greathouse to meet with faculty regarding p a r t i c i p a t i o n i n her study e n t i t l e d The Impact of Assigning a F a i l i n g Grade to a Student i n the F i n a l C l i n i c a l Semester. Signature of Department Head: Agency: Signature of Researcher: Date: Thesis Chair: Dr. Marilyn D. Willman Appendix C L e t t e r t o I n f o r m a n t s T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A School of Nursing T. 206-2211 Wesbrook Mall Vancouver, B.C. Canada V6T 2B5 Fax: (604) 822-7466 Dear Nursing Colleague: My name i s Susan Greathouse. I am a nurse educator currently enroled i n graduate studies i n nursing at the University of B r i t i s h Columbia. My master's thesis e n t i t l e d The Impact of Assigning a F a i l i n g Grade to a Student i n the F i n a l C l i n i c a l Semester i s directed toward describing t h i s experience from the perspective of college nurse educators. It has been m/ observation that f a i l u r e to complete the f i n a l c l i n i c a l semester of a nursing program r e s u l t s i n student responses d i f f e r e n t from and more exaggerated than c l i n i c a l f a i l u r e s i n e a r l i e r semesters. These situations, which are often coupled with highly emotionally charged student responses, may .have a major and l a s t i n g impact on nurse educators. The lack of researched-based data on th i s topic has lead to the development of t h i s study. Being aware of the feelings and reactions that may resu l t from such situations may a s s i s t nurse educators to cope with t h i s aspect of c l i n i c a l evaluation more e f f e c t i v e l y . I am seeking your p a r t i c i p a t i o n i n th i s study i f you have had to f a i l one or more students i n the f i n a l c l i n i c a l semester. Your involvement i n thi s study w i l l include sharing your experiences i n a series of two or perhaps three one-hour unstructured audio-taped interviews. These interviews w i l l be • conducted at a convenient time for you and i n a mutually agreed upon locat i o n . In addition, you w i l l be asked to answer a few demographic questions. A l l information obtained w i l l remain c o n f i d e n t i a l . The name of the agency, student(s) or f a c u l t y member w i l l not be revealed. Upon completion of the study a l l audio-tapes and w r i t t e n t r a n s c r i p t s of i n t e r v i e w s w i l l be destroyed. You are under no o b l i g a t i o n to p a r t i c i p a t e i n t h i s study and r e f u s a l to do so w i l l i n no way a f f e c t your teaching p o s i t i o n . You may withdraw from the study at any time or refuse to answer any questions. I f you are i n t e r e s t e d i n p a r t i c i p a t i n g i n t h i s study, or need more inf o r m a t i o n , please contact me at S i n c e r e l y , Susan Greathouse, RN, BN Thesis c h a i r : Dr. M a r i l y n D. Willman Appendix D S u b j e c t Consent Form The Impact of As s i g n i n g a F a i l i n g Grade to a Student i n the F i n a l C l i n i c a l Semester I understand that Susan Greathouse's study concerns my experience w i t h a s s i g n i n g a f a i l i n g c l i n i c a l grade to a nur s i n g student i n the f i n a l c l i n i c a l semester of a diploma n u r s i n g program. I understand that being a subject w i l l i n v o l v e two to three i n t e r v i e w s , each approximately one hour i n len g t h . The i n t e r v i e w s w i l l be audio-taped and t r a n s c r i b e d and w i l l take p l a c e at a mutually agreed upon place and time. I understand that c o n f i d e n t i a l i t y w i l l be maintained by coding of the t r a n s c r i p t s . My name and any i d e n t i f y i n g i n f o r m a t i o n obtained i n the study w i l l not be revealed. I understand I am under no o b l i g a t i o n to p a r t i c i p a t e i n t h i s study and r e f u s a l to p a r t i c i p a t e w i l l not a f f e c t my teaching p o s i t i o n . I may withdraw at any time or refuse to answer any questions. My questions have been answered and I understand that I can contact Susan Greathouse at i f I have f u r t h e r q u e r i e s . I, the undersigned, understand the nature of Susan Greathouse's study and give my consent to p a r t i c i p a t e . I acknowledge r e c e i v i n g a copy of t h i s consent. NAME PHONE NUMBER SIGNATURE DATE Appendix E Demographic Data Form The following data are to be used i n aggregate from only. Please check the appropriate response and/or f i l l i n the blanks. PERSONAL BACKGROUND DATA; 1. What i s your age bracket? ( ) 20-29 ( ) 30-39 ( ) 40-49 ( ) 50 and Over 2. What i s the highest l e v e l of educational preparation you have obtained? ( ) BScN ( ) MSN ( ) MEd ( ) PhD ( ) Other (Please specify) 3. How many years of teaching experience do you have? ( ) 0-12 months ( ) From 1 to 3 years ( ) From 3 to 6 years . • ( ) From 6 to 10 years ( ) Over 10 years 4. How long have you been employed i n your current teaching position? ( ) Less than 1 year ( ) From 1 to 3 years ( ) From 3 to 5 years ( ) From 6 to 10 years ( ) Over 10 years 5. How many students who have been i n th e i r f i n a l c l i n i c a l semester have you f a i l e d during your teaching career? ( ) 1 student ( ) 2 students ( ) 3 students ( ) 4-5 students ( ) More than 6 students Appendix F I n t e r v i e w Q u e s t i o n s Trigger Questions: Primary : 1. Describe what i t i s l i k e (from a nursing educator's perspective) to inform a nursing student that h/she has not met the c l i n i c a l course objectives i n the f i n a l c l i n i c a l semester. Secondary: 1. Describe how you f e l t when you had to f a i l a student c l i n i c a l l y i n the f i n a l semester of a diploma nursing program? 2. What helps you deal with the feelings that may arise i n this situation? 3. What makes the si t u a t i o n more d i f f i c u l t ?

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