What feels good must be good?
Implications of grade inflation in nursing education
by Teresa Seright
Grade inflation is a dangerous practice in programs of nursing. While the trend in education is to engage students in student-centered learning experiences and, at the same time, help them focus on accountability in learning, nurse educators must not lose sight of their own accountability in evaluating learning outcomes.
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| Teresa Seright |
Historically, lawsuits against programs of nursing have not been upheld in U.S. courts. However, increased public attention on patient safety and the impact nurses have on that safety, including litigation against nurses who fail to follow proper procedures, could lead to increased scrutiny of standards used by nurse educators to assess student learning.
History and implications of grade inflation
In a study of 29 institutions, Rojstaczer (2003) found that, over the course of 34 years between 1967 and 2001, grade point averages (GPAs) for undergraduates increased by roughly 15 percent per decade.
It is difficult to determine exactly when and how grade inflation became a trend. It may have been during the Vietnam War, when professors were burdened with the moral quandary of assigning a failing grade that could very well get a student drafted (Rojstaczer, 2003; Scocca, 1998). The trend might have been fostered by America’s feel-good culture, in which higher grades equate to heightened self-esteem (Mansfield, 2001). Consumerism has no doubt fueled the phenomenon. In exchange for high tuition rates, students expect good grades (Rojstaczer, 2003). These consumers—our students—may at times seek support in the offices of the nursing chair, dean or dean of academic affairs when assigned grades fall short of their expectations. The tactic can be effective, especially in institutions clambering to recruit and retain a dwindling student population.
People familiar with nursing education of the past, with its white-starched intolerance of anything less than perfection, would be shocked by the findings of Scanlon and Care (2004). These authors reported that a faculty of nursing at one university had a significantly greater increase in GPA over the past 25 years when compared with other faculties, a curious situation when one considers the accountability with which nurse educators are charged.
First, nurse educators must scrutinize a large pool of applicants and choose the best for a program that is constrained, out of concern for patient safety, by mandated clinical educator-student nurse ratios. GPAs from prerequisite course work are generally accepted as one of the criteria for this selection process.
Second, nurse educators must strive to design curricula, learning activities and evaluations that promote not just technical skill, but critical-thinking skills. A book published on behalf of the Institute of Medicine and the Board on Health Care Services (Page, 2004) reported that how well patients are cared for by nurses is a matter of life and death. As educators, we assess students for critical-thinking skills throughout their nursing studies. Many have turned to products such as those offered by Assessment Technologies Institute (ATI) and Health Education Systems Incorporated (HESI) not only to prepare students to think critically, but also to assess them for critical thinking as they progress through their programs.
It is with good reason that nurse educators should be concerned about their students’ ability to think critically. Kinsman (2000) reasons that educators in health professions are at a greater risk of liability than educators in other disciplines because of the public’s expectation that health care providers should adhere to a standard of care.
Lastly, programs of nursing are evaluated for effectiveness by state boards of nursing in part by student pass rates on the National Council Licensure Exam (NCLEX).
With these facts in mind, it seems ludicrous that nursing educators would participate in grade inflation. However, one of the criteria used to determine which students are accepted into nursing programs—GPA in prerequisite course work—contributes to the potential for failure in those programs if, indeed, previous grades were inflated.
Blueprint for change: Begin with the end
McTighe and Thomas (2003) suggest that the starting point for change needs to begin with the end, with nursing educators first identifying desired results. We must encourage students not to focus primarily on grades, but rather on mastery of assigned content and critical thinking. In nursing education, establishing content standards should not be a struggle, as the NCLEX itself provides guidelines for those standards.
Implementing structured assessment and evaluation plans is essential to improving teaching and learning. By educating students about the importance of these resources in shaping teaching, emphasis is removed from grading and placed upon learning. Student end-of-course evaluations lack a certain depth, but may provide some data. Frequent student feedback on specific learning strategies may, however, provide useful information about what a student has learned. Other sources of data include observations of classroom assessment techniques, careful assessment of knowledge gained from real-world learning activities, and a variety of student work collected over time.
Systematic analysis of data, together with reflection, should help nurse educators focus on desired competency and mastery outcomes rather than on grades alone. Early identification of at-risk students is but one possible advantage to this method. By analyzing a variety of data, educators may intervene through remediation and tutoring of at-risk students, rather than passing them along through less-than-authentic grading.
Once the data about student learning have been analyzed, an action plan with specified reassessment and reporting periods can be implemented to identify and address areas that require readjustment. For example, perhaps it’s not only students who are ill-prepared for the rigors of nursing education. There may be issues regarding faculty preparation, availability of resources for students and faculty, or lack of academic support for struggling students.
When one considers the fact that grade inflation has enjoyed a long history and is probably an extension of an altered approach to grading that begins in grade school, it may seem pointless to try and effect change. However, nursing educators have an ethical obligation to the public. Acceptance of grade inflation sets students up to fail, puts patients at risk and makes nurse educators the target of litigation. A much more effective approach calls for improving the quality of nurse education by establishing high standards for learning outcomes, implementing structured assessment and evaluation plans, and following up with reporting and further analysis. RNL
Teresa Seright, RN, MSN, instructor in the BSN program at Minot State University in Minot, North Dakota, is pursuing a PhD in Teaching at Learning at the University of North Dakota in Grand Forks.
References:
Kinsman, J. (2000). Malpractice liability in health profession education. Medical Law, 71(3), 239-246.
Mansfield, H. (2001). Grade inflation: It’s time to face the facts. The Chronicle of Higher Education: The Chronicle Review. Retrieved September 16, 2006, from http://chronicle.com
McTighe, J., & Thomas, R. (2003). Backwards design for forward action. Educational Leadership, 60(5), 52-55.
Page, A. (Ed.). (2004). Keeping patients safe: Transforming the work environment of nurses. Institute of Medicine, Committee on the Work Environment for Nurses and Patient Safety, Board on Health Care Services. Washington, DC: National Academy Press.
Rojstaczer, S. (2003). Grade inflation at American colleges and universities. Retrieved September 19, 2006, from http://gradeinflation.com
Scanlon, J.M., & Care, W.D. (2004). Grade inflation: Should we be concerned? Journal of Nursing Education, 43(10), 475-478.
Socca, T. (1998). The grade inflation lie. The Boston Phoenix. Retrieved September 16, 2006, from http://dmoz.org/society/issues/education/grade_inflation/.
