Supporting nursing students who fail: a review of lecturers practice

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1 Article Supporting nursing students who fail: a review of lecturers practice Julie Litchfield Julie Litchfield RGN, BA (Hons), MA in ED (Open), Lecturer in Health Studies, The University of York, Department of Health Studies, York, District Hospital, Wigginton Road, York Y031 8HE, UK. Tel.: This paper formed the basis of an interactive poster presentation at the Nurse Education Tomorrow 2000 Conference. Manuscript accepted: 5 June 2001 This small qualitative study explored how lecturers (also referred to as personal supervisors) supported nursing students who failed academically. It is acknowledged that failure on a nursing course may relate to failure in practice and theory (Marland & McSherry 1997). For the purpose of this study, only failure associated with assessment of theory was explored. The aim of the research was to establish whether there was consistency in the way that lecturers within the same department managed failure. At present, guidelines are in existence within the department to assist the lecturer in supporting the student who has failed. A sample of five nurse lecturers from a range of clinical backgrounds and programmes took part in the study. A semi-structured interview was employed to gather data from respondents, incorporating both open-ended and closed questions formulated with reference to the literature review. Results demonstrated that there was inconsistency in the way that academic support was provided to students who failed. The findings of this small study suggest that schools of nursing may need to produce specific protocols addressing the area of student support and the management of student failure. It is suggested that too diverse an approach in relation to managing student s academic failure could result in students appealing against the support process. It is, therefore, important that lecturers understand that: The aim in providing support is to ensure that the student derives maximum benefit from their course (Earwaker 1992, p. 11). Introduction Retaining students in nurse education is a major concern for nursing departments within higher education institutions (Coakley 1999). Although it is recognized that there are several reasons why students leave a course, this paper focuses upon academic failure by examining how lecturers support students who fail. With governmental initiatives such as Making a Difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare (DOH 1999) there is an impetus to re-consider, amongst other issues, training and education. Any investment in learning heralded by this initiative may need to reappraise the personal supervisor role in supporting students who have failed academically, and thereby avoid wasting valuable resources, through students leaving a nursing programme, at a time when spending on nurse education is at a premium. This paper is not intended to be generalizable but to provide an insight into an improvement of the outcome of failure for the student nurse. 142 doi: /nepr , available online at on

2 Academic failure Academic failure, it could be argued, also relates to failure in practice since achievement in practice for pre-registration nursing students has a 50% input to overall registration (ENB 2000). For the purposes of this study, however, academic failure relating to a failed written (theoretical) assignment will be considered as the main focus. Academic failure is, according to Peelo and Wareham (1999, p. 30): part of university life and yet a failed student can say as much about the lecturer as the student. If a lecturer fails to provide the required support to a student then they could be considered to be failing in their role. Morgan and Knox (1987) identified that students perceived those teachers who were unapproachable and lacking in understanding of the student s position to be the worst. Support of this nature can only result in the student gaining little learning from a programme. Trust, one of the main features which has to develop during a supportive interaction (Lawton 1997), will not develop between the student and lecturer. Literature review Educational support A review of the literature revealed a growth of information around the topic of supporting students who fail academically. There appeared, however, to be more written about students experiences of seeking help (Blair et al. 1998, Glackin & Glackin 1998, Grayson et al. 1998, White et al. 1999) than about lecturers supporting students who failed. In a study by Blair et al. (1998) exploring adult learning opportunities, they reported that of the students who responded to questions concerning the academic support they had received to assist their studies, half did not make use of any formal guidance networks provided by the educational institution. Utilization of support networks by students subsequently became a question to be addressed within the research study. Blair et al. (1998) also found that respondents saw the successful completion of a course as being mainly due to the efforts of their teachers, suggesting a contradiction in their findings. Paradoxically, the author found on investigation of students academic failure the issue of a lecturer suggesting that a student ceased his/her studies has been raised. Marland and McSherry (1997) imply that there is a financial cost to the taxpayer when considering pre-registration nursing students and academic failure. It may be less of a burden to advise a student to stop earlier in the course of study before they have made use of further educational resources. For post-registration nurses, the financial burden may be borne by the employer and, ultimately, the education consortium who funds post registration education and training. Nevertheless, when monies are scarce even for the basic necessities, wasting valuable resources might impact on how the consortium commissions further courses and student numbers. Monitoring academic failure Blair and Tett (1998), in discussion of the future for guidance, access and networking for students, suggest that institutions need to investigate systematically why students who discontinue leave and academic failure may well play a part in that decision. If support can also be explored then how lecturers provide help to students may be able to be monitored and the opportunity for appeal against marking decisions be reduced. Failure, instead of being a negative experience, may then become a positive one. A study funded by the Higher Education Funding Council, interviewing lecturers as well as other higher education (HE) staff about the support they provide to students with learning difficulties, made further recommendations (Stanley et al. 1999). Although, ultimately, the focus of this study was to elicit general insight into academic support as perceived by different levels of HE staff, the results demonstrated the value of support provided by personal supervisors. A major conclusion from this report found that any review of academic support needed to include that provided by personal supervisors. 143

3 Supporting the need for guidance to be given by lecturers, Blair et al. s study (1998) indicated that adult learners felt that they were happier speaking to course tutors or family about personal and academic difficulties. Conclusions from these studies appeared to negate the need for a more formal guidance/counselling service. It could also be considered that the issues surrounding academic failure for nursing students are too specialized because assessment is more complex in that it involves both practice and education. Any comparison, therefore, with non nursing undergraduates becomes less relevant. Contrastingly, in a qualitative study undertaken by Grayson et al. (1998) which explored students help seeking behaviour, a reluctance to approach lecturers was noted. A rationale for this reluctance was put forward by the researchers as being related to the staff student relationship, involving various key relations e.g. rapport where it is clear that being a lecturer, as someone who is qualified and more informed, holds a certain amount of power over the student. Edwards (1998) also discusses the academic discourse entailed in providing guidance to students as one which comprises subjectivity and power relations. The author would argue from experience that, when helping a student who has failed academically, the power relationship is one that is constituted by the student who may believe that the lecturer can turn failure into success. This can place an intolerable burden of achieving a pass for the student upon the lecturer when supporting those who have failed. A study by White et al. (1999), investigating why students leave on the common foundation programme of the Project 2000 course, found that a major leaving factor was academic failure and accounted for 44% of discontinued students. It was recognized, however, that there are other variables which may influence student withdrawal, e.g. the dynamics of the student/lecturer realtionship, financial hardship, inappropriate career choice (White et al. 1999). Findings also revealed that students were affected by staff attitude, and some teaching staff needed training in interpersonal skills. This brings into question personal supervisors use of communication and human understanding when dealing with academic failure, and whether they possess the skills required to provide feedback to the student who has failed. In providing support to students who have failed academically, the lecturer may have to incorporate counselling skills into their interactions. Mcleod (1998), when reflecting upon the actualities of counselling, advises that working in this way often highlights irresolvable dilemmas. One of the biggest dilemmas may be the availability of a block of time in a nurse lecturer s workload. The importance of providing time for the individual is well understood (McLeod 1998). However, as Mcleod continues, it is sometimes difficult to move out of the experiential reality (i.e. tutorial workload) of counselling one client (i.e. student) to another. In the nurse lecturer s situation, it is likely that personal tutorials are fitted in around teaching sessions where, from personal experience, the lecturer may be mentally preparing for the impending session. This lack of engagement may prevent the lecturer from empathising fully with the student and attending to the students concerns (Taylor 1989, Rogers 1998, Mcleod 1998). This raises the question of whether lecturers should be trained counsellors. In supporting students who have failed, there is a danger of assuming that what the lecturer is doing is counselling. Relearning of subject material also has to occur for the student when he/she has failed academically. This can have an impact on the relationship between lecturer and student. The facilitation of this learning, suggests Rogers (1998), depends upon certain attitudinal qualities existing between the facilitator and learner. If the lecturer, as facilitator, fails to appreciate the concept of failure and what it could mean to the student, then the level of helping to relearn will be hindered. For some lecturers, it may be easier to suggest that a student discontinue their studies rather than persevere to achieve their ultimate goal. For an older student, this journey into higher education may be their last attempt to obtain a career (pre-registration nursing student) or progress within it (post-registration student). Therefore their experience of support in nurse education may greatly influence whether they leave or stay on a course. 144

4 Glackin and Glackin (1998) found that this lack of understanding of the students needs was a concept that older students undertaking a pre-registration diploma in nursing felt that lecturers failed to relate to. They also found re the same issue that older students received little support, which had ramifications for the student whose main fear was of academic failure. In attempting to integrate other disciplines such as research and practice into their role, nurse lecturers may, the author believes, give less priority to academic support. This review of the literature subsequently suggested potential areas and questions to be investigated within this research study. The aims were: 1. Identify lecturers awareness of the issues involved in providing educational guidance, particularly to students who fail academically 2. Examine how lecturers provide support to students who fail academically 3. Establish whether students were referred onto any formal counselling network that may exist within a university. Methodology In order to address the question of how lecturers supported students who fail academically, and ascertain if there was any consistency, a qualitative approach was adopted. Coolican (cited in Faulkner et al. 1994, p. 12) clarifies this as one which: emphasizes meanings, experiences descriptions and so on. Raw data will be exactly what people have said (in interview or recorded conversation) or a description of what has been observed. Qualitative data were collected using semistructured interview. Transcripts were transcribed and analysed by the researcher using content and thematic analysis. This type of research seemed compatible with an exploratory aim (Robson 1993). Sample The sample group comprised five lecturers from a variety of nursing backgrounds within a Department of Nursing Studies whose staff work on a variety of sites. This did not, however, create problems of access. All were volunteers. It is recognized that the small number of respondents and the manner in which interviewees were selected would preclude generalizations from being made to a larger population (Faulkner et al. 1994). The sample included the following: two (2) Pre- Registration Mental Health lecturers, one (1) Pre-Registration Adult Branch and two (2) Post-Registration lecturers teaching a variety of topics associated with both acute, critical and mental health care. Data collection method A semi-structured interview was used to obtain data. Six key questions were identified based upon the literature review and addressed the following areas: 1. Area of nurse education in which lecturer had responsibilities 2. Addressing the occurrence of student academic failure 3. Identifying how students were supported and the difficulties associated with providing support 4. Suitability of students to continue a programme of study 5. Referral to a format support network 6. Personal student workload and management of support. To ensure the instrument s rigour and the skills of the researcher the interview schedule was piloted with a colleague, a necessary aspect on Bell s (1993) interview checklist to allow the researcher to practice asking questions and obtain responses. Subsequently questions were re-ordered, but the content was still considered to be pertinent to the research focus. Interviews were undertaken in the respondent s office and following their transcription the scripts were returned to interviewees within h to validate that what was written was a true record of their responses; a means of verification as advocated by Bell (1993). 145

5 Ethical considerations Any qualitative researcher should consider moral and ethical questions, advise Miles & Huberman (1994). Consent to interview was discussed following the interest respondents had demonstrated to the initial focus for the study. They were assured that anonymity and confidentiality would be maintained throughout the interviews. Interviewees were informed that cassette tapes used for interview would be destroyed along with transcribed conversations. Ethical committee approval was not sought as patients were not involved in this research. However, permission to access volunteer participants was sought from the department management team. Findings/discussion It was evident from the results of questions 1 and 2 that lecturers in nursing were providing support across a variety of disciplines and with differing educational needs i.e. pre and post registration. Some lecturers were supporting students in both areas. From identifying the different areas of education where students were receiving support, it would be seen whether lecturers shared the departmental aim of providing effective student support. All lecturers interviewed had experienced students who had failed academically. It would probably have been more of an anomaly if a lecturer had not encountered a nursing student who had failed academically. Content analysis was subsequently undertaken upon responses to questions 3 6. This is, as Stevens et al. (1993) suggest, a labour intensive method of categorizing data. Content and thematic analysis revealed four themes: Not really knowing what to do Advising students to discontinue their studies Referral for formal counselling Workload does not impinge upon student support. Not really knowing what to do Asking the question as to how lecturers supported students who failed academically resulted in no agreement on the manner of providing support. Relating to the timescale when a student would be seen, one respondent reported writing to all students following the results of an assignment and reviewing their feedback sheets. Contrastingly, another interviewee did not know what she was supposed to do when students failed, what other lecturers did or if what she was doing was what she was supposed to do. The remaining lecturers, discussing how they managed students who failed, agreed that they saw students as soon as possible but placed a different emphasis on the extent to which they would read a failed script in full or not. It could be argued that, in relation to seeing the failed student or reading the script, some lecturers: Inadvertently encourage an unhealthy dependency in students who are already somewhat insecure. (Earwaker cited in Crawford et al. 1998, p. 97) Subsequently, whilst lecturers are undertaking support for the student who has failed academically in several different ways, they could be laying themselves open to appeals against tutorial support. It is nevertheless appreciated that some individuality in practice will occur. Contrastingly, although there was no agreement in the manner of supporting the student who has failed academically, a recurring difficulty related to this theme was the need to encourage students to appreciate the feedback that they had received. For example: sometimes they feel angry towards you because they ve failed and that sort of stops them actually listening to what you re saying and actually taking on board the feedback. (Lecturer) If the student is unable to acknowledge constructive criticism within their feedback (perhaps due to their emotive state) this then renders them incapable of self-help. Time, or lack of it, was another stated difficulty as was the idea of over helping the student to the extent that the revised essay becomes less of the students work and more of 146

6 the lecturers! This could be attributed to the power relationship within an academic discourse as previously discussed (Edwards 1998). By undermining the students responsibility for their own learning the lecturer may also risk the development of the student becoming an autonomous practitioner (Phillips 1994). Advising students to discontinue their studies The following theme emerged from question four of the interview schedule, where the question asked whether the interviewee had ever considered advising their personal student who had failed academically to discontinue his/her studies. Only one respondent admitted to doing this, adding that as lecturers/personal supervisors, we should not set up students to fail. Interestingly, in light of new recommendations for nurse education (Department of Health 1999), in particular widening the entry gate into nursing and accepting those who lack academic ability, this concept may be reinforced. Students may need to be weeded out more thoroughly during the interview process rather than be allowed to struggle on a programme only to fail at the first hurdle. Failing academically has been acknowledged to impact upon student attrition. A realistic response emerged from another interviewee who suggested that if a student was adult enough to decide to undertake a course of study then they were capable of making the decision to step off it: if an individual is adult enough to decide to undertake a course of study then he/she is capable of making the decision to step off it. (Lecturer) Referral for formal counselling As stated in the literature review, academic failure may be associated with the student succumbing to personal difficulties (Blair et al. 1998). The fifth question, therefore, required the interviewee to state whether they would refer a student with personal problems leading to academic failure to a more formal counselling network within the organization. Overall, not one lecturer would initially refer a student to this service, and saw themselves as the first line in examining students difficulties. Indeed, one respondent was not even aware of the university s counselling network. This suggests that there may be a need for more transparency in the academic support system so that lecturers are aware of the resources available to them. An academic support unit could also be established, addressing all issues relating to student support, i.e. development of protocols relating to student support for the failed student and the appointment of a lecturer solely responsible for seeing all failed students. Although it is recognized that with larger student numbers this may not be a viable proposal. Interestingly, Blair et al. (1998) found in their study exploring adults perceptions of guidance that relationships with teachers had been preferred. Only 50% had made use of the provider organization s formal guidance network. Workload does not impinge upon student support The final question in the interview schedule explored the question of the number of personal students a lecturer was supporting. The English National Board (1997, p. 4b) recommends that a lecturer should support no more than 15 students. Four out of the five lecturers admitted to having over 15. The average number of students either pre or postregistration supported by interviewees in this study was 22. No one appeared to consider their present workload excessive, as they were able to manage their workloads in relation to student support through spending more time with the academically weaker student during lulls in curriculum delivery. As student numbers are set to rise in pre-registration courses, this may become more difficult and no longer a viable option. Conclusion From this explorative, pilot study it can be seen that the area of student support for those who fail is very subjective and individualized. 147

7 In particular, its management is very diverse. From this small sample of five lecturers, two areas of guidance (education and counselling) can be seen to emerge from the support role, with a danger of lecturers seeing themselves as counsellors. It is therefore important for the lecturer providing support to identify when a lack of skills in either aspect may impinge on the student, particularly one who has failed. As noted, establishing an academic support unit could be one way to address issues surrounding student support. It would provide a focal point for both lecturers and students to identify good practice and improve upon areas of weakness by undertaking collaborative research. Through contact with such a unit, providers of nurse education would be able to demonstrate greater transparency with reference to support networks both formal and informal, available to students who fail. Finally, with reference to Government initiatives there needs to be a review of lecturer-student ratios in the area of support in nurse education in order to provide effective systems of support for students who fail. Subsequently, impact may be able to be made upon the student attrition rates resulting from academic failure. References Bell J 1993 Doing your research project. A guide for firsttime researchers in education and social science. Open University Press, Buckingham Blair A, McPake J, Munn P 1998 The clients perception of guidance. In: Edwards R, Harrison R, Tait A (Eds) Telling tales. Perspectives on guidance and counselling in learning. Routeledge, London Blair A, Tett L 1998 Guidance, access and networking. In: Crawford M, Edwards R, Kydd L (Eds) Taking issue. Debates in guidance and counselling in learning. Routeledge, London Coakley AL 1999 The search for strategies to reduce nurse wastage. Professional Nurse 14(11): Crawford M, Edwards R, Kydd L (Eds) 1998 Taking issue. Debates in guidance and counselling in learning. Routeledge, London Department of Health 1999 Making a difference. HMSO, London Edwards R 1998 Mapping, locating and translating: a discursive approach to professional development. Studies in Continuing Education 20(1):23 27 English National Board for Nursing, Midwifery & Health Visiting 1997 Standards for the approval of higher education institutions and programmes. ENB, London English National Board for Nursing, Midwifery & Health Visiting 2000 Education in focus. Strengthening preregistration nursing and midwifery education. Section 2. Specific curriculum guidance and requirements for preregistration nursing programmes. ENB, London Faulkner D, Swann J, Baker S, Bird M, Carty J 1994 Professional development in action. Methodology handbook. Open University, Milton Keynes Glackin M, Glackin M 1998 Investigations into experiences of older students undertaking a pre-registration diploma in nursing. Nurse Education Today 18: Grayson A, Clarke DD, Miller H 1998 Help seeking among students: are lecturers seen as a potential source of help? Studies in Higher Education 23(2): Lawton S 1997 Supportive learning in distance education. Journal of Advanced Nursing 25: Marland G, McSherry W 1997 Do we fail those who fail? Nursing Times 93(38):61 63 Mcleod, J 1998 An introduction to counseling, 2nd edition. Open University Press, Buckingham Miles B, Huberman AM 1994 Ethical issues in analysis. Qualitative data analysis 2nd ed. Sage Publications, London Morgan J, Knox J 1987 Characteristics of best and worst clinical teachers as perceived by university nursing faculty and students. Journal of Advanced Nursing 12: Peelo M, Wareham T 1999 How to help students who fail exams. The Times Higher July 9:30 31 Phillips R 1994 Providing student support systems in Project 2000 nurse education programmes the personal tutor role of nurse teachers. Nurse Education Today 14: Robson C 1993 Real world research. Butterworth Heinemann, London Stanley N, Manthorpe J, Bradley G 1999 Responding effectively to students mental health needs. A short report. School of Community and Health Studies, University of Hull Stevens P, Schade A, Chalk B, D A Slevin O 1993 Understanding research. Campion Press Limited, Edinburgh Taylor B 1989 Working with others. Oasis Publications, Leeds White J, Williams RW, Green BF 1999 Discontinuation, leaving reasons and course evaluation comments of students on the common foundation programme. Nurse Education Today 19: