Standard 9

Assessment of Candidate Competence

Prior to recommending each candidate for a Health Services: School Nurse Credential one or more persons responsible for the program determine on the basis of thoroughly documented evidence that each candidate has demonstrated satisfactory performance on the School Nursing Competencies (SNCs).  The program uses formative assessment processes to inform candidates of their status in relation to the SNCs, and to assure that candidates have the appropriate knowledge, skills and abilities prior to being recommended for the credential. The evaluation of candidate competence is provided by at least one school nurse preceptor and one institutional supervisor.

Criterion 1: Prior to recommending each candidate for a Health Services: School Nurse Credential one or more persons responsible for the program determine, on the basis of thoroughly documented evidence, that each candidate has demonstrated a satisfactory performance on a range of School Nursing Competencies (SNCs).

The program coordinator is responsible for evaluating the candidate’s accumulated coursework, and verifying the existence and currency of all required documents, and for ascertaining that the candidate has met the required clinical skills and competencies that will determine if the candidate is eligible to apply for a Clear Professional School Nurse Services Credential based on sound documentation. A check-off sheet is initiated when an application is received by an applicant and attached to the front of the perspective candidate’s file. This check-off sheet, kept current throughout the period of time the candidate is in the program, includes dates of advising sessions; verification of receipt of required documents, licensure and certificates; confirmation of completed program course coursework, and GPA (Notes: A 3.0 GPA must be maintained throughout program coursework). This time saving tool is used by the program coordinator to determine completeness of a candidate’s file and fulfillment of program requirements. Once the program coordinator is satisfied that the candidate has complied with all coursework required, and after reviewing the candidate’s CSUF transcript for completeness, the coordinator signs off on the Exit Statement on the back of this same check-off form which now becomes the Exit Clearance Form that is send to the CSUF credential analyst as proof the candidate has complied with all program requirements. The candidate is then notified that he/she may apply for a Clear School Nurse Services Credential once two full years of school nurse employment have been verified. Steps for applying for a Clear credential are spelled out in NURS 186 and NURS 187 practicum course syllabi, as well as in the Documents section in the Blackboard software program.

The following are reviewed and verified for satisfactory completion:

  • Program coursework while maintaining a 3.0 GPA:  CDDS 125, Audiometry for School Nurses (3U); PSYCH 168, Abnormal Psychology, or SPED 120, Mainstreaming the Exceptional Child (3U); COUN 174 (or COUN 200) Introduction to Counseling (3U); NURS 136, Health Appraisal (3U); NURS 137, Teaching Strategies for the Healthcare Client (3U); NURS 183, Vision and Scoliosis in the School Setting (1U); NURS 184, Introduction to School Nursing (3U); NURS 185, Seminar in School Nursing (3U); NURS 186, School Nurse Practicum I (3U); and NURS 187, School Nurse Practicum II (3U). 
  • Satisfactory completion of NURS 186 and NURS 187 clinical skills and competencies which have been verified by the candidate’s preceptor in each practicum course by initialing and signature on the final page of the document, “Preceptor Checklist of Skills and Competencies.” This checklist of skills and competencies is in keeping with the 2007 CCTC standards and addresses skills and competencies specific to primary, secondary and tertiary prevention, and professional management. Other things that are verified by the program coordinator are candidate completion of required clinical hours and the preceptor response to the question, “Would you recommend this candidate for a Clear Professional School Nurse Service Credential.” As noted in the NURS 186 and NURS 187 syllabi, candidates who fail to demonstrate competence in a specific area, may be required to spend additional time with his/her preceptor to demonstrate competence in that particular area if other arrangements have not been made.
  • “Preceptor Evaluation of Student Professional Dispositions” another evaluation tool reviewed by the program coordinator. These dispositions adopted by the CSUF Kremen School of Education and Human Development in keeping with NCATE (National Council of Accreditation for Teacher Education) requirements are expectations for all credential candidates throughout the university. On entrance to the core school nurse courses in the program, school nurse candidates are given a written and verbal explanation of these dispositions during a program orientation and informed that the candidate’s preceptor will rate candidate competence in these areas using a 5-point (Excellent, Very Good, Good, Fair, Poor) Likert scale at the end of each practicum experience. Preceptors are also given an explanation of the dispositions and written instructions on rating candidates. Candidates are rated on the following: The Ability to Reflect, to demonstrate critical thinking, to make ethical judgments, have the tendency to value diversity, demonstrate a collaborative disposition, and demonstrate enthusiasm for life-long learning (See document in N186/187 Preceptor Syllabus). As a rule, school nurse candidates rate well in these dispositional areas because, as nurses, they have already been exposed to them in their undergraduate programs, as well as in their nursing practice prior to entering the program, though they may not have known them as “disposition.” Should a candidate rate low in any one of these areas, an appropriate type of remediation will be recommended.

Criterion 2: The program uses formative (constructive) assessment processes to inform candidates of their status in relation to the SNCs, and to assure that candidates have the appropriate knowledge, skills and abilities prior to being recommended for the credential:

Candidate competence related to the school nurse role is assessed in phase I courses prior to entering core school nurse courses. In NURS 136, Health Assessment, candidates are required to demonstrate competence in carrying out physical assessment skills in a classroom setting on manikins and classmates on the various systems. Candidates are observed during return demonstrations, and if competence is not demonstrated, the candidate is asked to repeat the skill until competence is demonstrated. This also true in CDDS 125, Audiometry of School Nurses, where candidates must demonstrate competence in screening hearing and in carrying out hearing thresholds on clients under the supervision of an audiologist or another qualified professional who offers constructive feedback.  Again, in COUN 174, Introduction to Counseling (or COUN 200), candidates are observed for their ability to use appropriate counseling techniques when counseling in mock counseling sessions and constructive feedback is given.

Constructive assessment processes used in seminar courses (NURS 184, Introduction to School Nursing, and NURS 185, School Nurse Seminar). In these courses, candidates expand their knowledge of school nursing and school nursing practice related to legal guidelines, standards of school nursing practice, client care, and the multifaceted role of the school nurse as demonstrated through written assignments, responses to weekly research questions that requires researching current journals and course texts, participating in the development and presentation of an online Blackboard presentation for classmates, and in meaningful participation in class discussion following Blackboard presentations. Faculty critiques Blackboard presentation by candidates and offers constructive feedback and acknowledgement for quality and creativity. Classmates are also invited to rate Blackboard presentations by fellow classmates. Faculty also monitors candidate participation in class discussion following presentations, provides feedback, and assigns points accordingly. Written work turned in by candidates at the end of each module, of which there are four modules in a given semester, is read, a point value assigned to each paper with faculty constructive comments. A “Progress Report” sheet is also generated at this time which includes a breakdown of module points earned, summary comments regarding quality of work and acknowledgement for work well done. Both the graded paper and the progress report are sent to the candidate through the candidate’s online grade book. Candidates are invited to contact their instructor at any time with concerns regarding assignments and/or grades.

Constructive assessment processes used in practicum courses (NURS 186, School Nurse Practicum I, and NURS 187, School Nurse Practicum II). Candidates are required to spend practicum hours under the supervision of a qualified school nurse preceptor who monitors and supervises their clinical activities and provides constructive feedback. In the beginning of the semester, one of the first responsibilities the preceptor has is to assist the candidate in developing realistic student goals and objectives that include learning activities that will meet those goals and lead to a meaningful clinical learning experience. The clinical instructor has final approval of the candidate’s goals and objectives and offer constructive input as necessary. Candidates will be asked to rewrite goals and objectives they are not relevant or appropriate for the learning needs of the individual candidates. Once the candidate’s goals and objectives have been approved, clinical hours may begin in earnest.

Constructive feedback provided after reviewing candidate clinical journaling: Candidate must maintain a journal of weekly clinical activities. Journaling must include specific experiences that the candidate can relate to a meaningful learning experience and can apply to his/her own school nursing practice. Clinical instructors monitor candidate clinical activities through their journaling and are then able to provide constructive feedback to the candidates with regard to relevancy of those activities in keeping with planned learning experiences. For example, in “Suggested guidelines for time spent in clinical practice” in the NURS 186/NURS 187 Preceptor Syllabus, guidelines have been established to prevent overspending time participating in one particular experience, i.e. excessive times spent in school wide screening, that threatens to skew the candidate well rounded learning experience. Preceptors are asked to review the candidate’s journaling periodically. Candidates are required to turn in journaling for review by clinical instructors at the end of each of the four modules in a given semester and the clinical instructor provides the candidate with constructive through a written Progress Report. The clinical instructor contacts the candidate directly if an issue warrants. 

Constructive feedback provided to candidate during Mid-Term Evaluation of Clinical Progress: Within the specified mid-term timeframe, the candidate is asked to sit down with his/her preceptor to discuss the candidate’s progress toward accomplishing the candidate’s “Student Goals and Learning Objectives” which were created by the candidate with input from the candidate’s preceptor in the beginning of the semester. At this time the preceptor and candidate are also expected to review progress toward meeting school nurse skills and competencies as spelled out in Preceptor Checklist of Skills and Competencies in the NURS 186/NURS 187 Preceptor Syllabus. Following this meeting with the candidate’s preceptor, a mandatory 3-way conference must takes place between the candidate, preceptor and university clinical instructor to discuss the candidate’s progress and to resolve any problem areas or concerns. This is also an opportunity, if necessary, for the preceptor and the clinical instructor to make constructive suggestions on ways the candidate can improve his/her learning outcomes or strengthening a learning experience through adding or making changes in an objective or learning activity. The clinical instructor completes a Mid-Term Progress Report on the meeting with the candidate and the candidate’s preceptor which is filed in the candidates cum.

Preceptor Checklist of Student Clinical Skills and Competencies, which is the most useful tool to inform candidates of their status in relation to the SNCs. For each practicum course there is a checklist of clinical skills and competencies specific to that particular educational level that meets CCTC (2007) standard guidelines. The Preceptor Checklist of Skills and Competencies can be use by the preceptor in assisting the candidate in developing meaningful goals and objectives in the beginning of the semester, as an tool that can also be used by the preceptor throughout the semester to document met skills and competencies, and in directing, mentoring, and supervising the candidate in mastering these skills and competencies, and keeping track of candidate progress towards completing the required list. If a experience does not present itself within the semester timeframe, the preceptor and student are expected to discuss the skill to the length that the candidate has the understanding and insight to how it should be carried out in his/her own school nursing practice. Preceptors are advised that if an experience cannot be provided at the preceptor’s school site(s), the preceptor is to make arrangements with another qualified school nurse in that district who is able to provide the experience. Each skill area and competency must be initialed by the candidate’s preceptor and a written explanation provided if a skill or competency could not be mastered. The preceptor is to advise the candidate regarding areas of weakness and suggest remedies. If necessary, the candidates may be advised to spend additional time with that preceptor to accomplish the skill or competency.

Other constructive feedback offered to candidates related to their clinical competence (NURS 186 and NURS 187): The following is relevant to professional management skills and professional dispositions. In clinical practice, candidates are assessed by their preceptors and provided feedback on their ability to demonstrate knowledge of child and adolescent health issues, relate legal guidelines to school nursing practice; reflect on previous experiences and apply that knowledge to current situations; use critical thinking skills; demonstrate ethical judgment in decision making; demonstrate value for diversity; demonstrate the ability to collaborate and work effectively with others; communicate on a professional level, both written and verbal; demonstrate the ability to think creatively; plan, organize effectively, and schedule time wisely; and work successfully with children, adolescent, families, and in the community.

Examples of clinical experiences that relate to written assignments for which candidates need mentoring and direction, and for which candidates receive constructive feedback are: A comprehensive Cross-Cultural Special Ed Case Study that involves client and family assessment, insight into the IEP (Individual Education Plan) process, and effective communication and collaboration with other members of the education team; development of a health curriculum and teaching outline which must be carried out in a classroom setting; facilitating discussion on a health issue(s) with a small group; creating a newsletter at the secondary level; reviewing district health policies, and participating in making changes or creating a new policy that require School Board approval; and attendance at a School Attendance Review Board meeting for insight into  process.

Candidate Narrative Self-Evaluation Related accomplishments in Clinical Experience: At the end of each of practicum courses, candidates complete a Narrative Self-Evaluation in which they are discuss the length to which they were able to accomplished student goals and learning objectives; areas of major learning, strengths, weaknesses, new skills and improvements; and things they might have done differently to strengthen their clinical experience. This gives the candidate insight into areas they will continue to work on in their own nursing practice.

Pre/Post Program Knowledge base Self Assessment Questionnaire: On entry into core school nurse coursework (NURS 184, NURS 185, NURS 186, NURS 187), candidates complete a self reported knowledge base assessment questionnaire. At the completion of the final core nurse course (NURS 187, School Nurse Practicum II), candidates complete that same knowledge base questionnaire as a post assessment. This self reported growth in knowledge of school nursing gives the candidate insight into the level of learning that has taken place throughout core school nurse coursework. The questionnaire consists of 26 topic areas with sub-topics in each of these areas. Candidates frequently comment that they are surprised at the amount of learning that has taken place, especially candidates who enter the program after having practiced school nursing for two or more years.

Criterion 3: The evaluation of candidate competence is provided by at least one school nurse preceptor and one institutional supervisor:

In each practicum course (NURS 186 and NURS 187) the candidate’s competence to practice school nursing is evaluated by a qualified university field supervisor (clinical instructor) who holds at minimum a master’s degree, a Clear Professional School Nurse Services Credential, and who has an extensive background in school nursing practice in the community, which gives that field supervisor the necessary insight to effectively evaluate the candidate’s performance in the field. The candidate’s competence to practice school nursing is also evaluated by a qualified school nurse preceptor who is required to have a minimum of five full years of school nursing experience, hold a Clear Professional School Nurse Services Credential, and have the approval of their immediate supervisor to act in this capacity. Qualifications of potential school nurse preceptors are also reviewed by faculty before final approval is given. If a preceptor receives an unfavorable evaluation by a candidate at the end of the semester indicating a lack of commitment, that school nurse will not be invited back to act as a preceptor for future students.

In order to establish an effective ongoing working relationship between the university field supervisor and the school site school nurse preceptor in order for them to work together to affectively evaluate a candidate’s competence in clinical practice, communication between the university field supervisor and the preceptor is initiated as soon as possible in the beginning of the semester. Once approved, the school nurse preceptor is contacted by the university field supervisor to discuss roles and responsibilities of all three parties (the preceptor, the candidate, and the university field supervisor). The preceptor is also given a comprehensive NURS 186/NURS 187 Preceptor Syllabus which reinforces discussed roles and responsibilities, includes the necessary contracts, and most importantly the “Preceptor Checklist of Skills and Competencies” which the preceptor will be used to evaluate the candidate’s abilities. Prior to beginning clinical practice, to ensure at the candidate and the preceptor both have a clear understanding of expectations in the NURS 186/NURS 187 Preceptor Syllabus and  competencies expectations in the “Preceptor Checklist of Skills and Competencies,” candidates are asked to sit down with their preceptor to review the syllabus together before starting clinical hours. Preceptors are also given insight into the need to evaluate the candidate in the area of “Student Professional dispositions,” which the preceptor will need to do and to provide constructive guidance as necessary. Throughout the semester preceptors are expected to use the “Preceptor Checklist of Skills and Competencies” as a guide in directing and evaluating the candidate’s performance, as well as to use to check off skills and competencies as they are observed and met. Conferences between the preceptor, candidates and university field supervisor are encouraged throughout the semester whenever a need arises. The preceptor is asked to meet with the candidate at mid-term and to evaluate progress related to student goals and objectives, as well as candidate progress with regard to skills and competencies. A mid-term 3-way mandatory conference follows between the preceptor, the candidate, and the university field supervisor to discuss candidate progress. At the end of the practicum experience, the preceptor is again asked to meet with the candidate to discuss accomplishments with regard to skills and competencies, and to determine at that time if these have been satisfactorily met. Preceptors are asked to sign the final page of the “Preceptor Checklist of Skills and Competencies” evaluation form to add validity to the document.

The evaluation forms, both the “Preceptor Checklist of Skills and Competencies” and the “Preceptor Evaluation of Student Professional Dispositions” must be turned in to the university field supervisor, along with a Preceptor Evaluation of the Course, by the end of the semester for the candidate to receive a final grade. The program coordinator uses these evaluation tools in conferencing with candidates and in completing exit evaluations for candidates after program coursework has been completed. The university field supervisor evaluates the candidate’s field experience through reading required candidate journaling on clinical experiences, turned in at the end of each of the four modules in a given semester; through conferencing with the candidate and the candidate’s preceptor, and through reading the candidate’s papers and written work relevant to assignments, and response to journal questions.

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