Strengthening Clinical Evaluation through Interrater Reliability

By: Rebecca Davis, EdD, RN, CNE, CNE-cl, University of Alabama in Huntsville

Meaningful clinical evaluation provides descriptive feedback on clinical abilities of students, allows clinical educators to individualize students’ future clinical experiences, and may contribute robust data regarding clinical competence to the science of nursing education. As nurse educators, we probably associate interrater reliability with the tightly controlled conditions of a research study and wonder, How can this concept transfer to the highly subjective and unpredictable clinical learning environment? The answer is that researchers establish interrater reliability for exactly that reason: to standardize and strengthen the often-complex task of providing consistent evaluation.

Interrater Reliability for Fair Evaluation of Learners

We all desire to evaluate our students fairly and consistently but clinical evaluation remains highly subjective. Individual programs often develop and implement their own evaluation tools without establishing validity or interrater reliability (Leighton et al., 2021; Lewallen & Van Horn, 2019). Establishing interrater reliability for clinical evaluations should improve consistency among faculty when evaluating a group of learners as it is important that we evaluate students similarly and set similar expectations for passing a clinical rotation.

A further concern is that educators have been found to pass students clinically if they are uncertain of whether the student should pass, particularly if there is inadequate time for assessment (Hughes et al., 2019). Novice educators especially could benefit from the clearly defined guidelines and rater education provided during the process of establishing interrater reliability.

Interrater Reliability for Better Communication between Educators

Consistency in assessment and communication of findings is as important in education as it is in health care.  Establishing interrater reliability for clinical evaluation improves communication of students’ abilities to other educators. When a nurse receives a handoff report on a client, priorities for care are clear and apparent because both assessment techniques and terminology are standardized. Establishing reliability and standardizing language allow for clear, objective description of student performance (Altmiller, 2019; Kopp, 2018), enabling  educators to tailor the learners’ subsequent clinical experiences to their individual strengths and areas requiring remediation. 

Interrater Reliability for Stronger Clinical Outcomes Data

Nursing education research requires interrater reliability for meaningful assessment of clinical education outcomes. Statistically validated instruments have been a requirement for research in the simulation setting for some time (Adamson & Kardong-Edgren, 2012) and are increasingly being recommended for clinical evaluation as well (Holland et al., 2020; Leighton et al., 2021, Lewallen & Van Horn, 2019). If nurse educators use validated tools to establish interrater reliability before evaluating learners’ clinical performance, any data collected may also be used to quantitatively evaluate the impacts of new learning strategies or curricular innovations. These findings can be used to strengthen the body of evidence on clinical outcomes and clinical competence, two areas where much additional research has been recommended.

Conclusion

Whether you are an experienced clinician transitioning to the nurse educator role or a seasoned educator who wants clinical evaluation to feel a little less subjective, interrater training among your teaching team can strengthen your clinical evaluation of learners. Evaluation tools that are instructor-friendly with clearly defined criteria are essential. Competencies established by the National League for Nursing (NLN, n.d.) for academic and clinical nurse educator emphasize effective, evidence-based evaluation of clinical learning. Establishing interrater reliability ensures all clinical educators interpret and apply evaluation criteria consistently, making evaluations both fair and learner centered.


References

Adamson, K.A., & Kardong-Edgren, S. (2012). A method and resources for assessing the reliability of simulation evaluation instruments. Nursing Education Perspectives, 33(5), 334-339.

Altmiller, G. (2019). Content validation of quality and safety education for nurses prelicensure clinical evaluation instruments. Nurse Educator, 44(3), 118-121.

Holland, A.E., Tiffany, J., Blazovich, L. Bambini, D., & Schug, V. (2020). The effect of evaluator training on inter- and intrarater reliability in high-stakes assessment in simulation. Nursing Education Perspectives, 41(4), 222-228. doi: 10.1097/01.NEP.0000000000000619

Hughes, L.J., Mitchell, M.L., & Johnston, A.N.B. (2019). Just how bad does it have to be? Industry and academic assessors’ experiences of failing to fail: A descriptive study.  Nurse Education Today, 76(2019), 206-215. https://doi.org/10.1016/j.nedt.2019.02.011

Kopp, M.L. (2018). A standardized clinical performance grading rubric: Reliability assessment. Journal of Nursing Education, 57(9), 544-548. doi: 10.3928/01484834-20180815-06.

Leighton, K., Kardong-Edgren, S., McNelis, A.M., Foisy-Doll, C., & Sullo, E. (2021). Traditional clinical outcomes in prelicensure nursing education: An empty systematic review. Journal of Nursing Education, 60(3), 136-142.

Lewallen, L.P., & Van Horn, E.R. (2019). The state of the science on clinical evaluation in nursing education. Nursing Education Perspectives, 40(1), 4-10.

doi: 0.1097/01.NEP.0000000000000376

National League for Nursing. (n.d.) Nurse educator core competencies. http://www.nln.org/professional-development-programs/competencies-for-nursing-education/nurse-educator-core-competency

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