bluff or brilliance - assessment that is more than skin deep

I’ve been reading an article about assessment of clinical practice (Chambers 1998) and it’s left me feeling quite encouraged. It isn’t just me who has problems with how best to assess – no one really has a clue about the best way to provide reliable and valid assessment in the clinical setting! Admittedly this article is from 1998 and more thought has gone into the topic since then, but here is a literature review that cannot describe the best way to assess nursing practice.

One interesting point in the article is that many nurses feel that overconfidence of a student or beginning level practitioner suggests unsafe practice or incompetence.

I’ve been caught out by this one before. It was only towards the end of one graduate’s six month placement that I realised their practice was based on bluff and bravado. They seemed to know the answer to lots of questions, or at least their withering tone of voice suggested they knew everything (“do you really think it’s necessary to ask me these questions when I obviously know the answers?!”). However in the cold light of day, their practice wasn’t up to scratch. By the time I finally saw through the bluff and recognised their incompetence it was too late - they only had a week or two left on the ward.

Interestingly I have an overconfident graduate under my care at the moment. Again they are full of answers, but in this case they are also derisive in their attitude to more experienced staff on the ward. I’m continually hearing about the way other nurses don’t know the answer to any of the questions they ask. I suppose the good thing is that the graduate then sniffs out policies and procedures to find the answer for themselves – but it’s the attitude that bothers me. It’s almost as if they feel invincible – “I don’t trust anything anyone tells me because I must find the answers on my own”. No one in nursing is invincible – we all come a cropper with some silly mistake at some point, usually when we thought we were most invincible!

This particular graduate is only half way through their placement, so I have time to investigate and intervene. I’ve worked with them once, but because I struggle to stand back and be a detached observer I’ve not seen what they do when working completely independently. I think it’s time to pull out my best observer skills and seek out the truth of what’s going on here. Are they competent or are they employing a clever ruse?

Here I come to accurately assess exactly what this graduate is up to.

The article mentioned here is:
Chambers MA , 1998, "Some issues in the assessment of clinical practice: a review of the literature" in Journal of Clinical Nursing 7, 201-208