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A report released by the Institute of Medicine (IOM, 2003) informs us that "nurses and other health professionals are not being adequately prepared to provide the highest quality and safest care possible, and there is insufficient assessment of their proficiency" (p. 1). In response there has been much attention dedicated to curricular and teaching methodology reform, but unfortunately the development of sound clinical evaluation methods has often been an afterthought. This raises the question: In nursing education, is the dog wagging the tail or is the tail wagging the dog?
Serious attention needs to be devoted to reducing educational inconsistencies by linking the essential outcomes required for a degree in nursing with clinical evaluation outcomes in order for nurse educators to be accountable to their students, patients, and society (Holaday, 2004, 2006; Holaday, Buckley, & Miklancie, 2006). Although curricular requirements are similar in nursing schools throughout the United States, there is little consistency in expected outcomes that are assessed in the clinical setting and the methods used for evaluating them. Often, faculty rely on personal perceptions and instincts about expectations in the clinical setting, resulting in much variation. Variation in expected clinical outcomes leads to variation in actual clinical outcomes and proficiency. Therefore, the variations and inconsistencies of assessment and evaluation in the clinical setting are strongly linked to the inadequate preparation of nurses in general.
Factors that partly contribute to the variations in clinical evaluation are the differences in clinical settings, patient populations, and experiences. However, the greatest contribution is associated with a lack of standardized clinical outcomes and instruments to measure those outcomes, confounded by the difficufty of measuring the subjective variables inherent in any clinical environment. Nevertheless, the need to evafuate the safety and competency of nursing students in the clinical setting remains, regardless of probfems associated with doing so. If the assumption is that the performance that is assessed and measured in the ciinicai setting should tightly afign with expected outcomes, then we must bridge the gap of variations and inconsistencies in the ciinicai setting with standardized outcomes, and strengthen the evaluation methods of those outcomes, to ensure that our nurse graduates are equipped with the knowfedge and skiffs necessary to practice as competent health care professionals.
Nurse educators must...