Rita Kennedy: case analysis for decision-making Vivian Wood and Sandra Rubin
For nurse educators, the teaching environment has changed drastically. During the past two decades, the pressures of public, professional and educational accountability have impacted on the nursing instructor. Clinical teaching of student nurses has not escaped these pressures and poses concerns for nursing instructors. The Rita Kennedy case illustrates some of today’s issues. To illustrate some of the difficulties in dealing with such issues, the case will be analysed using the Schnelle’s model. Although Schnelle’s framework was initially used for analysis for business cases, the framework for analysis and decision-making is also applicable in nursing education. The following analysis will first discuss assumptions, followed by an alternative course of action, decision and recommendation. However, to assist understanding, the information in the Kennedy case has been categorised in the Table.
RITA KENNEDY: EVENTS After
a year
Kennedy Nursing
withdrew because
registered applied Nursing.
programme,
from the Glacier
of academic
failures,
from high anxiety.
the school following
ation. Three
encountered
OF
School
Rita of
claiming Kennedy
high school gradu-
years later she was employed
as a
nursing assistant. At the age of 26, she for
readmission
She provided
met the admission
study
skills
to Glacier
School
letters of reference
requirements,
although
problems,
passed all the courses in Term failed one course.
in a nursing
that they resulted entered
A SUMMARY
of and her
became Terms
At the end of’ Term
ill and missed
Kennedy
Kennedy
1. In Term
her clinical
II she II she
experience.
had been working on weekends during
I and II. When Term
still ill and absent experience.
III began, she was
and had missed
The Progression
May to discuss the alternative (Gabourey 198.4). Examination of the Table
her clinical
Committee options
suggests
met in for her
that Ken-
nedy is a high risk student, but is stronglv motivated to complete the programme.
grades were low. After passing a medical examination,
she
was
readmitted.
Although
she
High-risk Reed
Vivian Wood RN BScN MEd, Professor, Faculty of Nursing, The University of Western Ontario, London, Ontario N6A 5C1, Canada, Sandra Rubin RN BScN MScN, Expanded Role Nurse, University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada (Requests for offprints to VW) Manuscript accepted 24 September 1991
and Hudepohl
(1983)
defined
the high-
risk student as ‘one who for one or more reasons may not be able to accomplish
the necessary
learning’. Inadequate academic preparation Although Kennedy met the minimal
education 19
Illness
Fig 1 Rita Kennedy: High-risk student
requirements for admission, her high school average was low. High school grades are considered to be the best predictor of future success (De Tornyay & Russell 1978). The fact that Kennedy encountered problems is not altogether surprising. At the beginning of the programme, Kennedy encoutered study difficulties thus supporting our high-risk hypothesis.
Kennedy failed one course, dropped her mark in another and, because of illness, missed many classes and all of her clinical experience. Her physician stated that her condition did not improve over the 4 months following Term II. At the beginning of Term III she was still absent from school. Nevertheless she continued to work part-time. She borrowed her classmates notes and prepared for the examinations. Her poor health may be a chronic problem. Recovery could be inhibited by the stress of studies (Davidhizar 1985). Previous failtire
Litwack, Lint and Bower (1985) stated that students who have previously failed have an increased risk of failing again. The Chairman of
Table Categorization of data: a summary Organizational
Facts
Operating
College: Curriculum: Psychosocial, biophysical, nursing sciences, and humanities. Practice: Year 1 - community Year 2 - hospital.
and hospital
Kennedy: 26 years old, lives alone, full-time student, works part-time as registered nursing assistant on weekends.
Past Action Past Action Facts
Facts
Admission: Grade XII diploma, with 2 science courses in Grade Xl & XII. No readmission
policy.
Promotion: Nursing science - C in theory and practice Pass mark in all courses Failure in nursing science theory or practice results in repeat or withdrawal. No written policy re sick time Appeals: May appeal decision of promotion committee. Counsellor identified study skill problems
Kennedy admitted to nursing programme: withdrew after 1 year due to academic failure. Experienced high level of anxiety Kennedy worked as RNA for 3 years Readmitted to nursing programme. Letters of reference -work performance satisfactory. Passed medical examination. Term I - Passed all courses, no practice Term II - Failed psychosocial science, English mark dropped, no practice Nursing Science - B both terms Absences - Unwell end of term II and missed classes Hospitalised for 1 month around Christmas (fever). Permission of Doctor to attend classes in January. End of Term II -condition same, missed classes but kept up by borrowing notes Instructor comments Conscientious, participated, overwhelmed by anxiety at times, missed many classes but examination results were good Term Ill - Still absent due to illness
NURSE EDU(:A’I’ION
the Nursing failure
Department
attributed
in the first nursing
programme
high anxiety
which she had exhibited.
her
instructors
current
Kennedy
had
to the One of
commented
was at times overwhelmed
(Malarkey
gression criteria,
Kennedy’s
that
by anxiety
experience
having missed her clinical
and having failed one course.
Advantages Save faculty
the inconvenience
clinical schedules
1979).
of rearranging
to accommodate
Kennedy.
Save time and money since Kennedy ably fail in the long run - poor
Role overload While a full-time work part-time De Tornyay impossible
student,
Kennedy
as a registered
and Russell for a nursing
continued
nursing
(1978) student
state that it is to work during
the school year, maintain
the necessary standards
grades
for clinical
for many students summarises
as a barrier
(Hooper
1987).
to success
The
Figure
Remove the stress of school so that Kennedy
Evidence
correlates
(Davidhizar
1985).
with
passing
consistent
is
Kennedy
was highly
registered
nurse.
motivated
to become
She had worked
a
as a nursing
assistant for 3 years and found the work within her capabilities.
Her work references
good. She had gained sufficient the nursing
quent absences
were very
confidence
to try
programme.
ability to comIn spite of fre-
due to illness, she kept-up,
nursing
examinations
Disadvantages Loss of potentially motivated,
good
enthusiastic,
nurse
-
Kennedy
experienced
and
done well academically. Class morale
rnay suffer
- ma\’ feel dismissal
and
did
main-
Devastating increased
to Kennedy
anxiety
to fail again - may cause
and lessen self-esteem.
Dismissal could be grieved - violation of human
tained a B average in nursing theory during both
rights, no stated policy with regard
terms.
due to illness (Litwack et al 1985).
to absences
Loss of a year’s salary and school expenses nothing
THE PROBLEM Progression
cision. Should
Kennedy
must make
a de-
be allowed to continue?
She has not met the progression requirements. Illness continues to keep her from classes and clinical experiences.
Several courses of action are
available. The options and their advantages disadvantages
and
are listed.
Absence illness.
She
course
work
Term
I. Require
that Kennedy
programme.
withdraw
science)
She does not meet the pro-
would
he exempt
in Term
from the from
I, but re-enter
the in
II. to rest and
- at that time the only school work
II will be limited from the
take a Leave of
Advantages Kennedy will have until September recuperate
courses of action
that Kennedy
until she fully recovers
she will be required
Alternative
with
to show for it.
2. Recommend
Committee
is has
unfair.
course again.
I she demonstrated
plete the nursing
The
can
well.
requirements.
Motivation
well on the
to getting
that sick time as a student
Dismissal
In Term
illness, failed pre-
More time for faculty to spend with students who
with sick time as an employee
the above discussion.
to complete
ongoing
are succeeding.
devote her energy
work. Lack of time to study due to job commitments has been identified
marks deteriorating,
will prob-
study habits,
viously.
assistant.
and perform
at accepted
to
2 1
TODAY
to do is her practical. to one course
and practical.
This
reduced
will be less stressful and decrease relapse of her illness.
Term
(psychosocial workload
likelihood
of
22
NURSE EDUCATION
Kennedy
TODAY
will not be required
to repeat courses
Will preserve
those
her self-esteem.
graduate
1 year
behind
her
to adjust
to a new
group
of
classmates. may
practice
have since
difficulty
applying
she will have
taken
theory
to
the theory
of the nursing class a year before
the
faculty
time will be required
her clinical performance
to monitor
to ensure application
of
inherent
of
theory to practice. she
does
not
3. Recommend
capability
that
the inevitable.
Kennedy
whole of Year I commencing
repeat
the
in September.
the
programme
opportunity and
repeat
to continue missed
in the
practice
and
failed courses. concurrent
with practice
will enhance
applicability. Gradual
increase
build confidence,
in workload reduce
will reduce
likelihood
stress,
of serious
relapse of illness. Will allow time for part-time job - Kennedy save money and attend
school full-time
can
for her
last year without working.
reduce attrition
repeating
nursing
theory
when she has already passed the theory courses. Will graduate
1 year after her classmates.
Will have to adjust to a new class.
to eliminate
services and additional pro-
as factors
students.
influencing
Greater
support
services
on college
nursing
faculty with student (Stephenson
the
utilisation
of
campuses
to assist
problems
has been
1978).
students present a particular
lenge to educators. that
to
manda-
advising and competent
effective
required
or treat
designed
good
counselling
recommended
of
have
identified
teaching,
chal-
Reed and Hudepohl(1985) all
readmitted
students
be
to accept a faculty advisor as a condi-
tion of readmission.
They claimed an increase
in
the pass rate from 50 to 85% for all readmitted after institution
of an advisement
gram. Wood and Cook identified
pro-
several factors
involved in the success or failure after re-entry nursing
school:
original
nursing
physical _
health,
programme,
life
to
goals,
understanding
theory,
emotional
suitability and scholastic achievement.
They
stated
contribute
clinical
skills,
of
nursing
that lack of a re-entry
to problems
encountered
and faculty. Written
guidelines
assist in recognition
of potential
facilitate their prevention The Chairman perception
may resent
and failure
rates have incorporated
fessional
suggested
failure. selection
to their retention
study skills classes. Stark (1978)
of
of
from
Programmes
of
initiative, policy can by students
for readmission problems
and
(Wood & Cook 1982).
should meet with Kennedy
discuss the committee’s
Disadvantages Kennedy
at risk
of drop-out
these causes described.
students
Advantages
Theory
are
has shifted
of students
Causes
Readmitted have
passing, a leave will only postpone
Provides
students.
retention
practical experience.
If
who
the focus
tory advisors, counselling
component
Extra
examined, to eliminate
applicants
have
been studied and methods
will need
She
been
and revised in an attempt
and admission
will
classmates. She
policies
Recently,
Disadvantages Kennedy
Admission critiqued
she has already _ passed.
her
concerns
to
and to elicit her
performance
and
future
plans. If she wishes to continue
in nursing,
then
alternative
However,
if she
number
has any hesitation then
number
2 is feasible. regarding
1 should
instance
Kennedy
nursing
was her career
be
convinced
her career pursued.
goals, In
the Chairman
goal. Her course
this that prob-
DISCUSSION
lems were blamed on her illness. Kennedy pointed out that her nursing course work in Term I was acceptable. She was strongly moti-
High attrition rates in schools of nursing have received much attention in the literature.
vated and the instructors had noted that she was ‘conscientious’ and ‘enthusiastic’.
NLIKSF. EDL’(:A
A judgement
call was made as to her capabili-
ties and she was granted following
conditions
1. Kennedy until
The
were made.
was granted
she had
illness.
a Leave of Absence.
fully
A doctor’s
a leave of absence recovered
letter
from
her
would be neces-
sary, confirming her ability to function the classroom and in the clinical area.
in
2. Kennedy was told to terminate her parttime employment. Data for financial assistance could be provided. 3. A nursing academic counsellor
was appoin-
ted. This move was critical for her success (Hudepohl ings about
& Reed
are
1984).
necessary
course
to
Regular
discuss
work or clinical
meet-
concerns experience
and to identify any problems.
These
ings
to refer
provide
opportunities
meetthe
client to support services for assistance with study skill problems advisable.
if the advisor deems it
Malarkey
that counselling ing anxiety
(1979)
pointed
can be effective
and building
out
in reduc-
a positive
self-
image. She stated that as the student grows, there is a gradually developing stability and a lessening of anxiety. 4. Kennedy was assessed re-entry
at the time of her
to the programme.
completed
her
first
Although
two nursing
courses with a B average,
she
theory
a year has passed
since she took them. The clinical instructor will need to assess her knowledge ability
to apply
Decisions
it in the clinical
at re-entry
performance monitored
and her setting.
and her subsequent
in the clinical setting will be closely.
CONCLUSION What could have been done to assist Kennedy? Her performance
and frequent
attributed
to illness.
attempted
to continue
For her
absences
several
can be
months
part-time
job
she and
school work in spite of ill health. She was allowed
\ET
B
to continue
TODAY
I‘lOii
2.‘1
with class work even though she was
unable to participate
in the clinical component
the nursing
Absenteeism
is particularly
experience
is an integral
critical
course.
when clinical
part of the nursing student’s education
of
(Wood 8c
Cook 1982). If there had been a policy indicating the amount of time a student could miss and still continue
in the
programme
then
Kennedy’s
situation would have been more clear-cut. instance
the progression
give Kennedy riders.
What
from
the employment
committee
.a Leave of Absence happened? programme. as a registered
and did not return
In this
decided
to
\+ith several
Kennedy
withdrew
She continued nursing assistant,
to the programme.
References Davidhizar R 1985 Rates of absence an~cmg nurses. Hospital Topics 63. 3: 34-38 De Tornyay R, Russell M 197X Helping the high-risk student achieve. Nursing Outlook 26: 576-580 C’abourer , D 1984 Rita Kennedy In: Wood V (ed) Student nurse issues. A case hook. L(mdon. Ontario: The University of Western Ontario Hooper J 1987 Motivations. harriers. and support svstcms of ADN students. Nurse Edtc~ator 12. 2: lti. 2‘6 Hudepohl N. Reed S 1984 High-risk nursing students, Part 2. Establishing a student retention program. Nurse Educator 9, 3: 19-24 Litwack 1.. Lint 1, Bower D 19X5 Evaluation irt nursing principles and practice (Pub. No. I .i- 1976). New York: National League for Nursing Malarkey L 1979 The older student - stres% ot- success on campus. Journal of Nursmg Edwation 18. 2:
I .‘- I $1 Reed S, Hudepohl N 1983 High-risk nursing students: Emergence of remedial/development programs. Nursing Educator 8,4: 21-26 Reed S. Hudepohl N 19% High-risk students. Part 9. Evaluating a student retention program Nurse Educator 10, 5: 32-38 Schnelle K E 196:’ Case analysis and bllsiness problem solving. TOI-onto: McGraw-Hill Stark,] 1978 Students are our business. In: Promoting student retention in a nursing program (Pub. No. 2% 1705). New York: National League for Nursing: 1 I-18 Stephenson P 19i8 Partnerships tor student retention. In: Promoting student retention in ;I nursing pt-ogram (Pub. No. 23.1705). Neb 1 (Irk: National League for Nut-sing: l-10 Wood V. Cook C: 1982 Dropping out dnd dropping in. ?‘he Canadian Uursing. May: 34-37
For nurse educators, the teaching environment has changed drastically. During the past two decades, the pressures of public, professional and educational accountability have impacted on the nursing instructor. Clinical teaching of student nurses has not escaped these pressures and poses concerns for nursing instructors. The Rita Kennedy case illustrates some of today’s issues. To illustrate some of the difficulties in dealing with such issues, the case will be analysed using the Schnelle’s model. Although Schnelle’s framework was initially used for analysis for business cases, the framework for analysis and decision-making is also applicable in nursing education. The following analysis will first discuss assumptions, followed by an alternative course of action, decision and recommendation. However, to assist understanding, the information in the Kennedy case has been categorised in the Table.
RITA KENNEDY: EVENTS After
a year
Kennedy Nursing
withdrew because
registered applied Nursing.
programme,
from the Glacier
of academic
failures,
from high anxiety.
the school following
ation. Three
encountered
OF
School
Rita of
claiming Kennedy
high school gradu-
years later she was employed
as a
nursing assistant. At the age of 26, she for
readmission
She provided
met the admission
study
skills
to Glacier
School
letters of reference
requirements,
although
problems,
passed all the courses in Term failed one course.
in a nursing
that they resulted entered
A SUMMARY
of and her
became Terms
At the end of’ Term
ill and missed
Kennedy
Kennedy
1. In Term
her clinical
II she II she
experience.
had been working on weekends during
I and II. When Term
still ill and absent experience.
III began, she was
and had missed
The Progression
May to discuss the alternative (Gabourey 198.4). Examination of the Table
her clinical
Committee options
suggests
met in for her
that Ken-
nedy is a high risk student, but is stronglv motivated to complete the programme.
grades were low. After passing a medical examination,
she
was
readmitted.
Although
she
High-risk Reed
Vivian Wood RN BScN MEd, Professor, Faculty of Nursing, The University of Western Ontario, London, Ontario N6A 5C1, Canada, Sandra Rubin RN BScN MScN, Expanded Role Nurse, University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada (Requests for offprints to VW) Manuscript accepted 24 September 1991
and Hudepohl
(1983)
defined
the high-
risk student as ‘one who for one or more reasons may not be able to accomplish
the necessary
learning’. Inadequate academic preparation Although Kennedy met the minimal
education 19
Illness
Fig 1 Rita Kennedy: High-risk student
requirements for admission, her high school average was low. High school grades are considered to be the best predictor of future success (De Tornyay & Russell 1978). The fact that Kennedy encountered problems is not altogether surprising. At the beginning of the programme, Kennedy encoutered study difficulties thus supporting our high-risk hypothesis.
Kennedy failed one course, dropped her mark in another and, because of illness, missed many classes and all of her clinical experience. Her physician stated that her condition did not improve over the 4 months following Term II. At the beginning of Term III she was still absent from school. Nevertheless she continued to work part-time. She borrowed her classmates notes and prepared for the examinations. Her poor health may be a chronic problem. Recovery could be inhibited by the stress of studies (Davidhizar 1985). Previous failtire
Litwack, Lint and Bower (1985) stated that students who have previously failed have an increased risk of failing again. The Chairman of
Table Categorization of data: a summary Organizational
Facts
Operating
College: Curriculum: Psychosocial, biophysical, nursing sciences, and humanities. Practice: Year 1 - community Year 2 - hospital.
and hospital
Kennedy: 26 years old, lives alone, full-time student, works part-time as registered nursing assistant on weekends.
Past Action Past Action Facts
Facts
Admission: Grade XII diploma, with 2 science courses in Grade Xl & XII. No readmission
policy.
Promotion: Nursing science - C in theory and practice Pass mark in all courses Failure in nursing science theory or practice results in repeat or withdrawal. No written policy re sick time Appeals: May appeal decision of promotion committee. Counsellor identified study skill problems
Kennedy admitted to nursing programme: withdrew after 1 year due to academic failure. Experienced high level of anxiety Kennedy worked as RNA for 3 years Readmitted to nursing programme. Letters of reference -work performance satisfactory. Passed medical examination. Term I - Passed all courses, no practice Term II - Failed psychosocial science, English mark dropped, no practice Nursing Science - B both terms Absences - Unwell end of term II and missed classes Hospitalised for 1 month around Christmas (fever). Permission of Doctor to attend classes in January. End of Term II -condition same, missed classes but kept up by borrowing notes Instructor comments Conscientious, participated, overwhelmed by anxiety at times, missed many classes but examination results were good Term Ill - Still absent due to illness
NURSE EDU(:A’I’ION
the Nursing failure
Department
attributed
in the first nursing
programme
high anxiety
which she had exhibited.
her
instructors
current
Kennedy
had
to the One of
commented
was at times overwhelmed
(Malarkey
gression criteria,
Kennedy’s
that
by anxiety
experience
having missed her clinical
and having failed one course.
Advantages Save faculty
the inconvenience
clinical schedules
1979).
of rearranging
to accommodate
Kennedy.
Save time and money since Kennedy ably fail in the long run - poor
Role overload While a full-time work part-time De Tornyay impossible
student,
Kennedy
as a registered
and Russell for a nursing
continued
nursing
(1978) student
state that it is to work during
the school year, maintain
the necessary standards
grades
for clinical
for many students summarises
as a barrier
(Hooper
1987).
to success
The
Figure
Remove the stress of school so that Kennedy
Evidence
correlates
(Davidhizar
1985).
with
passing
consistent
is
Kennedy
was highly
registered
nurse.
motivated
to become
She had worked
a
as a nursing
assistant for 3 years and found the work within her capabilities.
Her work references
good. She had gained sufficient the nursing
quent absences
were very
confidence
to try
programme.
ability to comIn spite of fre-
due to illness, she kept-up,
nursing
examinations
Disadvantages Loss of potentially motivated,
good
enthusiastic,
nurse
-
Kennedy
experienced
and
done well academically. Class morale
rnay suffer
- ma\’ feel dismissal
and
did
main-
Devastating increased
to Kennedy
anxiety
to fail again - may cause
and lessen self-esteem.
Dismissal could be grieved - violation of human
tained a B average in nursing theory during both
rights, no stated policy with regard
terms.
due to illness (Litwack et al 1985).
to absences
Loss of a year’s salary and school expenses nothing
THE PROBLEM Progression
cision. Should
Kennedy
must make
a de-
be allowed to continue?
She has not met the progression requirements. Illness continues to keep her from classes and clinical experiences.
Several courses of action are
available. The options and their advantages disadvantages
and
are listed.
Absence illness.
She
course
work
Term
I. Require
that Kennedy
programme.
withdraw
science)
She does not meet the pro-
would
he exempt
in Term
from the from
I, but re-enter
the in
II. to rest and
- at that time the only school work
II will be limited from the
take a Leave of
Advantages Kennedy will have until September recuperate
courses of action
that Kennedy
until she fully recovers
she will be required
Alternative
with
to show for it.
2. Recommend
Committee
is has
unfair.
course again.
I she demonstrated
plete the nursing
The
can
well.
requirements.
Motivation
well on the
to getting
that sick time as a student
Dismissal
In Term
illness, failed pre-
More time for faculty to spend with students who
with sick time as an employee
the above discussion.
to complete
ongoing
are succeeding.
devote her energy
work. Lack of time to study due to job commitments has been identified
marks deteriorating,
will prob-
study habits,
viously.
assistant.
and perform
at accepted
to
2 1
TODAY
to do is her practical. to one course
and practical.
This
reduced
will be less stressful and decrease relapse of her illness.
Term
(psychosocial workload
likelihood
of
22
NURSE EDUCATION
Kennedy
TODAY
will not be required
to repeat courses
Will preserve
those
her self-esteem.
graduate
1 year
behind
her
to adjust
to a new
group
of
classmates. may
practice
have since
difficulty
applying
she will have
taken
theory
to
the theory
of the nursing class a year before
the
faculty
time will be required
her clinical performance
to monitor
to ensure application
of
inherent
of
theory to practice. she
does
not
3. Recommend
capability
that
the inevitable.
Kennedy
whole of Year I commencing
repeat
the
in September.
the
programme
opportunity and
repeat
to continue missed
in the
practice
and
failed courses. concurrent
with practice
will enhance
applicability. Gradual
increase
build confidence,
in workload reduce
will reduce
likelihood
stress,
of serious
relapse of illness. Will allow time for part-time job - Kennedy save money and attend
school full-time
can
for her
last year without working.
reduce attrition
repeating
nursing
theory
when she has already passed the theory courses. Will graduate
1 year after her classmates.
Will have to adjust to a new class.
to eliminate
services and additional pro-
as factors
students.
influencing
Greater
support
services
on college
nursing
faculty with student (Stephenson
the
utilisation
of
campuses
to assist
problems
has been
1978).
students present a particular
lenge to educators. that
to
manda-
advising and competent
effective
required
or treat
designed
good
counselling
recommended
of
have
identified
teaching,
chal-
Reed and Hudepohl(1985) all
readmitted
students
be
to accept a faculty advisor as a condi-
tion of readmission.
They claimed an increase
in
the pass rate from 50 to 85% for all readmitted after institution
of an advisement
gram. Wood and Cook identified
pro-
several factors
involved in the success or failure after re-entry nursing
school:
original
nursing
physical _
health,
programme,
life
to
goals,
understanding
theory,
emotional
suitability and scholastic achievement.
They
stated
contribute
clinical
skills,
of
nursing
that lack of a re-entry
to problems
encountered
and faculty. Written
guidelines
assist in recognition
of potential
facilitate their prevention The Chairman perception
may resent
and failure
rates have incorporated
fessional
suggested
failure. selection
to their retention
study skills classes. Stark (1978)
of
of
from
Programmes
of
initiative, policy can by students
for readmission problems
and
(Wood & Cook 1982).
should meet with Kennedy
discuss the committee’s
Disadvantages Kennedy
at risk
of drop-out
these causes described.
students
Advantages
Theory
are
has shifted
of students
Causes
Readmitted have
passing, a leave will only postpone
Provides
students.
retention
practical experience.
If
who
the focus
tory advisors, counselling
component
Extra
examined, to eliminate
applicants
have
been studied and methods
will need
She
been
and revised in an attempt
and admission
will
classmates. She
policies
Recently,
Disadvantages Kennedy
Admission critiqued
she has already _ passed.
her
concerns
to
and to elicit her
performance
and
future
plans. If she wishes to continue
in nursing,
then
alternative
However,
if she
number
has any hesitation then
number
2 is feasible. regarding
1 should
instance
Kennedy
nursing
was her career
be
convinced
her career pursued.
goals, In
the Chairman
goal. Her course
this that prob-
DISCUSSION
lems were blamed on her illness. Kennedy pointed out that her nursing course work in Term I was acceptable. She was strongly moti-
High attrition rates in schools of nursing have received much attention in the literature.
vated and the instructors had noted that she was ‘conscientious’ and ‘enthusiastic’.
NLIKSF. EDL’(:A
A judgement
call was made as to her capabili-
ties and she was granted following
conditions
1. Kennedy until
The
were made.
was granted
she had
illness.
a Leave of Absence.
fully
A doctor’s
a leave of absence recovered
letter
from
her
would be neces-
sary, confirming her ability to function the classroom and in the clinical area.
in
2. Kennedy was told to terminate her parttime employment. Data for financial assistance could be provided. 3. A nursing academic counsellor
was appoin-
ted. This move was critical for her success (Hudepohl ings about
& Reed
are
1984).
necessary
course
to
Regular
discuss
work or clinical
meet-
concerns experience
and to identify any problems.
These
ings
to refer
provide
opportunities
meetthe
client to support services for assistance with study skill problems advisable.
if the advisor deems it
Malarkey
that counselling ing anxiety
(1979)
pointed
can be effective
and building
out
in reduc-
a positive
self-
image. She stated that as the student grows, there is a gradually developing stability and a lessening of anxiety. 4. Kennedy was assessed re-entry
at the time of her
to the programme.
completed
her
first
Although
two nursing
courses with a B average,
she
theory
a year has passed
since she took them. The clinical instructor will need to assess her knowledge ability
to apply
Decisions
it in the clinical
at re-entry
performance monitored
and her setting.
and her subsequent
in the clinical setting will be closely.
CONCLUSION What could have been done to assist Kennedy? Her performance
and frequent
attributed
to illness.
attempted
to continue
For her
absences
several
can be
months
part-time
job
she and
school work in spite of ill health. She was allowed
\ET
B
to continue
TODAY
I‘lOii
2.‘1
with class work even though she was
unable to participate
in the clinical component
the nursing
Absenteeism
is particularly
experience
is an integral
critical
course.
when clinical
part of the nursing student’s education
of
(Wood 8c
Cook 1982). If there had been a policy indicating the amount of time a student could miss and still continue
in the
programme
then
Kennedy’s
situation would have been more clear-cut. instance
the progression
give Kennedy riders.
What
from
the employment
committee
.a Leave of Absence happened? programme. as a registered
and did not return
In this
decided
to
\+ith several
Kennedy
withdrew
She continued nursing assistant,
to the programme.
References Davidhizar R 1985 Rates of absence an~cmg nurses. Hospital Topics 63. 3: 34-38 De Tornyay R, Russell M 197X Helping the high-risk student achieve. Nursing Outlook 26: 576-580 C’abourer , D 1984 Rita Kennedy In: Wood V (ed) Student nurse issues. A case hook. L(mdon. Ontario: The University of Western Ontario Hooper J 1987 Motivations. harriers. and support svstcms of ADN students. Nurse Edtc~ator 12. 2: lti. 2‘6 Hudepohl N. Reed S 1984 High-risk nursing students, Part 2. Establishing a student retention program. Nurse Educator 9, 3: 19-24 Litwack 1.. Lint 1, Bower D 19X5 Evaluation irt nursing principles and practice (Pub. No. I .i- 1976). New York: National League for Nursing Malarkey L 1979 The older student - stres% ot- success on campus. Journal of Nursmg Edwation 18. 2:
I .‘- I $1 Reed S, Hudepohl N 1983 High-risk nursing students: Emergence of remedial/development programs. Nursing Educator 8,4: 21-26 Reed S. Hudepohl N 19% High-risk students. Part 9. Evaluating a student retention program Nurse Educator 10, 5: 32-38 Schnelle K E 196:’ Case analysis and bllsiness problem solving. TOI-onto: McGraw-Hill Stark,] 1978 Students are our business. In: Promoting student retention in a nursing program (Pub. No. 2% 1705). New York: National League for Nursing: 1 I-18 Stephenson P 19i8 Partnerships tor student retention. In: Promoting student retention in ;I nursing pt-ogram (Pub. No. 23.1705). Neb 1 (Irk: National League for Nut-sing: l-10 Wood V. Cook C: 1982 Dropping out dnd dropping in. ?‘he Canadian Uursing. May: 34-37
