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Running head: DEVELOPMENT OF RUBRICS 1

Nurse Educator Proposal for the Development of Rubrics in the Clinical Setting

Erin Kibbey

Ferris State University

DEVELOPMENT OF RUBRICS 2

Abstract

The importance of measuring competency in the clinical setting is an important job for the nurse

educator, although a universal way of doing so has yet to be agreed upon. While rubrics have

traditionally been used in academia, they are much less commonly used for educating in the

hospital for future and new nurses. The creation and implementation of rubrics for use in the

clinical setting could provide a uniform method for documenting and evaluating competency.

This paper describes a proposed project involving the creation and implementation of rubrics for

use in the critical care internship program by preceptors and educators at a hospital in Traverse

City, Michigan. This paper further describes the project setting, preceptor, goals and objectives,

timeline of activities, and an evaluation tool. The project proposes to take place beginning

January, 13, 2014 and ending May 2, 2014.

Keywords: rubrics, clinical setting, competency, nurse educator


Nurse Educator Proposal for the Development of Rubrics in the Clinical Setting

As a future nurse educator, the ability to use assessment and evaluation techniques is an

important competency identified by the National League for Nursing (NLN, 2012). Developing

evidence-based assessment practices and implementing evaluation strategies appropriate to the

learner are also key to fulfillment of this competency (NLN, 2012). In order to help develop this

competency further, the proposed project, described throughout the rest of this paper, will take

place from January 13, 2014 to May 2, 2014. The proposed project involves the development

and implementation of rubrics for evaluating competency of nurses within the clinical setting.

The importance of documenting and measuring competency in the clinical setting cannot

be underestimated. However, the best way to accomplish this task has not been widely agreed

upon or established (Fahy et al., 2011). The degree of performance in the clinical setting can be

judged both qualitatively and quantitatively through the convenient use of a rubric form (Bonnel,

2012). Another issue associated with measuring competency in the clinical setting is that

measurement can be inconsistent and subjective amongst various evaluators (Bonnel, 2012).

Therefore, the purpose of the scholarly project described throughout the following proposal is to

establish a uniform method for documenting and evaluating clinical competence at a hospital in

northern Michigan, Munson Medical Center (MMC), through the development of rubrics.

Not only does the creation and implementation of rubrics have clinical importance, but

working on the proposed project will also help me gain experience in the assessment and

evaluation competency as defined by the NLN (2012). The purpose of this paper is to fully

describe the proposed project including setting, goals and objectives, preceptor, timeline, and

evaluation.


Setting

Although rubrics have been widely used in traditional academic settings, it has been used

less frequently as a tool in the clinical setting (Frentsos, 2013). Therefore, the proposed project

will take place in the hospital setting and be created for use by preceptors and interns in the

critical care internship program. Specifically, it is proposed that this project will occur at MMC,

in Traverse City. It is the largest hospital in northern Michigan and is comprised of 391 inpatient

beds (MMC, 2013).

The critical care internship is a five month program designed for nurses (either new

graduate nurses with some experience or newer nurses from non-critical care units) to provide

interns with the knowledge and skills to care for critical care patients upon completion of the

program (MMC, 2013). Candidates for the program require two years or less experience, letters

of recommendation, and a letter of intention. Applications for the spring 2014 class are currently

under review and interviews are set to take place in January. The spring internship class

officially begins in March.

The critical care interns spend the first few weeks rotating through the various critical

care units at MMC. Participating units in this program include: the emergency department (ED),

intensive care unit (ICU), cardiothoracic unit (A2), and the adult cardiac critically ill and cardiac

interventional unit (A3). The ED is a 43 bed unit and accredited as a level two trauma center.

The ICU is comprised of medical-surgical, trauma, and neurological patients. It contains 20 beds

including a progressive care area that also serves a variety of patients with multisystem

intricacies. Located in MMC’s Heart Center is A2, a 30 bed unit that provides care to

cardiothoracic surgical patients immediately post-operative until patient discharge. Lastly, A3 is

also located in MMC’s Heart Center and like A2 is a 30 bed unit that is acuity adaptable. The


ICU, A2, and A3 train nurses in the internship program to manage both critical and intermediate

care patients.

After the interns have been to the various units they are then assigned to a specific unit

for the remainder of the internship. As they continue in the rest of the internship program they

are oriented to their assigned unit by various preceptors that work on the unit. There is clinical

as well as didactic preparation included as part of the program (MMC, 2013). Moreover, there is

computer based education, skills labs, cases studies, simulation, and various critical thinking

experiences embedded into the program. The interns are overseen throughout the program by

the internship coordinator, Patti Hresko. Ms. Hresko is a master’s prepared nurse and will also

aid as my preceptor for assistance in the proposed project.

Identification of Preceptor

Preceptors assist not only as a teacher, but also as a coach (Ulrich, 2012). Preceptors

need to understand both the science of teaching as well as the art of teaching (Ulrich, 2012). I

believe I have selected a preceptor that is skilled in both of these areas. In addition, she is very

experienced and will be a good facilitator for my learning. The preceptor identified for the

proposed project, as previously mentioned, is Ms. Patti Hresko.

Ms. Hresko is the resource clinician and educator of MMC’s critical care internship

program. She is a master’s prepared nurse, although her degree is as a family nurse practitioner,

and she has been the coordinator and facilitator of the internship program for several years. She

also teaches a role transition class for new nurses that is required after about six months of

working at Munson. In addition, Ms. Hresko is certified as a critical care registered nurse

(CCRN) by the American Association of Critical-Care Nurses and continues to maintain her skill


set and knowledge by working in the intensive care unit at MMC once a week. She has been a

nurse for over ten years.

Since Ms. Hresko has experience working with various preceptors, unit managers, unit

educators, agency management, and the critical care interns for the last several years she is a key

stakeholder in the proposed project and will serve as a great facilitator. Her knowledge and

experience in implementing change within the critical care internship program will be

instrumental in helping guide me through the rubric implementation process. In addition, her

input and enthusiasm for the project will be valuable to helping the project succeed and

potentially carry on past the duration of the proposed project. Ms. Hresko can be reached by

telephone at 231-392-0193 or by email at [email protected]. Letters from both an MMC

representative, as well as Patti Hresko, stating approval of the proposed project are included in

Appendix A.

Goals, Objectives, and Activities

Background

Since there is no uniform measurement of clinical competence used throughout MMC, all

the interns in the critical care internship program are currently being evaluated using different

assessment practices, which has led to some difficulties in providing feedback between

preceptors, interns, and the internship coordinator (P. Hresko, personal communication,

September 5, 2012). The creation and use of rating scales or rubrics is supported by research in a

wide range of academic subjects including economics, writing, speech, dentistry, and

chiropractic medicine (McGoldrick & Peterson, 2013; O’Donnell, Oakley, Haney, O’Neill, &

Taylor, 2011; Rezaei & Lovorn, 2010; Saxton, Belanger, & Becker, 2012; Xiaohua & Canty,

2012). Although rubrics have been embraced throughout academia, nursing staff development


educators do not use rubrics consistently, instead they typically use the nursing skills checklist

(Frentsos, 2013).

Rubrics are defined as “scaled tools with levels of achievement and clearly defined

criteria placed in a grid. Rubrics establish clear rules for evaluation and define the criteria for

performance” (O’Donnell et al., 2011, p. 1163). Rubrics typically consist of three main parts

including a scale of the levels of performance, dimensions or criteria for evaluation, and a

description of the dimensions (O’Donnell et al., 2011). Rubrics are either holistic or analytical.

According to Kirkpatrick and DeWitt (2012), holistic rubrics are more globally scored and thus

typically focus on overall performance. Analytic rubrics, on the other hand, examine each

significant characteristic of performance. Depending on the type used, rubrics can provide

summative or formative evaluation of learning. Typically analytic rubrics are chosen for

formative evaluation and holistic rubrics are better suited for summative evaluation.

Despite the lack of consistent use of rubrics in clinical nursing education, rubrics have

many benefits. Rubrics support adult learning principles, provide competency documentation

required by regulatory agencies, can improve quality of care, allow more discrimination in

judging behaviors, and can increase knowledge gain through its use (Bonnel, 2012; Frentsos,

2013). It has also been noted by Bonnel (2012), that rating scales offer more detail about the

quality of a performance compared to nursing skill checklists. Further benefits of rubrics include

more specific guidance for graders, thus promoting reliability between graders, timely and

detailed feedback without superfluous writing, an opportunity to self-assess, and promotion of

clear communication for completion of skills using best practice (Bonnel, 2012; O’Donnell et al.,

2011; Walvoord & Anderson, 2010).


Rubric Creation

There are four main steps to creating a rubric according to Stevens and Levi (2005). The

first step involves reflection. The second step is listing and defining the specific learning

objectives. The third step consists of grouping similar components. The final step to rubric

creation is applying dimensions and descriptions.

Since the purpose of this project is to establish a uniform method for documenting and

measuring clinical competency through the use of rubrics, the first main goal of this project as

stated in Appendix B is to create the rubrics used for the critical care interns at MMC. In order

to achieve this goal several objectives were identified. The first objective related to this goal is

to obtain literature and references about rubrics. This objective was created as a first step to

understanding the creation of rubrics and how they may be best used in the specified setting.

Activities used to support this object will include a search of various databases, compilation of a

reference list, and a review of the literature.

The second objective is to perform a needs assessment. This coincides with Stevens and

Levi’s (2005) first step to rubric creation, reflection. Reflection takes into consideration what is

desired from the learner, why the assessment is being created, what type of rubric is needed, and

other issues associated with the construction of a rubric (O’Donnell et al., 2011). Since the

involvement of key stakeholders in the creation of rubrics can provide several benefits, according

to O’Donnell et al. (2011), collaboration is important during this stage. Thus, a needs

assessment tool will be created and distributed to preceptors and unit educators. Feedback from

these reflections as well as information gleaned from meeting with staff educators will be

utilized for the next step.


Since collaboration is so beneficial to the creation of rubrics, the formation of a

collaborative team for supplying input throughout the creation process is the third objective.

Some of the benefits of collaboration during this time is the opportunity to discuss differences

and clarify misunderstandings, take a sense of ownership, and increase the chances of creating

rubrics that everyone will accept (O’Donnell et al., 2011). Activities proposed to take place to

support this objective include identifying interested participants and key stakeholders, emailing

possible team members, and creating a forum for exchange of ideas.

The fourth objective related to the goal of developing rubrics is to determine the care

standards for the rubrics being created. This objective correlates with the second step of defining

the specific learning issues and level of performance to be accomplished with the creation of

rubrics. According to Stevens and Levi (2005), team members should decide whether the

assessment is about knowledge content, skills, or both. Taxonomy guides can be used during

this time to clarify specific objectives and defining the level and type of learning expected

(O’Donnell et al., 2011). Scales defining the level of performance usually include three to five

levels such as “excellent”, “competent”, and “needs work” (Kirkpatrick & DeWitt, 2012;

O’Donnell et al., 2011). Reviewing the standards of practice and any other application materials

needed for the development of specified learning objectives will be done at this time.

Collaboration and input from team members will also be sought as an activity to support this

objective.

The final objective is to completely develop the rubrics and a tool for feedback. During

this stage of rubric development, items with similar expectations for performance are put

together and form the rubric dimensions (O’Donnell et al., 2011). The performance or task being

evaluated is broken down into components during this step (Kirkpatrick & DeWitt, 2012). The


fourth and final step to rubric creation is application, or the creation of the rubric grid. The last

activity to support this objective is to evaluate the rubrics. A rubric should be easy to use and

interpret, valid and reliable, and fair (Bargainnier, 2003; O’Donnell et al., 2011; Stevens &

Levin, 2005). In order to make effective revisions to rubrics that are meant to be flexible and

adaptable tools, evaluation of the rubrics is required (Stevens & Levi, 2005). A metarubric is a

rubric used to evaluate rubrics (Stevens & Levi, 2005). In addition, metarubrics are for

individual use in refining the rubric details. A metarubric will be created for evaluation of

rubrics created.

Rubric Implementation

The second goal of this project is to implement the rubrics for use by the preceptors

working with the interns. In order to achieve the final third of this project, two more key

objectives were again identified (see Appendix B). The first objective is to present the rubrics to

preceptors. This objective is important because it relates to the reliability and validity of the

rubrics. Validity refers to ensuring that the performance questioned is the performance being

measured by the rubric (O’Donnell et al., 2011). On the other hand, reliability is concerned with

consistency of ratings across multiple performances. According to O’Donnell et al. (2011), it is

best to give the raters the rubrics prior to implementation in order to increase accuracy. Thus,

time will be spent with those that will be utilizing the rubrics prior to actual trialing of the rubrics

on the units. Education materials, including a PowerPoint will be created. A chance to ask

questions and role play will be afforded to those that will be using the rubrics. Opportunities for

discussion can lead to better consistency and possible modifications to the rubrics (O’Donnell et

al., 2011).


The final objective for the implementation stage is to obtain feedback. Feedback from

team members, preceptors, educators, interns, and Ms. Hresko will be compiled during this time.

Direct feedback from those mentioned as well as indirect feedback related to the quality of

performance associated with the rubrics will be collected. Rubrics can be used by facilitators to

identify areas of student strengths and weaknesses, assisting with both formative and summative

assessment (O’Donnell et al., 2011). Self-evaluation using the metarubric will also be included

as an activity to support this objective.

Theoretical Framework

Cognitive learning theory focuses on students taking an active role in learning (Candela,

2012). When taking an active role in learning students must be able to demonstrate what they

know (Bargainnier, 2003). Cognitive learning theory focuses on mental processes and

acquisition of knowledge and not just learning how to perform a task (Candela, 2012). This

central component of cognitive learning theory is the basis for the proposed project and the

reason for moving from a checklist to measure competency in the clinical setting to using rubrics

to measure learning. According to Marcotte (2006), “well-designed rubrics help instructors in all

disciplines meaningfully assess the outcomes of the more complicated assignments that are the

basis of the problem-solving, inquiry-based, student-centered pedagogy replacing the traditional

lecture-based, teacher-centered approach in tertiary education” (para 3). Thus, the use of rubrics

for assessment and evaluation emphasizes the application and use of knowledge, not just

measurement of isolated, discrete knowledge (Bargainnier, 2003). This emphasis is central to

cognitive learning theory and its constructivist approach to knowledge attainment.

A second theory providing a framework for the proposed project is Resnick’s self-

efficacy theory. Central to this theory is the belief that an individual can perform any given task


after observation and demonstration if they believe there is a positive effect (Peterson & Bredow,

2009). If there is a positive result the individual will be self-motivated to perform each task.

This theory is important to apply throughout the implementation stages of the proposed project.

Using this theory as a foundation during the implementation stages takes into consideration the

belief that people have more control over what they do when they choose how to behave (Liehr

& Smith, 2008). Thus, by providing education, including a demonstration of how to use the

rubrics and their benefits, to all those involved with the use of the rubrics, it is more likely that

there will be positive outcomes. Several nursing studies have used Resnick’s self-efficacy theory

when focused on interventions related to behavioral change (Liehr & Smith, 2008). Since the

implementation phase of the proposed project focuses on changing behaviors related to

evaluation and precepting, this theory will best serve as the guiding framework during this phase.

The theory of self-efficacy could also be utilized when considering the words used to

describe the levels of performance during rubric creation. According to Bargainnier (2003),

rubrics should focus on positive attainment of desired performance. Thus, positive language

associated with descriptions can provide positive guidance. The idea is central to the theory of

self-efficacy.

Timeline

In order to support the goals and objectives of the proposed project a timeline of the

previously mentioned activities was also created and included along with the goals and

objectives (see Appendix B). This timeline will serve as a guideline to all activities required for

successful completion of this project within the given timeframe. This project will start on

January 13, 2014 and be completed by May 2, 2014. The first goal was set to be completed by

March 28, 2014 due in part to the timing of the critical care internship. The critical care


internship is set to begin the second week of March with general hospital orientation. The

interns will be starting on the specified critical care units beginning the last week in March.

Thus, the creation and education pertaining to the use of the rubrics is planned to be completed

when the interns are actually on their assigned units. The proposed project is planned to finish

with a two week trial use of the rubrics. Feedback will be compiled at the completion of the trial

period.

Evaluation Tool

An evaluation tool (see Appendix C) was created as a means of evaluating the goals for

the proposed project. The evaluation tool utilizes a Likert five point scale. Likert scales are the

most widely used scaling technique (Polit & Beck, 2012). A Likert scale allows the evaluator

the opportunity to express an opinion on a particular issue through indicating the degree to which

they agree or disagree (Bourke & Ihrke, 2012). Analysis of data from a Likert scale can be

computed mathematically in order to further understand evaluator attitudes. An area for

comment is also provided next to each evaluation criteria. The evaluation tool will be completed

by my preceptor and me at the end of this project.

Conclusion

Measuring clinical competence is an important job for the nurse educator. Although

rubrics have been embraced throughout much of academia and provide many benefits, their use

in evaluating nursing competence in the clinical setting has not been consistent. This paper

described a proposed project involving the creation and implementation of rubrics for use in the

critical care internship program at MMC. The preceptor that will serve as a guide in completing

the proposed project is Patti Hresko, a master’s prepared nurse. She is the internship coordinator

a key stakeholder to the proposed projects success. Several objectives and activities to support


the creation and implementation of rubrics for use in the critical care internship program at

MMC were detailed in Appendix B. Cognitive learning theory and Resnick’s self-efficacy

theory will serve as a foundation for carrying out the proposed project. A timeline of activities,

agency and preceptor agreements, and a tool for evaluation of the project were also included in

Appendices A, B, and C.


References

Bargainnier, S. (2003). Fundamentals of rubrics. Retrieved from

http://www.webpages.uidaho.edu/ele/scholars/practices/Evaluating_Projects/Resources/

Using_Rubrics.pdf

Bonnel, W. (2012). Clinical performance evaluation. In D. Billings & J. Halstead (Eds.),

Teaching in nursing: A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier

Saunders.

Bourke, M. P., & Ihrke, B. A. (2012). The evaluation process: An overview. In D. Billings & J.

Halstead (Eds.), Teaching in nursing: A guide for faculty (4th ed.). (pp. 422-440). St.

Louis, MO: Elsevier Saunders.

Candela, L. (2012). From teaching to learning: Theoretical foundations. In D. Billings & J.



Fahy, A., Tuohy, D., McNamara, M. C., Butler, M., Cassidy, I., & Bradshaw, C. (2011).

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in Professional Development, 29(1), 19-23.

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(4th ed.). (pp. 441-463). St. Louis, MO: Elsevier Saunders.

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Springer Publishing Company.


Marcotte, M. (2006). Building a better mousetrap: The rubric debate. Viewpoints: Journal of

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Economics Education, 12, 33-47.

Munson Medical Center [MMC]. (2013). New graduate critical care nurse internship. Retrieved

from http://www.munsonhealthcare.org/upload/docs/HR/Critical%20Care

%20Internship.pdf

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nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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writing. Assessing Writing, 15, 18-39.

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Investigating intra-rater and inter-rater reliability of a scoring mechanism for critical

thinking performance assessments. Assessing Writing, 17(4), 251-271.


Stevens, D. D., & Levi, A. J. (2005). Introduction to rubrics: An assessment tool to save grading

time, convey effective feedback, and promote student learning. Sterling, VA: Stylus.

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Appendix A


Agreements


Appendix B

Project Planning Guide

Title of Project: Development of Rubrics for the Clinical Setting

Goals Objectives Activities TimelineGoal 1: Create rubrics for measuring competency of the critical care interns at MMC

1.1 Obtain literature and other references containing information about the use of rubrics and their development, development of clinical competency, nursing skills checklists, clinical performance evaluation, educational documentation requirements, adult learning theories, and cognitive learning theory

1.2Perform a needs assessment as to what rubrics need to be created

1.3 Generate a team to collaborate with throughout the process

1.1aSearch CINAHL, PubMed, ERIC, and other databases for literature

1.1bCompile literature reference list

1.1cReview literature for relevance to proposed project

1.2aCompose a needs assessment tool evaluating preceptor perception of assessment and evaluation strategies

1.2bDistribute tool to preceptors involved in internship program and unit educators

1.2cCompile feedback

1.2dMeet with MMC staff educator(s) for any additional information and resources to utilize for the process

1.3aUse needs assessment feedback to identify interested participants to collaborate with throughout the process

1.1aComplete by Jan. 19, 2014

1.1bComplete by Jan 19

1.1cComplete by Jan 19

1.2aComplete by Jan 26

1.2bDistribute Jan. 27

1.2cComplete by Feb. 2

1.2dComplete byFeb. 9

1.3aComplete by Feb. 2


Goal 2: Implement rubrics for use by the preceptors working with the interns

1.4 Determine patient-care standards and evidence based practices for rubrics being created

1.5 Develop rubrics and tool for feedback

2.1 Present the rubrics to preceptors

1.3bSeek help through email to possible interested participants

1.3cCreate a forum/blog for open exchange of ideas and updating of information amongst team members

1.4aReview standards of practice for rubric possibilities

1.4bCollaborate with team and MMC staff educators for input

1.5aComplete steps three and four from Steven & Levi’s (2005) stages of rubric development including: grouping and labeling, and application

1.5bBuild a metarubric

2.1aDevelop PowerPoint and educational materials for educating preceptors about the rubrics

2.1bPresent the information to preceptors and collaborative team

2.1cTrial rubrics on the units

1.3bComplete by Feb. 4

1.3cComplete by Feb. 9

1.4aComplete byFeb. 16

1.4bComplete by Feb. 23

1.5aComplete by March 28

1.5bComplete by March 28

2.1aComplete by April 6

2.1bComplete by April 13

2.1cFrom April 13 - April 27


2.2 Obtain feedback to determine ease of use and reliability of created rubrics

2.2aCompile feedback from first two weeks of implementation using formative and summative evaluation

2.2aComplete by May 2


Appendix C

Evaluation

Student name: Erin Kibbey________________________________________________________

Evaluated by: __________________________________________________________________

Goal/Objective Strongly Disagree

Disagree

Neutral Agree Strongly Agree

Comments

Demonstrates ability to use literature to design evidence-based rubrics for use in the clinical settingDemonstrates ability to participate in interdisciplinary efforts to develop rubrics for use at MMC Demonstrates ability to create rubrics for measuring competency of the critical care interns at MMCRubrics submitted on time according to proposed guideTeaching strategies for rubric implementation are grounded in educational theory and evidence-based teaching practicesUses information technologies skillfully to support the teaching-learning processCommunication


with preceptor was appropriate and professionalDemonstrates ability to compile feedback on rubric implementation trial on unitsDemonstrates ability to use assessment and evaluation data to enhance the teaching-learning process


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ekibbey.weebly.comekibbey.weebly.com/.../scholarly_project_proposal.docx · Web viewWhile rubrics have traditionally been used in academia, they are much less commonly used for educating