NUR 6300 Module 6 Legal Issues Paper: Clinical Failure, Due Process and a Request for Accommodation Example

Fair to the Student, Safe for Patients: Clinical Failure, Due Process and Accommodation in an Essex County Program

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-6300: Theoretical Foundations and Instructional Strategies in Nursing Education

Mentor Name

Month Day, Year

Fair to the Student, Safe for Patients: Clinical Failure, Due Process and Accommodation in an Essex County Program

The Situation

The program and the student are invented. A baccalaureate nursing program in Essex County has a student in her third clinical course on a medical-surgical unit. By midterm, her clinical instructor has documented repeated medication errors caught before reaching patients, late preparation and difficulty organizing care for two patients. The instructor issued a written warning at midterm with specific objectives the student must meet. Two weeks later, the student disclosed to the instructor that she has a learning disability affecting reading speed and asked for more time with medication administration and written work. She had not registered with the university's disability services office.

The course leader, an educator-track MSN student, was asked to advise the faculty on what the law requires and how to proceed.

Academic Dismissal and Due Process

In the case reported as Ewing (1985), a student sued the Regents of the University of Michigan after he was dismissed from a six-year combined undergraduate and medical program for failing the first part of the national medical board examination with an unusually low score and a weak record before it. He argued that being denied a chance to retake the examination violated his right to due process. The Supreme Court disagreed unanimously. It held that when courts review a genuinely academic decision, they should show great respect for the faculty's professional judgment and should set it aside only when the decision strays so far from accepted academic practice that no real professional judgment can be said to lie behind it. The Court built on its earlier recognition that academic decisions differ from disciplinary ones and do not call for formal hearings.

For the program, Ewing means that clinical failure is an academic decision to which courts generally defer, provided faculty actually exercise professional judgment: documented reasons, notice of deficiencies, a chance to improve and the same standards applied to every student. The midterm warning with specific objectives is part of that record.

Disability and Nursing Programs

In Southeastern Community College v. Davis (1979), the Supreme Court considered an applicant to a nursing program who had a serious hearing impairment. The college denied admission because she could not safely participate in clinical training without close supervision. The Court held that Section 504 of the Rehabilitation Act did not require the program to make fundamental alterations in its nature, such as eliminating clinical training or providing individual supervision, to accommodate her, while noting that refusing reasonable adjustments could sometimes be discriminatory. Later law, including the Americans with Disabilities Act and its amendments, has broadened who is protected and has continued to require reasonable accommodations that do not fundamentally alter a program or lower essential standards.

For the program, the case means that the student is entitled to consideration of reasonable accommodations through the proper process, but the program need not lower its essential standard that medications be given safely.

Fair Clinical Evaluation

Billings and Halstead (2020) describe the faculty practices that make clinical evaluation fair and defensible: clear objectives shared at the start of the course, frequent formative feedback, anecdotal notes recorded promptly and describing behavior rather than judgments, a written learning contract when performance is unsatisfactory, consistent application of the same standards to all students and consultation with colleagues and administrators when failure is likely. They also stress that evaluation should separate the student's performance from personal characteristics and that faculty should follow program policies precisely.

The Recommended Process

First, the instructor refers the student to the university's disability services office the same day, explaining that accommodations must be requested and approved through that office, and documents the referral. Accommodations are not applied retroactively to past performance, but any approved accommodations apply from the date of approval.

Second, faculty review the instructor's anecdotal notes with the course leader to confirm that they describe specific behaviors, such as a near-miss in which the student prepared the wrong dose, rather than conclusions such as "unsafe."

Third, if disability services approves an accommodation, such as extra preparation time before medication administration or a quiet space to review orders, the instructor and student revise the learning contract to include it, with the same essential objectives. The program does not waive the requirement that medications be given safely and accurately.

Fourth, the student continues to receive weekly written feedback. Should the objectives still be unmet when the course ends, the decision to assign a failing grade is made by the instructor in consultation with the course leader, following the program's policy, and the student is informed of her right to appeal.

Talking With the Student

The course leader recommended that the instructor and course leader meet with the student together, with a written summary afterward. In the meeting, they explained the midterm objectives and her progress, the referral to disability services and how approved accommodations would be built into her learning contract, and the date by which the final evaluation would be made. They asked what support would help her, and she requested a weekly meeting to review her medication preparation, which the instructor agreed to. The summary was sent to her the same day, so that she had the same information in writing.

Keeping the Student's Information Private

Disability information is confidential. The instructor shares only what is needed to apply approved accommodations, and the student's disclosure is not mentioned in clinical evaluations.

Limits

Nothing here is legal advice; the paper sets out general principles only, and the program should consult its university counsel. State law and institutional policies vary. Court decisions continue to develop, particularly about online and clinical accommodations.

Conclusion

A student failing clinical who has disclosed a disability presents two duties that must be held together. Ewing shows that clinical failure is an academic judgment that courts respect when faculty exercise it with care, Davis shows that reasonable accommodation does not require lowering essential standards and faculty guidance shows how to document fairly. The recommended process refers the student for accommodation, keeps standards for safe practice and documents every step.

References

Billings, D. M., & Halstead, J. A. (2020). Teaching in nursing: A guide for faculty (6th ed.). Elsevier.

Regents of the University of Michigan v. Ewing, 474 U.S. 214 (1985).

Southeastern Community College v. Davis, 442 U.S. 397 (1979).