‘Failure to fail’ in nursing – A catch phrase or a real issue? A systematic integrative literature review

• The quality of research on failure to fail is moderate to good quality.
• Failing a student is a difficult, emotional process for assessors and students.
• There are significant implications of failure to fail for nurses, organisations, and potentially for patient safety.
• More research needs to be conducted to examine if failure to fail impacts on patient safety.

‘Failure to fail’ is the allocation of pass grades to nursing students who do not display satisfactory clinical performance. This issue can have significant implications for individual students and assessors involved, as well as for nursing professionalism and patient safety. The aim of this systematic integrative literature review was to determine what is currently known about the issue of ’failure to fail’ within undergraduate nursing programs. A literature search of five databases up to May 2015 was conducted to identify primary research papers. The search yielded 169 papers of which 24 met the inclusion criteria. The majority of papers had moderate or good methodological rigour, with most of the literature originating from the Northern Hemisphere. Five main themes emerged: failing a student is difficult; an emotional experience; confidence is required; unsafe student characteristics; and university support is required to fail students. The results suggest that ’failure to fail’ is a real issue in tertiary facilities, with many complex facets. Given the costs of nurse education and the potential social and professional costs of poor quality nursing graduates, further rigorous research is required in this area.