Tired of the Theory-Practice Gap in Nursing?

After four decades, the practice gap continues to plague the nursing community.

Four decades!

The decades-long crisis has been well documented, and “A Crisis of Competency,” shows that the gap continues today: “only 23 percent of newly graduate nurses demonstrate entry-level competencies and practice readiness.”

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The most obvious concern with this gap is that it endangers patients. It also places a large burden on practices to train their new nurses, and it also contributes to a high turn-over rate in the nursing profession.

Here are some of the more promising solutions tackling the theory-practice gap in nursing.

What’s been tried before?

Before brainstorming solutions to a decades-old issue, it’s best to take a step back and ask: what’s been tried before?

Luckily, an excellent literature review outlines the five most promising strategies to address the theory-practice gap in nursing.

The strategies are broken down by institution. Some approaches are solely created and implemented by educators. Other strategies are created and applied by practices. And finally, there are strategies where educators and practices work together for a solution.

The authors of “The academic-practice gap” also include a helpful table outlining the different promising solutions.

Education Strategies

Increased use of simulated learning in nursing education

Disruptive innovations in teaching methods

Promoting learner-centered, active approaches to learning

Curriculum revisions

Competency-based education

Practice Strategies

Extended orientation for new graduates/Transition to Practice (TTP) Programs

Collaborative Strategies

Dedicated education units

Academic service partnerships

What can be tried in the future?

Is this enough? I recently attended the National Nurse Educator Summit. At the conference, I attended a presentation by Dr. Beth Macini and a panel with three nursing executives. Both of these experiences suggested that what’s being done to close the theory-practice gap isn’t enough.

Disruption

Dr. Macini spoke like a revolutionary in her presentation, “Hot Topics in Nursing Education.” She approached the problems in nursing for what they are—systemic problems. And with systemic problems, citing  Lewin’s Change Theory, she posed disruptive questions that would lead to structural changes in nursing education.

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It makes sense.

Yes, simulation technology and student nursing video assignments improve the depth of learning for students. However, because these are tools and not structural changes, they will never fully bridge it.

In order to bridge the theory-practice gap in nursing, the underlying structure of nursing education needs to change.

Communication

Collaborative strategies were listed in the literature review as successful strategies. Yet, after attending a panel with three executive nurses, it became clear there needs to more communication and collaboration.

Here’s a statistic that illustrates this problem. In a study by The Nursing Executive Center of the Advisory Board Company, nursing educators were asked if their graduates were ready to practice, and 89.9% said they were. Then the managers were asked if those new hires were ready. Only 10.4% of nurse executives felt that these new graduates were prepared.

Similarly, as I attended “Clinical Judgement: The Bridge Between Education and Practice,” expectations widely differed.

For example, some of the panelists prioritized nursing graduates that could do a skills check-off in their sleep. Others nurse executives were less worried about skill proficiency and prioritized nursing graduates that had a finely developed clinical judgement.

And then an audience member described how her state recently brought together educators, government, and nursing executives to define expectations and standards. This excited everyone in the room.

“Yes!” everyone seemed to say. And they latched onto this idea of more collaboration and communication.

Think Big and Talk More

While research shows that tools shorten the gap, today new leaders in the nursing community call for more. More structural changes. More collaboration.

After all, it takes more than tools and new technology to overcome the decades-long theory-practice gap in nursing. It requires a structural overhaul and coordinated effort by all parties involved.

So if you’re tired of hearing about the theory-practice gap in nursing, then it’s time to think about bigger structural changes and improve collaboration and communication.

If you’re interested in concrete teaching methods to use in your classroom, read 6 Ways to Teach Nursing Skills Faster.

Sources

Kavanagh, Szweda. “A Crisis of Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses’ Clinical Reasoning.” Nursing Education Perspectives.

Huston, et al. “The Academic-Practice Gap: Strategies for an Enduring Problem.” Nurse Forum.

https://www.nursingsummit.com/

Mancini. “Hot Topics in Nursing Education.” NNES Conference.

http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php

Lloyd-Fitzgerald, Springer, Sommer. “Clinical Judgment: The Bridge Between Education and Practice.” NNES Conference.

Jeffries, et al. “A Clinical Practice Partnership: A Clinical Education Redesign.” Journal of Professional Nursing.