Nurses play the essential role when it comes to delivering the healthcare services at all the existing levels of healthcare system. Nurses are responsible for the provision of health care services to all the individuals within the community who need it (Parks, Longsworth, & Espadas, 2011). In order to care for patients, nurses are required to have all the necessary theoretical knowledge, as well as practical preparedness (Parks, Longsworth, & Espadas, 2011). As a result of population growth and the increasing demand for nursing services, there is an acute shortage of nurses. The way to deal with the already existing shortage is to create more medical schools and encourage young people to study in the nursing field. Another possible challenge for the medical field is the level of qualification of the graduating nurses. It is especially important for nurses to be highly qualified, since inappropriate treatment of patients may lead to many undesired consequences.
Currently, there is a huge gap between nursing education and actual clinical practice. One of the ways this gap can be offset is through mentored clinical learning and teaching both in classrooms and in practice areas (McHugh & Lake, 2010). Clinical learning and teaching can help provide more opportunities for upcoming nurses to not only integrate but also to learn to apply theoretical knowledge in the nursing practice. It is essential for nurses to be proficient in nursing theory and practice. According to McHugh and Lake (2010), the lack of knowledge among nurses may lead to false judgments and result in the lack tools to learn through experience. Therefore, despite the gap is still present, there is a good probability it will disappear with time if the necessary issues will be addressed in order to promote the high quality of nursing care. The current paper aims to explain why there is the gap between nursing practice and education by addressing some of the reasons that have lead to this gap.
Reasons for Theory-Practice Gap
Nowadays, nursing students have many roles and responsibilities to fulfill, which sometimes deny them of an opportunity to entirely focus on educational process. Parks, Longsworth, and Espadas (2011) assert that some students, besides studying, are parents, religious leaders, community activists, have part-time jobs, and so forth. All of the above mentioned roles make them multitask, which usually results in lack of attention when trying to be able to fulfill all the roles. Some time ago it was quite uncommon to find married individuals in nursing schools. The nursing school students used to live in dormitories, having the sole responsibility of dedicating all the time to complete the nursing programs (Parks, Longsworth, & Espadas, 2011). On the one hand, because of the different roles nursing students have, most of them fail to successfully balance clinical practice and classroom education, resulting in the existing above mentioned gap. In fact, some students choose to focus a lot on class work and forget about the importance of clinical practice.
On the other hand, there are negative consequences when nursing students fail to balance the clinical practice with the taught theory because of proximity to their schools and areas of clinical practice. The Bliss Residence for nurses were usually located close to the principal clinical area (Parks, Longsworth, & Espadas, 2011). Such chosen location used to facilitate an easy access, in addition to the increased learning opportunities for nursing students. Such phenomenon has necessitated the timely application of students’ theoretical knowledge in practical situations. Unfortunately, things are quite different in modern sphere of nursing. Parks, Longsworth, and Espadas (2011) claim that students commute to school from their residential homes located all over the country. Such an approach takes away a lot of time that could have been invested in learning about both theoretical and practical nursing. When there is not enough time, students may find it quite challenging trying to balance between nursing practice and theory.
Furthermore, instructors’ qualifications contribute to the existence of gap between nursing knowledge and practice. Instructors who have a mastery of knowledge and clinical practice in nursing are likely to teach their students well, as they can serve as role models. However, nursing students taught by instructors who lack this mastery may end up having difficult times when trying to connect nursing education and clinical practice, resulting in the above described gap. Saifan, AbuRuz, and Masa’deh (2015) have conducted research to establish the reasons behind the nursing education practice gap. In their study, many students have confirmed that although some instructors meet the required qualifications for teaching, they may be weak in clinical practice. Nursing students have found that those instructors who are clinically inexperienced went through tough times when aiming to teach their students beyond the classroom knowledge. As a result of this, students may end up gaining quality and valuable nursing knowledge but have poor skills in practice.
Some of the medical field instructors obtain their positions through doing a lot of medical researches instead of gaining the valuable experience. This means that there are a lot of teachers who have never acquired practical experience before receiving the qualification to become a professor. For instance, clinical experience is not a requirement for an individual to become a professor at a nursing institution and some of the professors have never worked in hospital facilities (Saifan, AbuRuz, & Masa’deh (2015). It, therefore, means that such professors only gained clinical experience when they were students themselves. Practically, if instructors do not have enough experience in clinical practice, they will be unable to teach future nursing staff because the profession entails hands-on activities to be able to provide high quality care to patients. Students taught by teachers without experience are likely to fail when it comes to real medical practice. Such situation can result in the gap not only between nursing education and theory, but also fuel the already existing gap.
Moreover, some of the teachers in the nursing field concentrate on grades, rather than students’ actual skills and experience in clinical areas (McHugh & Lake, 2010). In their research, Saifan, AbuRuz, and Masa’deh (2015) have found out that some nursing instructors want their students to score high grades, rather than acquire the real clinical expertise. Such an occurrence may mean that students should focus on scoring high grades to earn their teachers’ favor, rather than actually learning about nursing practice. The nursing profession is not only an art, but it is also a science, which entails hands-on activities to promote the possible clinical outcomes. When students choose to focus on grades and nursing theory alone, the clinical practice is being compromised. As a result, there appears an imbalance between the nursing education and clinical practice among students.
Furthermore, the proper communication and collaboration between nursing education theory result in high-quality nursing professionals. Professors in nursing sphere try to provide assistance to the students in all the possible scenarios. However, there is a difference between what is taught in class and between the practical areas. This difference makes students choose what to focus their minds on - the materials taught in class or the practical implications. As a result, students may end up being unable to connect the two because of the dissimilarity of the two concepts. Saifan, AbuRuz, and Masa’deh (2015) say that while working on their research, they received several comments from students which showed that there is a drastic difference between what classroom teachers and clinical instructors teach them. In the research, one of the students said that both the teachers and instructors provide at times conflicting information with a different sequence. Notwithstanding, they further set different goals and needs, which means that they have different expectations. Such a difference brings a gap because the materials taught in class are different from the real nursing practice. Therefore, students may be forced to try to grasp the two unrelated issues in order to achieve good performance, both when working at the clinic and in school grades.
Poor communication between students, nursing staff, and clinical instructors contributes to the gap between nursing education and practice. On the one hand, students need to establish good communication with their trainers, so that they can be able to learn better in clinical areas (Clark, Olender, Cardoni, & Kenski, 2011). Saifan, AbuRuz, and Masa’deh (2015) explain that a gap widens because students lack the support, which is a result of improper treatment from their instructors. In medical sphere, there are clinical mentors that occasionally have bad attitudes about students, especially concerning their practice (Saifan, AbuRuz, & Masa’deh, 2015). There are times when medical students might feel especially stressed and fearful, and this is the time when cooperation with clinical mentors is necessary. In the end, nursing students may be unable to apply the gathered theoretical knowledge to nursing practice.
On the other hand, professors in the nursing field often give out irrelevant knowledge, as compared to the reality of nursing profession. Nursing is an ever changing profession in practicality with technological and population changes, among many others. Therefore, instructors should keep updating their knowledge before regurgitating the same to their students. However, the failure to update one’s knowledge is one of the things bringing irrelevance in teaching that, in its turn, widens the gap between nursing education and practice. According to Buncuan (2010), the gap widens because sometimes nurse educators teach outdated nursing knowledge to their students. In most cases, professors keep teaching the same materials for many years, despite the existing changes in the healthcare systems. Some of them do not know anything about the latest information regarding medical policies, procedures, protocols and so forth (Buncuan, 2010).
At the same time, clinical nursing instructors try to rely on their routine practices without continuously updating their knowledge and skills (Buncuan, 2010). On the one hand, nursing instructors share the same practices and knowledge with their trainees. On the other hand, students may have received the updated knowledge in class that is entirely different from the usual clinical routines. Nursing students may sometimes fail to appreciate the connection between the class theory and clinical practice. In some instances, when nursing students try to copy what the nurses teach at the clinic, they are likely to adopt some outdated materials from them. Receiving such an experience may result in differences between nursing practice and the received education.
Shortage of qualified nursing trainers has also greatly contributed to the existing gap between education and nursing practice. Students may receive supervision from clinical instructors and their teachers from the faculty. Each supervisor is supposed to have a manageable number of nursing students to be able to offer quality training services, especially the practice skills. For instance, each nurse instructor should have approximately nine students per one group in the clinical areas (Parks, Longsworth, & Espadas, 2011). However, there is a shortage of nursing staff, so there may be cases when each instructor will be responsible for a large group of up to twenty students or beyond that (Parks, Longsworth, & Espadas, 2011). In such cases, experienced nurses usually offer their teaching services. Despite this, nurses themselves experience an acute shortage of staff, just like the clinical instructors do. According to Parks, Longsworth, and Espadas (2011), it is quite unreasonable to leave the task of training student nurses to experienced nurses who are already overwhelmed with all the nursing work due to the already existing staff shortage in the medical field. Furthermore, nurses who perform this role should receive some compensation and institutional recognition, which is not the case in most circumstances. As a result of the above mentioned challenges, nursing students may receive poor clinical teaching, which leads to the gap between practice and education.
Nursing professionals play a significant role in the provision of quality healthcare services to the society. Unfortunately, the modern nursing professionals experience a big gap between nursing education and the actual clinical practice due to various factors. For instance, most of the nursing students have multiple roles and responsibilities to fulfill, which deny them of an opportunity to be able to participate fully in both their nursing theory and clinical education. Furthermore, nowadays, most students live far away from the learning institutions they attend, which makes them commute and waste a lot of time that could actually be used for learning. Moreover, some clinical instructors and class tutors are clinically inexperienced, which results in the delivery of poor teaching services to their trainees. Also, some teachers and instructors choose to concentrate on student’s scores, rather than the gained skills and experiences in clinical practice, something that forces students to focus on achieving better grades, rather than wanting to become competent nurses and help others. Another factor that has made the above mentioned gap a reality is poor communication among students, nurse instructors and educators. Routine practices and delivery of irrelevant and updated knowledge and skills to students have also led to the gap. Finally, the shortage of staff in both the clinical areas and nursing schools has greatly contributed to the gap between nursing education and clinical practice.