From the staff development bookshelf: Nurse residency programs and the preparation-practice gap

Staff Development Weekly: Insight on Evidence-Based Practice in Education, December 30, 2011

In the last few years, academic and industry nurse leaders have worked from both sides of the preparation-practice gap to build bridges. On the academic side, there has been a recent call to completely rethink the structure of nursing education in America. The 2009 report from the Carnegie Foundation titled, Educating Nurses: A Call for Radical Transformation, presents the findings of the first large-scale national nursing education study in more than 40 years. They present the data within the context that nursing has undergone profound changes in the areas of nursing science, technology, and patient advocacy. They also observe that nursing education has not evolved to the same degree that nursing practice has in adapting to a shifting market-driven healthcare industry and the resulting changes in the acute-care nursing environment.  

The research team conducted site visits, surveys, and interviews of hundreds of nursing school faculty and leaders, and they identified three key outcomes:

  1. Nursing programs today do well in helping students develop nursing ethics and values, and in assisting student with identifying with the profession of nursing.
  2. Students’ clinical experiences at the bedside are powerful learning experiences, and students use these opportunities to learn to work and think like a nurse. Learning is accelerated when clinical experiences are discussed within the context of classroom lectures and textbook knowledge; it seems that the best learning is accomplished as students see and apply in real life what they learned in the classroom.
  3. Nursing programs today are often ineffective at teaching nursing and social sciences and technology. Nursing faculty often teach decontextualized knowledge with a dependence on slide presentations, and make the assumption that students will naturally apply that information as they practice at the bedside. (Benner, Sutphen, Leonard, & Day, 2010, pp. 11–14)

The third finding lies at the very heart of the preparation-practice gap. The report goes on to affirm that nursing education must commit to some important structural changes that will allow the time in nursing school to be more efficient and efficacious.

Essentially, there needs to be a fundamental shift for nursing faculty from a nonclinical “sage on the stage” to a clinician “guide at your side” to connect what the students see and experience in the hospital with real nursing science and practice thinking in the classroom. The report recommends restructuring nursing education in four specific ways:

  • Shift from a focus on covering abstract knowledge to an emphasis on teaching for a sense of salience, situated cognition, and action in particular situations
  • Shift from a sharp separation of clinical and classroom teaching to integration of classroom and clinical teaching
  • Shift from an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking that include critical thinking
  • Shift from an emphasis on socialization and role taking to an emphasis on formation (Benner et al., 2010, pp. 82–89)

The Carnegie report is a tremendous step to spanning the preparation-practice gap and producing new nurses who are fully prepared to assume care for patients in the 21st century acute-care environment. However, accomplishing these deep structural changes will take significant amounts of time (i.e., years) and funding to accomplish. In the meantime, the gap remains.

Source: Book excerpt adapted from Nurse Residency Program Builder by Jim Hansen, MSN, RN-BC

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