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BlogPreparing for Practice

How to Close the Education-Practice Gap in Nursing Education

By April 9, 2017February 1st, 20192 Comments

After my second year of classroom teaching, I began to feel disillusioned and discouraged. Content presented in the classroom and skills lab had little contextualization to practice.

Textbook content was king. Classroom lectures were content heavy and students were clearly burdened and highly stressed by the heavy load I was inadvertently placing on them.

Between content-heavy lectures and NANDA-driven care plans that required a correctly-worded three-part nursing diagnostic statement, I was discouraged. I felt this accepted norm hindered the ability of my students to think like a nurse in clinical practice.

I did not know it at the time, but I was experiencing was the academic-practice gap that continues to persist in nursing education.

To transform nursing education and close this current gap, there is a mindset that nurse educators need to embrace.

This shift includes placing a greater emphasis on practically preparing students for real-world clinical practice by integrating clinical reasoning in the curriculum.

Why the Education-Practice Gap Exists

Though the education-practice gap is well documented in the nursing literature, why does it continue to persist?

Though there are multiple reasons that influence its persistence, I believe that one of the main reasons is that academia has set its sight on the wrong primary objective; preparing students to pass the NCLEX®.

An unintended consequence is that nursing education has chosen an ACADEMIC objective (NCLEX® success) instead of a PRACTICE based objective of preparing students for real-world practice.

As a result, the academic-practice gap persists.

Another Factor

Another reason the practice gap persists is the difficulty that full-time faculty have in maintaining currency in clinical practice and as a result, many faculty do not work in autonomous nursing practice outside of academia.

This is why new faculty who have a current lens of practice are the greatest asset to any program, they bring this needed salience to all that they teach despite being a novice nurse educator!

How to Emphasize Practice in Academia

Here are some practical ways to emphasize the PRACTICE of nursing that will practically prepare students for practice as well as the NCLEX®:

  1. Multiple patient assignments. Do you provide advanced students with opportunities to manage more than one patient in the clinical setting? Though there may be limitations in the clinical setting to do so, try to consistently provide your advanced students two patient assignments. One approach to encourage multitasking with first year students is to begin the clinical day with one patient and later in the day add skills/assessment with another patient.
  2. Time management. Most students can easily time manage one patient. If students have downtime, redeem this time with supplemental clinical reasoning tools, or better yet provide a second patient assignment to develop time management skills.
  3. Priority setting. Setting priorities with one patient can be handled by most students. Like time management, this skill requires caring for multiple patients in the clinical setting. Can you see the pattern? Prepare students to priority set by giving a second patient whenever possible, especially at the advanced level.
  4. Professional communication. Students don’t typically talk directly to primary care providers to communicate a concern in clinical. Practice report and communication using the SBAR in simulation, classroom, and the clinical setting.
  5. Simulation. In addition to practicing professional communication, simulation whether it be in the sim lab, or a case study (low fidelity simulation) in the classroom is essential to safely develop the nurse thinking skill of clinical reasoning: Think in action, recognize relevant data, and establish correct care priorities that capture the essence of the current situation. Clinical experiences can vary widely in the clinical setting. This problem can be minimized when simulation standardizes nurse thinking and practical priority setting. Provide as many opportunities for simulation in your program. Using clinical reasoning case studies in the classroom also accomplishes this essential objective.
  6. Emphasize clinical reasoning. This is an essential paradigm shift that is required to radically transform nursing education (Benner, et al., 2010). I have developed a simple step-by-step template that breaks down this essential thinking skill so that students can readily understand and apply it to practice. Click this link to download: Clinical Reasoning Questions to Develop Nurse Thinking
  7. Maintain clinical practice as an educator. In medical school, the majority of faculty are current in practice or research. This is not the norm in nursing programs. Faculty should strive to maintain casual status and faculty should receive academic credit for maintaining clinical currency outside of academia so it is counted towards their credit hours (A dream, but one we should strive to achieve!)

Maintain Proper Perspective

The NCLEX® is important for both nursing students and programs. Without passing the NCLEX®, no graduate student can become a nurse.

When NCLEX® pass rates of a program decline too far, the program’s accreditation is at risk and being placed on probation by the state Board of Nursing is possible.

But if nurse educators emphasized clinical reasoning and developed a “clinical reasoning based curriculum” throughout the program, knowing that the NCLEX® is in essence a clinical reasoning exam, students would be prepared not only for the NCLEX®, but more importantly decades of clinical practice.

I have developed numerous case studies and tools that can help time strapped educators realize this needed objective.

In Closing

How educators perceive and THINK about nursing education is what ultimately determines if the academic-practice gap is bridged or remains a wide open chasm with no closure in site.

Make “NCLEX® success” the most important thing in your program and the status quo prevail.

Emphasize clinical reasoning and do all that is needed to prepare students for practice, and transformation of your program can be realized as well as improvement in NCLEX® pass rates.

For those that have heard the call to embrace this paradigm shift in nursing education, persevere, and be empowered to pursue this journey one step at a time.

Be confident that nursing education can be transformed, but instead of looking at the big picture, this needed change begins one educator at a time!

What do you think?
How have you emphasized preparing students for practice in your program?
Comment below and let the conversation begin!

RELEVANT Past Blogs

Learn more! The following past blogs provide additional background on todays topic!

Want More?

Today’s blog was derived from my upcoming book for nurse educators TEACH Students to THINK Like a Nurse: TRANSFORMATIONAL Strategies that will PREPARE Students for PRACTICE.

My manuscript is being finalized and the book will be available Spring/Summer 2017.

Download my table of contents, and introduction and stay in the loop with updates and be first in line to receive pre-publication $$$ discounts!

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How to Teach Students to Think Like a Nurse Using Clinical Reasoning!

Join the discussion 2 Comments

  • Dana Merritt says:

    As I agree with you, wholeheartedly, the reality is that NCLEX® is King!! Schools of Nursing want students to pass the test. I see that we have to do both, teach to the test as well as reinforce “thinking like a nurse” through case studies and clinical reasoning exercises. As an educator that primarily teaches clinical, I see that students have trouble putting the pieces together (what they’ve learned in class, an application of learned information). So teaching to the test will not effectively give the students what they need to know.

    • Keith Rischer says:

      I agree with your insights Dana. As educators we need to do both, but preparing for practice through integrating clinical reasoning needs to be a higher priority and greater emphasis. Thanks for sharing!

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