What nurses learn is not what they practice

A commentary in the latest Journal of Advanced Nursing says expresses deep concern about the persisting reality gap between education and practice in the nursing profession.

Professor Jill Macleod Clark from Southampton University says that despite sincere efforts by the profession to bring about change, the basic problems identified by Eve Bendall in a 1976 paper continue.

Dr Bendall's paper, which is reprinted in the 30th Anniversary Issue of the Journal, had warned that there was a danger of producing nurses who were "increasingly proficient on paper and decreasingly proficient in practice." She believed that what nurses were learning in theory was becoming increasingly divorced from what they were actually doing in practice in their profession.

In an updated commentary, Professor Macleod Clark, head of the University's School of Nursing and Midwifery, calls for a total review of the nursing education system and introduction of tough policy measures.

More funds are also needed to radically modernize the practice learning requirements and outcomes of nursing students in the 21st century, the Professor, who is also Chair of the Council of Deans and Heads of UK Faculties for Nursing and Health Professions, says.

Dr Bendall's paper, written when she was Registrar of the General Nursing Council for England and Wales, looked at the behavior of 321 student and pupil nurses from 19 hospitals; she examined 22 real-life nursing situations to explore the gap between what they had been trained to do and what they did in reality.

She found that their written descriptions of what they should do in practice with what they actually did differed in 84 per cent of cases. Bendall concluded that on many occasions, nurses did not follow the ideal behavior they have been taught when they were faced with the real situations they encountered on hospital wards.

"I suspect that if my research study was replicated today, the result would be similar," Dr Bendall writes in the Anniversary Issue, which focuses on how many of concerns raised in the last 30 years are still relevant today. Though much has changed in the last 30 years, she feels the conflict between the ideal and the real remains.

Professor Macleod Clark adds that the profession has made considerable efforts to bring about change, but that the pressures on today's nurses are a key factor in the continuing "reality gap" identified by Eve Bendall.

The Professor also feels the need to provide good role models and fewer, but higher quality, practice placements.

Until the fundamental issue of an over-stretched nursing workforce is resolved, the gap between theoretically sound practice and actual care delivery would remain, she says. "As a profession we should be deeply concerned, indeed embarrassed, that the problems identified by Eve Bendall 30 years ago still persist in today's nurse education system, in spite of everyone's best efforts to change."

The original paper and the commentaries are featured in the 30th Anniversary Issue of the Journal of Advanced Nursing.