Nursing Education & Practice: Bridging the Gap

Given the demands of healthcare reform and the American Recovery and Reinvestment (ARRA) “meaningful use” of electronic health records, nurses will increasingly participate in multispecialty care coordination and collaboration on new models of care, treatment and policy.

Nurses will care for a growing elderly population with increasingly high levels of chronic disease, and they will continue to work across the continuum of care – from prevention, employee wellness and public health, to treatment and end-of life care.

In short, nurses will continue to function as what President Obama calls “the bedrock” of healthcare.

Unfortunately, “nurses are ill-prepared for the profound changes in science, technology and the nature and settings of nursing practice,” observes the authors of Educating Nurses: A Call for Radical Transformation, a 2010 report from the Carnegie Foundation for the Advancement of Teaching.

The solution will only come from an intentional change in the methods used to educate future nurses, which is possible by altering the traditional preparation nurse educators receive.

Every player in the healthcare system can play a role in enhancing education and bridging the gap between school and work.

For example, Elsevier, a company which provides learning tools at all levels of nursing education, can team with healthcare systems, hospitals, primary providers, nursing associations and schools to ensure essential knowledge, skill and experience are integrated into basic and advanced nursing degree and lifelong learning programs through clinical decision support (CDS) simulations and education courses.


What can be done to make clinical practicum experiences in academic nursing education more relevant to clinical nursing practice?

We propose a series of strategies that will more closely align clinical teaching in nursing education with the reality of clinical practice in today’s healthcare environments.

Knowledge Sharing

We should tap and expand the existing programs or consortiums such as the American Nurses Credentialing Center’s Magnet Program or the CPM Resource Center (CPMRC) international healthcare consortium to intentionally bridge education and practice.

For years the CPM Resource Center has experienced Practice-Education Partnerships amongst its consortium members who have found that utilizing common, evidence-based tools to teach and to actualize in the practice setting has been very successful. In addition, faculty and hospital clinical leaders have become members on each other’s Partnership Councils in an effort to enhance learning and collaboration.

Members of CPMRC’s consortium have spent the past 25 years sharing lessons learned through Partnership Councils, which encourage partnerships across settings and teamwork across disciplines; consortium gatherings, which advance models of care that address health and healing care, interdisciplinary integration, evidence-based practice application, partnership culture, health informatics; and the CPMRC International Conference, which highlights learnings and outcomes produced in the clinical and academic settings of consortium members.

With an effort to advance the bridge between clinical and academic settings on a larger scale, more focus is being placed on faculty engagement, integrating evidence-based clinical tools throughout the curriculum, sharing information on-line and at conferences, and more thought leadership on education and practice transformation.

The same types of models could be applied to nursing education and practice with functions such as online community information sharing and education, real-world conferences and boot camps, searchable databases of innovations, partnership mentoring and training, survey and academic research on provider and educator needs, practice trends, awards programs, and thought leadership on nursing education .

Technology Education, Hands-On Experience and Support

We should provide nursing students and practitioners with education, training and experience in handling new and emerging information and clinical technologies-EHRs, CDS and medical devices-as well as the opportunity to share real-world experiences and lessons learned.

Both students and practitioners can benefit from software that allows them to practice and perform electronic documentation and care planning within a simulated electronic health record (EHR), along with a tool to assess their knowledge and competency.

What role do EHR and CDS vendors and providers play in helping students and practitioners obtain the necessary skills?

If these vendors increasingly involve nurses in developing clinical decision support and EHR content and learning materials, they could reduce the potential for errors and improve clinical coordination and patient care outcomes.

Just as essential to the professional development of nurses as EHR and CDS proficiency is the expanding use of patient simulation as an adjunct to clinical teaching and evaluation. Such technology has been created in response to intense competition for clinical sites, the growing complexity of the healthcare setting and the desire of faculty to move away from straight didactic lecture.

Simulations give each student the opportunity to demonstrate knowledge and skill across a group of standardized patient scenarios while experiencing a range of clinical situations in a safe, secure environment.

Meanwhile, faculty who rely on simulations are better able to make comparisons among students and lead provocative case discussions. Much of the learning occurs in the preparation and de-briefings that occur just prior to and immediately after the simulation scenario is enacted.

As a result, the best simulation activities are governed by protocols that include pre-simulation quizzes, access to patient reports and charts, and reading assignments followed by student participant selection and role delineation, the simulation itself, debriefing and post-simulation quizzes.

Many examples of ways to integrate technology into the education experience can be found by the efforts of the TIGER Initiative (Technology Informatics Guiding Education Reform). The TIGER Initiative is a grass roots nursing effort to support practicing nurses and faculty to integrate evidence and informatics into their day to day practice. More information of how technology is bridging the gap can be found at http://

Explore New Nursing Roles and Capabilities

Finally, we should encourage nursing education and practice to join forces to focus on care delivery alternatives and enhanced roles for nurses, such as the Clinical Nurse Leader, originally articulated by the American Association of Colleges of Nursing.

Vendors, educators and providers must carefully evaluate nurses’ current roles, exploring opportunities for refinement, expansion and development. For example, Advanced Practice Nurses (APNs) function as members of interdisciplinary teams, implement clinical practice guidelines and ensure quality of care across healthcare settings.

One other bridge to explore: How could APNs extend the reach of providers through new forms of community-based care that would prevent re-admissions and emergency department visits, support post-hospital discharge care, and keep patients engaged in their health?

What’s Ahead

We have described the challenges that vendors, providers, educators and association leaders will face in the near future, and have offered a few strategies that will make clinical practicum experiences in academic nursing education more relevant to the ever-changing clinical nursing practice world.

Nursing program directors should select opportunities for clinical learning that directly relate to the current healthcare environment, they should recruit more faculty who are proficient in handling technologies that are changing these environments, and establish creative and worthwhile nurse residency programs that facilitate the transition of the new nurse into the patient care arena.

Equally important, they must develop academic and continuing education curricula that incorporate nurses’ emerging advanced practice roles, integrate interprofessional team-based approaches to patient safety, evaluation and quality, and respond to trends such as EHRs, telemedicine, chronic disease management, geriatrics and ambulatory care.

These new ways of thinking required to change our status quo will be critical to bridging the gap between education and practice.

Ainslie Nibert is Vice President, Review and Testing, eEducation, producing the HESI computerized testing program, and Michelle Troseth, MSN, RN, DPNAP, CPMRC, is Executive Vice President and Chief Professional Practice Officer, both at Elsevier, Inc.

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