Diane M. Billings, Ed.D, RN, ANEF, FAAN, Chancellor's Professor Emeritus, Indiana University School of Nursing, Indianapolis, IN
The goal of nursing education is to prepare nurses for clinical practice, and schools of nursing are increasingly collaborating with their clinical partners to provide relevant education and a smooth transition to practice. However, recent evidence indicates several areas where there are gaps between nursing education and nursing practice that can be narrowed.
Two gaps require immediate attention: making clinical nursing judgments and implementing quality and safety education standards for nurses (QSEN). Nurse educators, and our colleagues in nursing service, must collaborate to close these gaps, as safe and patient-centered care depend on it.
When considering these gaps and how to close them, nurse educators must take a systems view. This includes understanding the clinical setting and collaborating with clinical partners, reviewing the curriculum to ensure inclusion of essential competencies, and, at the course level, using the full teaching-learning cycle and evidence-based teaching practices to prepare students for the realities of the clinical setting.
Making clinical judgments
Recent evidence indicates that only 23 percent of new graduates have entry-level competencies, and many of the errors related to patient safety are caused by ineffective clinical judgments. These gaps in the nursing practice of new graduates are caused by ineffective communication, the complexity of the clinical environment, lack of knowledge about patient care, and lack of experience in working with teams.
Interventions can be planned at all levels of the system to close this gap. In the clinical area, this could include using a dedicated educational unit for student clinical experiences, collaborating with nurses and professional development educators to create an environment that will help students (and staff nurses!) learn to be more deliberate in making clinical judgments, and initiating a transition program or residency to allow new graduates time to adjust to the demands of clinical practice.