Why such a gap between theory & practice?

I disagree. It's not a case of "good guys vs bad guys" etc. It's wrong to think that one side of the theory/practice split is 100% wrong and the other is 100% right. That kind of thinking is part of the problem and not part of the solution.

I agree that it's not a case of "good guys vs bad guys." I think everyone involved in the nursing profession would like to see nurses garner more professional respect and be treated as educated, self-directed professionals. I believe there is great value in compassion and universal caring, and my values align with many of the modern nursing theories. Unfortunately, I do see that the course of the nursing profession is often charted by nurses with PhDs who have been away from actual patient care for a long, long time.

I think that part of the problem is that the nursing profession has tried very hard to separate itself from the medical profession through nursing theory, even though the majority of nurses not employed in education work in facilities that are governed by a medical model. While nursing diagnoses are seen as the hallmark of our profession by academics, they are viewed by those outside the profession as inane nonsense that talks around the real reason that most patients are receiving care in an institutional setting.

Unfortunately, nurses of any educational level make up a very small percentage of upper administration in any health care institution, although they provide the majority of the care in said institutions. In the last 20 years, our health care system has evolved into a business model ruled by insurance executives, finance officers and businessmen, with little input from doctors and even less from nurses. I think that one of the biggest issues facing our profession is the lack of acknowledgement by our leaders and theorists of the fact that healthcare is not driven by philanthropists and religious orders anymore, and much of the nursing process is a luxury that is not viewed as valuable or profitable by hospital administrators, insurance execs or politicians. Unfortunately, that is the reality for the bedside nurse who struggles on a daily basis to complete her designated tasks and goes home feeling guilty that not much true "nursing care" by definition of the theorists was given during her shift.

Although I digress and am not sure what this has to do with the questions on standardized tests...

Respectfully,
Jami

I completely agree.

One problem that I find is that many nurses do not view education as valuable. I have heard more than one BSN student say, "I don't know what 'insert subject' has to do with nursing."

Well, maybe it has to do with broadening one's scope, enhancing one's frame of reference... I have gotten grief from co-workers for continuing my education. I have had higher-ups get angry at my offering training classes - while I was the informatics nurse - on using the computers on work time. That has happened to me solely in nursing.

I have also had instructors tell me that statistics are meaningless, make amazing conflations of causation from mere correlation, and tell me that she couldn't explain the disease process she was teaching because "I'm L&D."

I don't know. I spend my days banging out meds like a trained chimp. Nursing process? I just spent the shift picking a 300 pound guy off the floor four times because we can't restrain him and he likes the attention he gets when we have to call all hands to hoist him and fill out incident reports.

I don't know what the answer is, but I am really disappointed in nursing as I have experienced it.

I too, am disheartened by the leaders in hospitals, etc. turn away from the values of nursing and towards those of pure business. A business perspective is necessary to some extent. I realize that. But too many managers, clinical leaders, etc. just adopt the role of supporting the administrators and physicians in their work and leave nursing behind. They no longer stand up for the staff nurses and fight for those nursing values and perspectives. They act as "lackeys" for other disciplines rather than leaders of nursing.

But I think that it's hard to determine cause and effect here. When considering what I just said in relation to the theory/practice split, which is the cause and which is the effect? I think it is a little of both.

Another main issue is the current model of instruction. When I went through my master's program, the majority of the courses focused heavily on nursing theory with little emphasis placed on education theory and practice. It is difficult to be a true expert in multiple didactic content areas while maintaining clinical expertise in all these areas as well.

Especially in smaller universities, I see many of my colleagues struggle to balance full time employment, family life, and part time work at the hospital to maintain clinical experience. Many of us teach in many different courses.

In order to maintain the best standards I can for my students, my solution has been to work full time every summer and during most holidays, and two weekends per month. I also read a LOT of journals in my specialty. It is definitely not a perfect solution. It is quite tiring trying to work 70+ hours a week, spend time with my family, and pursue my doctorate all at the same time.

I would love to a partnership between clinical sites and the schools in which the hospital pays a portion of the employee's salary and benefits, and the school pays the other portion. I have heard of other schools using this model and they mention it has gone well. It sounds as if it would be an appealing option as long as communication and expectations were made clear and upheld consistently as to what the students' objectives would be.

I think the overwhelming majority of faculty members I work with strive to maintain expertise in not only clinical nursing but also as nurse educators, but unfortunately, there are a select few who have likely not laid hands on an actual patient in years.

dorimar, you should definitely look into a Sylvia Rayburn workshop. I was able to attend one early in my career. She has valuable input on content saturation. Also, last I checked Donna Ignatavicius' Boot Camp for Nurse Educators had a lot of valuable information on content saturation. I think an issue at the heart of the problem is that so many things have been added to nursing curriculum, but nothing is ever taken out. For example- nursing informatics, magnet hospitals, so much new technology- none of which was around when I was in school. We work in an ever-changing profession, and it can be difficult to "edit" down to the priorities.

I also think just the sheer understaffing that is a reality on the floors of hospitals in this day and age is partly to blame for the disparity between what we teach as an ideal and what is practiced. For example- I teach my students how to perform a competent, thorough, targeted assessment. I teach them to carefully identify each patient using 2 forms of ID and never to give a medication they are not familiar with. Yet the last time I was in the hospital watching a relative who was post-op, I never once saw the nurse perform a correct assessment. Although he was elderly and largely immobile, they did not turn him frequently (I did), did not listen to his lungs even once, and gave him "something for pain" without even checking his arm band or identifying his pain level. I witnessed this over three days, so I know the issue was widespread. Yet, I will still continue to teach my students how to thoroughly and correctly assess, despite the fact that it is not always practiced this way on the floor. It should be! I really believe almost every nurse wishes it was possible to provide the highest level of care to all patients, to really do what most of us wanted to do when we entered this profession- to help people, to care, and to save lives. I know that I wish it were possible every day I'm on the floor to have enough time for perfect assessments, comforting of the frightened, and knowing all the important facts you need to know to give perfect care. But as we all know, some days you are lucky just to keep everyone alive, reasonably content, and still have time to use the bathroom once during a twelve hour shift.

I think this disparity between what we know to be the best way to take care of someone and what our limited time and staffing allows will also account for the high attrition rate among new graduates. I remember being acutely disappointed that I could not be that "perfect" nurse when I was a new graduate, and it took years for me to be okay with doing my best every day, even if it meant I wasn't perfect.