Graduate Nurse's Perspective of Simulation to Address the Theory-Practice Gap in Nursing

Graduate nurses are being employed to provide care in high acuity care areas, and this becomes a problem of significance as the literature suggests that graduate nurse's experience a deficit in integrating theoretical concepts in the clinical environment, described as the theory-practice gap; which can result in a risk to patient safety and the potential for negative outcomes. For graduate nurses, the impact of the theory-practice gap results in a demonstrated lack of clinical competence and a manifestation of unsafe clinical practices promoting hazardous clinical environments for patients with a potential risk to human life. The purpose of this qualitative study was to explore the perceptions and experiences of 13 graduate nurses employed at a community hospital in northern New Jersey of the effects of simulation when used in pre-licensure programs in addressing the theory practice gap on entry to practice. Cognitive constructivism was the conceptual framework that guided this study. A qualitative phenomenological design was used to explore the lived experiences of the graduate nurses. After recruiting the participants through purposive sampling, semi-structured interviews were conducted with them utilizing a researcher-developed interview protocol based on the Casey-Fink Graduate Nurse Experience Survey. The research questions addressed the graduates' clinical experiences and their perceptions of simulation in facilitating the integration of theory to practice. Interviews were transcribed verbatim, coded, and analyzed to identify four themes: (a) the theory-practice gap, (b) effective educational pedagogy, (c) theory-practice integration, and (d) simulation-based learning. Data analysis revealed all the graduates experienced the theory-practice gap on their transition to clinical practice as independent practitioners with variations in the extent. The crucial finding was that graduate nurses perceived the theory-practice gap could be reduced through the use of high-fidelity simulation utilizing scenario-based learning exercises in prelicensure programs prior to entry to practice. The graduates opined the effects of the simulation was reliant on the quality of the experience. Collectively their recommendations are as follows: The integration of simulation technology to facilitate integration of theory to practice should be supported by (a) the use of high fidelity technology, (b) integrating scenario-based learning exercises, (c) adoption of a guiding framework, (d) use of a dedicated faculty trained in simulation best practices, (e) alignment of simulation with course objectives, and (f) learner-centered facilitated debriefing immediately following the simulated exercise. Based on these findings, the graduate's recommendations supported by the International Nursing Association for Clinical Simulation Learning (INACSL) Standards of Best Practice and the results of the landmark National Council State Boards of Nursing (NCSBN) National Simulation Study were presented in a white paper. The recommendations provide evidentiary support to encourage administrators of schools of nursing to make informed decisions to effect curricular changes that promote the student's integration of theory into practice. In addressing the theory-practice gap during pre-licensure preparation, the graduate nurse will be able to provide care to promote patients safety and optimize positive patient outcomes sooner on entry to practice.