Graduate nurses can experience a deficit in integrating theoretical concepts in the clinical environment. The deficit is problematic for nurses in general but is more severe for graduates with less than two years of clinical experience employed in high acuity areas. Known as the theory-practice gap, this may result in a risk to patient safety with the potential for negative outcomes. The detrimental impact of this deficit results in a demonstrated lack of clinical competence and a manifestation of unsafe clinical practices contributing to hazardous clinical environments for patients with a potential risk to life. The purpose of this study was to explore the theory-practice gap from the perspectives of graduate nurses based on their experiences, and to determine their perceptions of simulation an instructional strategy in pre-licensure programs to address the deficit prior to entry to practice.
Methods:
Cognitive constructivism was the conceptual framework that guided this study. A qualitative phenomenological design was used to explore the lived experiences of 13 graduate nurses employed at a community hospital in northern New Jersey recruited through purposive sampling. Semi-structured interviews were conducted utilizing a researcher-developed interview protocol based on the Casey-Fink Graduate Nurse Experience Survey.
Results:
Interviews were transcribed verbatim, coded, and analyzed to identify four themes: (a) the theory-practice gap, (b) effective instructional strategies, (c) integrating theory into practice, and (d) simulation-based learning. Data analysis revealed all the graduates experienced the theory-practice gap on the transition to clinical practice with variations in degree; additionally, the graduates voiced aspects of their programs which contributed to reducing the challenges experienced during the transition period.
Conclusion:
The crucial finding was graduate nurses regardless of their pre-licensure preparation experienced similar hardships and perceived the theory-practice gap could be reduced through the use of high-fidelity simulation utilizing scenario-based learning exercises in pre-licensure programs. In addressing the theory-practice gap during pre-licensure preparation, the graduate nurse will have an amplified ability to integrate theoretical concepts, make sound clinical judgments, and optimize positive patient outcomes sooner on entry to practice.